Table of Contents. Legend. Coverage Option Overview 6

Size: px
Start display at page:

Download "Table of Contents. Legend. Coverage Option Overview 6"

Transcription

1 Modified Adjusted Gross Income (MAGI): Exchange and Medicaid Eligibility Flow Charts Updated per March 2012 Final Rules and June 2012 Supreme Court Decision October 3, 2012 These charts illustrate MAGI eligibility processes for premium tax credits, cost-sharing reductions, and Medicaid eligibility. They also detail the new Medicaid eligibility groups, based on our interpretation of the regulations. The document highlights the areas where states have policy flexibility and where decisions need to be made by the State. 1

2 Table of Contents Topic Area Legend Page (s) 4 Coverage Option Overview 6 MAGI Calculation 8 MAGI Calculated Public Assistance Categories 10 n-magi Medicaid Other Categories 11 n-magi Medicaid Referral 12 MAGI Tax Subsidy Determination Detailed Processes 14 Check Citizenship/Verify SSN 15 Check Incarceration 16 Check State Residency 17 Determine Household Size 18 Calculate MAGI Household Size 19 Determine Household Income 20 Calculate FPL State Decisions Needed

3 Legend 3

4 Flow Chart LEG Prior Enrollment State Specific Comment Determine Household Size P# Detailed Process Indicator 1 Continued from Another Page P# Detailed Process Page # Household Size Info Found Electronically? Process Description *# State Decision Needed Process Decision Connector 1 Continued on to New Page Process End Indicator The Exchange must enter into agreements with Medicaid Agency to enable individual and dependents to be screened for Medicaid based on non-magi eligibility example disability. Regulation/Rule Brief Start Process Connector Process Start Indicator 138%* FPL 5% disregard included (For optional expansion, applies to Medicaid determinations only) Brief Coverage Area ** Under PTC eligibility % of income indicates the % of income an individual is required to pay after which the PTC will cover remaining premium. For Cost-sharing this indicates the increased plan Actuarial Value (AV) an individual is eligible for based on a 70% AV silver plan. AV indicates the % of costs the plan covers vs. the individual. At 100% AV an individual has no cost sharing. 4

5 Coverage Option Overview 5

6 Coverage Option Overview Individuals enrolled in affordable employer sponsored coverage or eligible for minimal essential coverage through an employer are not eligible to receive advanced payments for premium tax credits or cost sharing reductions. Coverage Options Employer Sponsored Coverage /Other Acceptable Insured with Minimal Essential Coverage Individuals applying for coverage on the Exchange have the ability to decline to be screened for eligibility for Medicaid, PTC and cost-sharing reductions. In States that elect Medicaid expansion, Medicaid eligibility extends to all non-medicare eligible individuals under 138%* FPL and tax credit eligibility extends from 138%*FPL to 400% FPL based on MAGI. Exchange Individual Coverage Insured by non-exchange Commercial Plan Off Exchange Public Assistance n MAGI Medicaid n-subsidized Individual Coverage Public Assistance Individual Mandate Exemption The Medicaid Agency must adopt the Modified Adjusted Gross Income (MAGI) calculation methodology for all individuals applying for the new and consolidated Medicaid categories. t Eligible for Assistance Insured through Individual Exchange Commercial Plan Tax Subsidy/Cost-Sharing Reduction Insured through Exchange Commercial Plan w/ Subsidy MAGI Calculation Medicaid Categories Children s Group Pregnant Women Parent/Caretaker Adult (State Option) SCHIP Former Foster Children Insured through Medicaid t Insured The regulation consolidates eligibility categories for parents and other caretaker relatives, pregnant women, and infants and children under age 19. n-magi Medicaid Determination Medicaid n-magi Medicaid Income Determination Required 65 & older ABD & Medically Needy Long-Term Services & Supports Medicare Cost Sharing By Request Individuals can still be eligible for Medicaid based on disability or other current Medicaid categories; their income would not be calculated based on MAGI. Insured through Medicaid 6

