SummaryAvalere examines states participating in the ACA expansion that may reduce eligibility levels for some current beneficiaries.
A discussion in September’s Medicaid Monthly notes that of states participating in Medicaid expansion, five (CT, NJ, NY, RI, VT) and DC who currently cover populations with incomes over 138 percent of the federal poverty level (FPL) are expected to reduce eligibility for some groups with higher eligibility levels. Two states yet to approve the expansion, ME and WI, are also rolling back eligibility levels for certain groups, while other states are making efforts to ease the transition for current Medicaid beneficiaries who will soon move into the exchanges. Regardless of patient cost sharing, these shifts will have impacts on prescription drug rebate liability and access.
As 2014 approaches, Medicaid expansion decisions are mostly solidified, though a few states remain undecided. To date, 24 states and DC plan to expand eligibility in early 2014, 22 states have rejected the option for now, and 4 remain undecided. This month, Arkansas and Iowa submitted waivers to CMS to implement premium assistance approaches to Medicaid expansion. Arkansas proposes to enroll most of its expected 250,000 new Medicaid eligibles-childless adults earning up to 138 percent FPL and parents between 17 and 138 percent FPL-into qualified health plans (QHPs) on the state’s exchange, and it will use Medicaid funds to pay their premiums and cost-sharing. Iowa aims to implement a hybrid plan of traditional Medicaid and premium assistance, under which individuals with incomes between 101 and 138 percent FPL would receive premium assistance to enroll in QHPs. Both states’ approaches require CMS approval.
This article was excerpted from the September issue of Medicaid Monthly, which tracks the latest federal and state Medicaid activity in one comprehensive source. For access, contact Holly Wittenberg.