HHS Issues Rule to Equip Medicaid,
States to Better Handle Influx of New Medicaid Patients
Hopes to streamline eligibility,
appeals and give states more flexibility as millions more join Medicaid,
Children’s Health Insurance Program
Jan. 14, 2013 – Medicaid is headed
for significant expansion in 2014 due to the Affordable Care Act, and
Health and Human Services proposed a rule today to promote consistent
policies and processes for eligibility notices and appeals in this
program, the Children’s Health Insurance Program (CHIP) and state-based
health insurance marketplaces known as Exchanges.
It is also designed to give states
more flexibility in operating their Medicaid programs, according to the
announcement by HHS Secretary Kathleen Sebelius.
She emphasized that due to the
Affordable Care Act, millions of Americans will be newly eligible to
receive quality, affordable health care through Medicaid and the new
Exchanges in 2014.
10, 2012 - Editor’s Note: Too often baby boomers and senior citizens
ignore the Medicaid program, assuming they will never need that medical
assistance for the poorest. It also happens too often that many who
thought that find they do, as medical, housing and long-term care
expenses devour their nest egg.
The HHS news release emphasized
that HHS wants “all Americans to review and submit comments on the
“Before the health care law was
passed, millions of Americans were unable to obtain or afford quality
health coverage,” Secretary Sebelius said. “Today, we are proposing a
rule to provide Americans with access to affordable, high quality health
coverage and give states more flexibility to implement the law in a way
that works for them.”
Beginning in 2014, the health care
law provides new opportunities for Medicaid coverage for adults who earn
up to 133 percent of poverty -- $14,865 for an individual or $30,656 for
a family of four. Other Americans looking for coverage will be eligible
to buy it through a health insurance marketplace, where many will be
eligible for tax credits to make coverage more affordable.
The rules proposed today will help
develop systems that will make it easy for consumers to determine if
they are eligible for Medicaid or tax credits that make insurance more
Today’s proposed rule includes
information on how consumers will receive coordinated communications on
eligibility determinations and can appeal eligibility determinations.
It gives states flexibility in designing benefits and determining cost
sharing in the Medicaid program.
The proposed rule also provides
flexibility to state-based Exchanges by allowing them to choose to rely
on HHS for verifying whether an individual has employer-sponsored
coverage and conducting some types of appeals.
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