7 MAGI Calculation 7

8 MAGI Calculation Eligibility must be redetermined every 12 months. *2, 3, 4, 5 Start Request for Public Assistance/Insurance *1 When possible the agency must complete the redetermination without requiring information from the individual. *2 For Eligibility determinations the Exchange will rely on the federal hub for income and citizenship information, when available. n MAGI application or trigger or request for non- MAGI review? 2 The Exchange must verify whether an applicant is eligible for or enrolled in an employer-sponsored plan. Access Federal HUB Eligible for Employer Sponsored Plan? Includes verification of Indian status. Indians are eligible for reduced and special costsharing reductions and may not have to complete subsidy eligibility process. An applicant can have employer coverage and be MAGI Medicaid eligible or have ESI and Medicaid as payor of last resort (with exception to SCHIP). In Medicaid, all unborn children counted in determining family size of pregnant women. If household tax filer does not verify applicants attestation, applicant will not be eligible for advanced payments of the PTC or cost-sharing reductions. The Medicaid Agency must adopt MAGI calculation methodology for all individuals applying for the new and consolidated Medicaid categories. Individuals that are determined not eligible for Medicaid must be screened for advanced payments of PTC and costsharing reductions. Public Assistance Enrollment 1 Denied Exchange Coverage Does t Request Medicaid Eligibility Review? Determine Household Size Determine Household Income Calculate FPL Below 400% FPL? *6 P17 P19 P20 Independent Enrollment through Exchange Check Citizenship/SSN Check Incarceration Check State Residency Citizen, t Incarcerated, and State Resident? P14 P15 P16 Individual Case Approved? Individuals who are in the process of being determined eligible for Medicaid on a basis other than MAGI must be screened for eligibility in insurance affordability programs (MAGI Medicaid, Premium Tax Credits, and Cost Sharing Reductions) for interim coverage. If an applicant s attestation cannot be verified, the Exchange must review on a case by case basis and provide exceptions, as appropriate, and an explanation of circumstances. The Exchange must accept attestation if the discrepancy or difference does not impact the eligibility of the applicant. Denied Exchange Coverage All individuals have the right to appeal any eligibility determination for Medicaid, PTC, cost sharing subsidies, or QHP eligibility. At any FPL an Indian enrolled in a QHP is eligible for services without cost sharing from Indian Health Services, Indian Tribes, Tribal Organizations, or Urban Indian Organizations. This special costsharing must be provided without the individual having to go through the determination for insurance eligibility programs. 8

9 MAGI Calculated Public Assistance Categories % FPL? Under 19 years old? Under State s Income Threshold? Children s Group *19 *19 Minimum: 133% FPL - or - for infants under age 1 such higher income standard as of 12/19/89 or 7/1/89 had authorizing legislation Maximum: Higher of 133% FPL; MAGI equivalent of 3/23/10 or 3/23/13 income level if higher; or for infants under age 1 185% FPL 3 Info on App suggests non-magi eligible or requests non-magi determination or Medicaid income determination required? Pregnant? Under State s Income Threshold? Minimum: Higher of 133% FPL or such higher income standard up to 185% FPL as of 12/19/89 or 7/1/89 had authorizing legislation Maximum: Higher of MAGI equivalent as of 3/23/10 or 3/23/13 income level if higher; or 185% FPL Pregnant Women Group 3 Below State s SCHIP income threshold -or- Medicaid enrolled child on 12/31/13 determined ineligible for Medicaid due to elimination of income disregards? 2 Parent/Caretaker? Under State s Income Threshold? Minimum: AFDC income standard as of 5/1/88 Maximum: MAGI equivalent for 1931 families as of 3/23/10 or 12/31/13 or 7/16/96 AFDC income standard increased by CPI Parent/Caretaker Relative Group 3 The regulation consolidates eligibility categories for parents and other caretaker relatives, pregnant women, infants and children under age 19. n-consolidated mandatory and optional eligibility groups are maintained. *7, 8, 19 Between Parent/Caretaker FPL & 138%* FPL? Have Child under 19 enrolled in Medicaid or minimum essentially covered? Option: Adult Group 3 Between 0%-138%* FPL? Option: Adult Group 3 t eligible for Medicaid Under 26, in foster care on 18 th birthday, Medicaid enrolled while in foster care? Former Foster Child Group 3 Exchange Commercial Plan A new optional category is created for adults between 19 and 65 who are at or below 138%* FPL regardless of caretaker status % FPL SCHIP 3 Determine Tax Subsidy 4 9

10 n-magi Medicaid Other Categories The regulation exempts from MAGI methodology individuals for whom Medicaid does not make an income determination, Medicare Savings Program individuals, and individuals being determined eligible on basis of blindness, disability or need for long-term services & supports. 2 income determination required by Medicaid (e.g., Title IV-E, SSI, Express Lane) Electronic Case Transferred to Medicaid & enrolled in applicable category Application for Medicare Savings Program? Electronic case transferred to Medicaid &enrolled in Medicare Savings Program n MAGI application, request for non-magi review or application identifies potential non-magi eligibility Exchange notified of Medicaid determination Exchange notified of Medicaid determination Can enroll in Adult Group or PTC and/or cost sharing reductions while non-magi review is pending. Electronic Case transferred to Medicaid Review for eligibility on basis of blindness, disability, medically needy coverage or need for long-term services & supports Determined Eligible based on disability/need for long term services & supports? Enrolled in applicable category Eligibility maintained in Adult Group or Tax Subsidy Exchange notified of Medicaid determination 10

11 n-magi Medicaid Referral 3 Individual Request n- MAGI Medicaid Determination? OR Exchange have reason to believe eligible for n- MAGI Medicaid? Referral to n-magi Medicaid 11

12 MAGI Tax Subsidy Determination 4 At any FPL an Indian enrolled in a QHP is eligible for services without cost-sharing from Indian Health Services, Indian Tribes, Tribal Organizations, or Urban Indian Organizations. This special costsharing must be provided without the individual having to go through the determination for insurance eligibility programs. Between % FPL? Between % FPL? If individual is an Indian below 300% FPL then individual is eligible for Cost Sharing Reduction to 100% of Plan AV. PTC** Cost Sharing ** 2% of Income 94% Plan AV Between % FPL? PTC** Cost Sharing ** Between % FPL? 3% of Income 94% Plan AV PTC** Cost Sharing ** Between % FPL? 4% of Income 87% Plan AV PTC** Cost Sharing ** Between % FPL 6.3% of Income 73% Plan AV PTC** Cost Sharing ** 8.05% of Income 70% Plan AV PTC** Cost Sharing** 9.5% of Income 70% Plan AV DRAFT - Eligibility Process Flows -Based on our Interpretation of IRS NPRM 26 CFR PART 1 and February 2012 CCIIO Actuarial Value and Cost Sharing Bulletin 12

13 Detailed Processes 13

14 Check Citizenship/Verify SSN Check Citizenship Start Citizenship found in federal hub to match attestation? Citizen National Lawfully Present Native American Continued Medicaid requirement to provide emergency services to individuals not eligible for full Medicaid due to their immigration status. Self-Attestation Agency must verify Indian status and cannot accept self-attestation. Eligibility process continues SSN verified by info in federal hub? Exchange finds an inconsistency Information verified against information from electronic sources (DHS) for lawful presence in US, individual with no SSN and where SSN doesn t match Reasonably Compatible? *9 Eligibility process continues Exchange makes reasonable effort to identify the inconsistency and notifies individual and gives 90 days for application filer to provide satisfactory documentation. Eligibility process continues and if meets other eligibility criteria, HIX provide non-medicaid coverage during this time. *10 The 90 day reasonable opportunity period does not apply to Medicaid. Individual is not enrolled in Medicaid until the discrepancy is resolved. Inconsistency resolved after 90 days? Individual remains enrolled Period can be extended if applicant is making good faith effort to obtain additional documentation. If enrolled, Individual is disenrolled *11 14

15 Check Incarceration Check Incarceration Start Incarceration is not a factor of eligibility which needs to be verified for purposes of determining Medicaid eligibility. It is generally prohibited for Medicaid to cover services while individuals are incarcerated. Approved Electronic Data source available for verification of incarceration? *12 Reasonably compatible? *9 Eligibility process continues Exchange makes reasonable effort to identify the inconsistency Inconsistency resolved? Eligibility process continues The 90 day reasonable opportunity period does not apply to Medicaid. Resolution period can be extended if applicant is making good faith effort to obtain additional documentation. *11 Self Attestation Exchange makes reasonable effort to identify the inconsistency and notifies individual and gives 90 days for application filer to provide satisfactory documentation. Eligibility process continues and if meets other eligibility criteria, HIX provide non-medicaid coverage during this time. Inconsistency resolved after 90 days? Individual remains enrolled *10 Individual is disenrolled, if enrolled 15

16 Check State Residency Check State Residency Start State Residency found in federal hub? Residency verified? Adult: Where living & intends to reside or is seeking employment or employed Document that provides evidence of immigration status may not be used alone to determine that individual is not state resident. Eligibility process continues Self Attestation Child <21: living in, or state of residency of parent/caretaker with whom child resides Exchange finds an inconsistency If attestation of residency is not reasonably compatible with other information provided, the Exchange must examine information in data sources that are available to the Exchange and approved by HHS. Eligibility process continues. State can accept selfattestation without further review Data in another Electronic Source & Compatible? *9, 12 The 90 day reasonable opportunity period does not apply to Medicaid. An individual is not enrolled in Medicaid until the discrepancy is resolved. Exchange makes reasonable effort to identify the inconsistency and notifies individual and gives 90 days for application filer to provide satisfactory documentation. Eligibility process continues and if meets other eligibility criteria, HIX provide non-medicaid coverage during this time. *10 Resolution period can be extended if applicant is making good faith effort to obtain additional documentation. *11 Inconsistency resolved after 90 days? Eligibility Process Continues Eligibility process stops 16

17 Determine Household Size Determine Household Size Start Household Size Info via Fed Data Hub - Filer? Verified by Requestor? The Exchange must compute annual household income for the family based on the number of dependents on the tax return. Calculate MAGI Household Size P18 Data Found via Other Sources? *12 Use data from Hub as household size Basic rule for tax filers is that the household size consists of the taxpayer and all tax dependents. Attestation must be verified with the tax filer. Self-Attestation from Requestor Reasonably Compatible? *9 Agency must accept self-attestation of pregnancy unless the State has information that is not reasonably compatible with the attestation. States can require verification of pregnancy with multiples for purposes of determining household size for Medicaid. *13 Use Self-Attested Household Size In Medicaid, a pregnant woman is considered a household of two (or more if carrying multiples). States have the option to count the unborn children in determining the family size of other members of a pregnant woman s household for Medicaid eligibility purposes. *14 Use Manually Calculated Size as Household Size Calculate MAGI Household Size Requestor Provide Paperwork Received and Approved w/in 90 Days? P18 *10 Sufficient Electronic Secured Data Available? Use Other Electronically Found Household Size The 90 day reasonable opportunity period does not apply to Medicaid. Individual is not enrolled in Medicaid until the discrepancy is resolved. t eligible for Continued Determination Due to Insufficient Data 17

18 Calculate MAGI Household Size Calculate MAGI Household Size Start Is the individual a tax filer? Is the individual claimed as a dependent? If individual cannot substantiate that another individual is a tax dependent for the year in which Medicaid coverage is sought, non-filer rules apply. Is the individual: Other than a spouse, biological, adopted or step child Under 19 or under 21 & full time student & claimed by non-custodial parent Living with both parents who will not file joint tax return *15 The individual is a non filer The individual s Household size is the tax filing household size Married couples living together are included in the household of the spouse regardless tax filing status. In Medicaid, unborn children are included in household size for pregnant women. State has option to count unborn children in household size for other household members. *14 Household size consists of if living with the individual: (1) the individual s spouse; (2) the individual s qualifying children ; (3) if the individual is under 19 or 21 and a full time student the individual s qualifying parents and siblings. 18

19 Determine Household Income Determine Household Income Verified by Requestor? Start Household Income Info via Fed Data Hub - Filer? Tax subsidy requires filing for continued receipt of benefits. Must search to see if applicant has filed for unemployment benefits. Attestation must be verified with the tax filer. Data Found via Other Sources? Self-Attestation from Requestor *12 Reasonably Compatible? *9 If applicant s income attestation is higher than reported and does not impact eligibility OR is no more than 10% below, Exchange must accept attestation without further verification. Higher Self-Attestation and eligibility impact? < 10% Lower and PTC? If Medicaid and eligibility impact? Use Fed Hub Electronically Found Household Income Medicaid eligibility is based on current monthly income. Annual income must be converted to monthly number. State option to use projected annual income for ongoing eligibility. Medicaid MAGI exceptions must be applied including : Deduct sources counted as income by IRS but not Medicaid (taxable *18 scholarships, grants; AI/AN exceptions; Lump Sum Payments counted only in month received) Exclude income of child or other tax dependent who files taxes but isn t required to *16 Count Social Security Income that is tax exempt Accept Self-Attested Household Income without further verification Gather sum of income for household: Pay Stubs, Letters of employment *17 Medicaid count Lump Sum in month received. Grants/ Scholarships not counted (<138%* Only), AI/AN Income not counted Attest that to an accurate projection of next benefit year income for non-medicaid. Use Manually Calculated Income as Household Income *18 Requestor Provide Paperwork Received and Approved w/in 90 Days? Sufficient Electronic Secured Data Available? Use Other Electronically Found Household Income *10 The 90 day reasonable opportunity period does not apply to Medicaid. Individual is not enrolled in Medicaid until the discrepancy is resolved. t eligible for Continued Determination Due to Insufficient Data or no longer filer 19

20 Calculate FPL Calculate FPL States have the option of performing an Assessment via an Exchange and then a Determination through Medicaid (option A) or a Determination through the Exchange (option B) *6 Start Option A Calculate FPL The State-Operated Federal PTC Partnership model may allow contracting with the Federal Exchange to perform the Determination Assessment as shown in Option A. Start Option B Calculate FPL If a state selects the option that the Exchange will perform the eligibility determination, no additional information can be collected at this time from the applicant. Assessed Above 100% FPL or 138%* FPL at State Option Assessment = Determination for Exchange Gather Additional State Medicaid Specific Information from Applicant In the event that the State has another entity perform an eligibility assessment, the State can then collect additional, non-duplicative, information to determine Medicaid eligibility. Perform Medicaid Determination and Re- Calculate FPL Assessed Above 138%* Assessed Above 100% FPL or 138%* FPL at State Option PL Replace Assessed FPL with Medicaid Process Calculated FPL Medicaid Process FPL Determined 20

21 State Decisions Needed 21

22 State Decisions Needed (1 of 4) 1. Will the State use the CMS application or develop a state specific application? For the n-magi application, will the State use the single streamlined application & supplemental forms or an alternative application? 2. A redetermination of eligibility must be made without requiring additional information from the individual when reliable information is available to the State to complete the renewal. What will be considered reliable information? 3. For Medicaid renewals, the State can extend the reconsideration period during which a new application is not required. Will the State offer a longer reconsideration period? The State may also implement a 90 day reconsideration period for reasons other than non-timely submission of renewal materials. 4. The State may replicate the MAGI redetermination process for non-magi Medicaid populations. Will the State implement these renewal procedures for non-magi? 5. The Exchange may automatically enroll qualified individuals at open enrollment in QHPs. Will this option be implemented? 6. The State may delegate Medicaid determinations to the Exchange or Medicaid may make an eligibility determination in addition to the Exchange s initial assessment. 22

23 State Decisions Needed (2 of 4) 7. The State can expand the definition of caretaker relative to include another relative based on blood, adoption or marriage, domestic partner or adult with whom the child is living and assumes primary responsibility. 8. In defining who is considered a dependent child for purposes of eligibility for the Medicaid Parent/Caretaker Relative Group, the State may eliminate the deprivation requirement. Dependent children can also be defined as either under 18 or 18 and full time student in secondary school or training if before age 19 child is expected to complete training. 9. Within the rules guidelines for upper and lower limits, State to define rules for what is considered reasonably compatible when self-attestation does not match electronic data. State to determine when self-attestation will be allowed without further verification through electronic data sources. 10. State to determine the reasonable time period for allowing individuals to provide verification documents for Medicaid eligibility determinations. 11. The 90 day grace period for providing documentation to resolve discrepancies may be extended when the applicant demonstrates a good faith effort has been made to obtain the required documentation. Will this option be utilized and under what circumstances? 23

24 State Decisions Needed (3 of 4) 12. State to define other electronic data sources (approved by HHS) that will be utilized in addition to those accessed through the Federal Data Hub. 13. For Medicaid eligibility, State may require verification of pregnancy with multiples for purposes of determining household size. 14. States have the option to count the unborn child(ren) in determining the family size of other members of a pregnant woman s household for Medicaid eligibility purposes. 15. For purposes of determining household composition for Medicaid, State has option to count children as either under Age 19 or under Age 19 or in the case of full-time students, under If individual is found Medicaid ineligible due to lump sum payment, State may opt to reconsider eligibility in a subsequent month without requiring a new application. 17. For a tax dependent claimed by an individual other than a spouse or parent, the State has the option to count as income available cash support provided by the tax filer. 24

25 State Decisions Needed (4 of 4) 18. For individuals determined Medicaid eligible under MAGI, states may elect to base ongoing financial eligibility on current monthly household income or projected annual income for the remainder of the calendar year. Thus, State needs to decide whether to use a point in time income or projected annual income in the Exchange. State can also opt to continue to account for reasonably predictable fluctuations in income for Medicaid determinations. 19. States to determine income standard for Medicaid consolidated groups within minimum and maximum parameters defined in federal regulation. 25

Health Insurance Exchange:

Health Insurance Exchange: Health Insurance Exchange: MAGI Eligibility Flow Charts October 18, 011 Comments and questions may be submitted to info@svcinc.org. 1 Flow Chart LEG Prior Enrollment State Specific Comment Household Size

More information

CMS Medicaid and CHIP Eligibility Changes Under the Affordable Care Act Proposed Rule (CMS-2349-P) Section-By-Section Summary -- September 27, 2011

CMS Medicaid and CHIP Eligibility Changes Under the Affordable Care Act Proposed Rule (CMS-2349-P) Section-By-Section Summary -- September 27, 2011 MEDICAID 431.10, 431.11 Single State Agency. Organization for Administration. Modifies existing regulations to allow government operated Exchanges to make Medicaid eligibility determinations. Sets forth

More information

Family Related Medicaid In-Service Training

Family Related Medicaid In-Service Training Family Related Medicaid In-Service Training September 2013 The information contained in this document is current as of September 20, 2013 1 Kaiser Video on Healthcare Reform The animated movie you are

More information

State of Rhode Island and Providence Plantations. Executive Office of Health & Human Services

State of Rhode Island and Providence Plantations. Executive Office of Health & Human Services State of Rhode Island and Providence Plantations Executive Office of Health & Human Services Access to Medicaid Coverage under the Affordable Care Act Section 1307: MAGI Income Eligibility Determinations

More information

Eligibility & Enrollment Regulations

Eligibility & Enrollment Regulations Eligibility & Enrollment Regulations Thien Lam Deputy Director, Eligibility & Enrollment California Health Benefit Exchange Board Meeting September 19, 2013 Eligibility & Enrollment Proposed State Regulations

More information

Overview of Final Medicaid Eligibility Regulation

Overview of Final Medicaid Eligibility Regulation Overview of Final Medicaid Eligibility Regulation Prepared by Manatt Health Solutions March 27, 2012 Support for this analysis was provided by a grant from the Robert Wood Johnson Foundation s State Health

More information

Tennessee Public Health Association. Overview of the Affordable Care Act

Tennessee Public Health Association. Overview of the Affordable Care Act Tennessee Public Health Association Overview of the Affordable Care Act Susie Baird Director of Policy Health Care Finance and Administration September 12, 2013 1 Origins of ACA Signed into law on March

More information

Determining Eligibility for Premium Tax Credits

Determining Eligibility for Premium Tax Credits Determining Eligibility for Premium Tax Credits November 20, 2013 Center on Budget and Policy Priorities Topics Understand the tax definitions of filing status and dependency and how they apply to common

More information

5/16/2013. Local Florida KidCare Coalitions Conference and Training May 21 and 22, 2013

5/16/2013. Local Florida KidCare Coalitions Conference and Training May 21 and 22, 2013 Local Florida KidCare Coalitions Conference and Training May 21 and 22, 2013 On March 23, 2010 President Obama signed the Patient Protection and Affordable Care Act (ACA) into law. The intent of the ACA

More information

Special Enrollment Period Reference Chart

Special Enrollment Period Reference Chart Special Enrollment Period Reference Chart A Guide to Special Enrollment Period Triggers and Timing The open enrollment period is the time each year when people can newly enroll in a plan or change to a

More information

Help your constituents gain the most from the Affordable Care Act

Help your constituents gain the most from the Affordable Care Act 1 Help your constituents gain the most from the Affordable Care Act Quick refresher course on Covered California: your destination for affordable, quality health care, including Medi-Cal Help your constituents

More information

Part 5 Eligibility Criteria for Children

Part 5 Eligibility Criteria for Children Part 5 Eligibility Criteria for Children 41. 41 42. 42 43. 44. 43 44 45. 45 46. 46 47. 48. 47 49. 48 50. 49 50 Which children are eligible for the most comprehensive coverage: MassHealth Standard?...52

More information

AFFORDABLE INSURANCE EXCHANGES: HIGHLIGHTS OF THE PROPOSED RULES

AFFORDABLE INSURANCE EXCHANGES: HIGHLIGHTS OF THE PROPOSED RULES 45 CFR, Parts 155 and 157 Patient Protection and Affordable Care Act; Exchange Functions in the Individual Market: Eligibility Determinations; September, 2011 National Conference of State Legislatures

More information

The Evolving Role of CHC s in Consumer Assistance

The Evolving Role of CHC s in Consumer Assistance The Evolving Role of CHC s in Consumer Assistance OACHC Spring Conference Tricia Brooks March 12, 2014 2 2014 Federal Poverty Levels o On February 18, Ohio starting using the 2014 FPLs o The new levels

More information

Presumptive Eligibility

Presumptive Eligibility & ACA The Affordable Care Act (ACA) expanded Presumptive Eligibility (PE). Since 1988, PE has been available for pregnant women. This group is still eligible. ACA established PE criteria for parents, caretakers,

More information

MEDICAID COMMUNICATION NO DATE: November 17, 2014

MEDICAID COMMUNICATION NO DATE: November 17, 2014 State of New Jersey DEPARTMENT OF HUMAN SERVICES DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES CHRIS CHRISTIE P.O. Box 712 JENNIFER VELEZ Governor Trenton, NJ 08625-0712 Commissioner KIM GUADAGNO

More information

Eligibility and Enrollment

Eligibility and Enrollment Page 1 of 100 Course 5 Topic: 01 Page: 01 Course Introduction 1 of 3 Introduction Text Description of Image or Animation Long Description: Animation. Welcome to the Course. The Department of Health & Human

More information

MAGI BUDGET GROUPS/ASSISTANCE UNITS

MAGI BUDGET GROUPS/ASSISTANCE UNITS 2610 - MAGI BUDGET GROUPS/ASSISTANCE UNITS POLICY STATEMENT BASIC CONSIDERATIONS The Family Medicaid MAGI Assistance Unit (AU) includes individuals for whom health coverage is requested and for whom Medicaid

More information

Part I: Premium Tax Credits

Part I: Premium Tax Credits Part I: Premium Tax Credits Coverage Year 2018 Center on Budget and Policy Priorities September 19, 2017 Overview of Upcoming Open Enrollment Shorter Open Enrollment for OE5 3 Nov 1: Open enrollment begins

More information

Changes to MassHealth Provisional Eligibility. MA Health Care Learning Series June 2018

Changes to MassHealth Provisional Eligibility. MA Health Care Learning Series June 2018 Changes to MassHealth Provisional Eligibility MA Health Care Learning Series June 2018 1 Agenda What is MassHealth Provisional Eligibility? What Are the Changes What applicants and members need to know

More information

Eligibility and Enrollment for the Non MAGI Population. September 24, 2015

Eligibility and Enrollment for the Non MAGI Population. September 24, 2015 Eligibility and Enrollment for the Non MAGI Population September 24, 2015 1 Agenda Current Landscape Key Non MAGI Requirements and Options Emerging Approaches Issues and Challenges Next Steps Information

More information

Countdown to Coverage Webinar Series Medicaid 101 June 7, 2013 Karin Kramer Eligibility, Policy and Service Delivery

Countdown to Coverage Webinar Series Medicaid 101 June 7, 2013 Karin Kramer Eligibility, Policy and Service Delivery Medicaid in 2014 Countdown to Coverage Webinar Series Medicaid 101 June 7, 2013 Karin Kramer Eligibility, Policy and Service Delivery Purpose and Objectives Purpose: This presentation is to review the

More information

Definition of Income in PPACA for Certain Medicaid Provisions and Premium Credits

Definition of Income in PPACA for Certain Medicaid Provisions and Premium Credits Definition of Income in PPACA for Certain Medicaid Provisions and Premium Credits Janemarie Mulvey, Coordinator Specialist in Health Care Financing Evelyne P. Baumrucker Analyst in Health Care Financing

More information

2017 National Training Program

2017 National Training Program 2017 National Training Program Module 12 Medicaid and the Children s Health Insurance Program (CHIP) Contents Lesson 1 Medicaid Overview... Lesson 2 Children s Health Insurance Program (CHIP) Overview...

More information

Answers to Frequently Asked Questions

Answers to Frequently Asked Questions Answers to Frequently Asked Questions Beyond the Basics of Health Reform Center on Budget and Policy Priorities December 11, 2013 2 Cost-Sharing Charges and Plan Selection How does cost-sharing work? 3

More information

Open Enrollment is here!

Open Enrollment is here! Navigating the Federal Marketplace AFFORDABLE CARE Open Enrollment is here! Reminders On November 20 at 9:30 AM ET, IPHCA is hosting a call with Matt Cesnik from FSSA again. CMS has released guidance on

More information

Chapter 5. Eligibility Determination Process. This chapter covers the eligibility process pertaining to HCRA. It covers the following in detail:

Chapter 5. Eligibility Determination Process. This chapter covers the eligibility process pertaining to HCRA. It covers the following in detail: Chapter 5 Eligibility Determination Process This chapter covers the eligibility process pertaining to HCRA. It covers the following in detail: A. The documents that are to be provided and used to verify

More information

COVERED CALIFORNIA POLICY AND ACTION ITEMS March 20, 2014

COVERED CALIFORNIA POLICY AND ACTION ITEMS March 20, 2014 COVERED CALIFORNIA POLICY AND ACTION ITEMS March 20, 2014 PROPOSED STANDARDIZED PLAN DESIGNS Tim von Herrmann, Advisor, Plan Management 1 CRITERIA FOR UPDATES IN BENEFIT DESIGN 1. Limited Changes from

More information

State Health Reform Assistance Network

State Health Reform Assistance Network State Health Reform Assistance Network Charting the Road to Coverage ISSUE BRIEF March 2014 Consumer Assistance Resource Guide: American Indians and Alaska Natives Prepared by the Center for Health Care

More information

ACA 101 Conference Call FAQs

ACA 101 Conference Call FAQs ACA 101 Conference Call FAQs 1. How will MA help residents (particularly the most vulnerable) transition from the simplicity of needing a pay stub for eligibility to having to have their taxes filed? This

More information

2016 Regional Conferences FOR ENROLLMENT ASSISTERS

2016 Regional Conferences FOR ENROLLMENT ASSISTERS 1 2016 Regional Conferences FOR ENROLLMENT ASSISTERS Eligibility 2 All lawfully present individuals living in the US are eligible to purchase Marketplace health insurance. EXCEPT those who have job-based

More information

WV INCOME MAINTENANCE MANUAL. Eligibility Determination Groups

WV INCOME MAINTENANCE MANUAL. Eligibility Determination Groups ADULT GROUP The Patient Protection and Affordable Care Act, enacted March 23, 2010, amended by the Health Care and Education Reconciliation Act of 2010, enacted March 30, 2010, are together referred to

More information

Date: February 6, From: Center for Consumer Information and Insurance Oversight, Centers for Medicare & Medicaid Services

Date: February 6, From: Center for Consumer Information and Insurance Oversight, Centers for Medicare & Medicaid Services DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Date: February 6, 2014 From: Center for Consumer Information and Insurance Oversight, Centers for Medicare & Medicaid Services

More information

Elderly, Blind and Disabled Categories (AABD)

Elderly, Blind and Disabled Categories (AABD) Elderly, Blind and Disabled Categories (AABD) Program SSI DHS does not determine eligibility for this category. Individuals who qualify for SSI automatically receive Medicaid. Individual Couple $637 $956

More information

Eligibility & Enrollment

Eligibility & Enrollment Eligibility & Enrollment Thien Lam Deputy Director, Eligibility & Enrollment California Health Benefit Exchange Board Meeting April 23, 2013 Eligibility and Enrollment Guiding Principles Through a No Wrong

More information

RULES OF TENNESSEE DEPARTMENT OF HUMAN SERVICES DIVISION OF MEDICAL SERVICES CHAPTER COVERAGE GROUPS UNDER MEDICAID TABLE OF CONTENTS

RULES OF TENNESSEE DEPARTMENT OF HUMAN SERVICES DIVISION OF MEDICAL SERVICES CHAPTER COVERAGE GROUPS UNDER MEDICAID TABLE OF CONTENTS RULES OF TENNESSEE DEPARTMENT OF HUMAN SERVICES DIVISION OF MEDICAL SERVICES CHAPTER 1240-03-02 COVERAGE GROUPS UNDER MEDICAID TABLE OF CONTENTS 1240-03-02-.01 Necessity and Function 1240-03-02-.04 Enrollment

More information

Marketplace 101. Find health care options that meet your needs and fit your budget

Marketplace 101. Find health care options that meet your needs and fit your budget Marketplace 101 Find health care options that meet your needs and fit your budget Objectives This session will help you Explain the Health Insurance Marketplace Define who might be eligible Define options

More information

Regulations Table of Contents Application, Eligibility, and Enrollment Process for the Individual Exchange

Regulations Table of Contents Application, Eligibility, and Enrollment Process for the Individual Exchange Regulations Table of Contents Application, Eligibility, and Enrollment Process for the Individual Exchange T I T L E 1 0. I N V E S T M E N T C H A P T E R 1 2. C A L I F O R N I A H E A L T H B EN E F

More information

Health Insurance Premium Credits in the Patient Protection and Affordable Care Act (ACA)

Health Insurance Premium Credits in the Patient Protection and Affordable Care Act (ACA) Health Insurance Premium Credits in the Patient Protection and Affordable Care Act (ACA) Bernadette Fernandez Specialist in Health Care Financing Thomas Gabe Specialist in Social Policy July 31, 2013 CRS

More information

Putting it Together: Beyond the Basics

Putting it Together: Beyond the Basics Putting it Together: Beyond the Basics Center on Budget and Policy Priorities September 18, 2013 Topics Review and apply key concepts to three family scenarios: Household and income determinations Premium

More information

Health Insurance Premium Tax Credits and Cost-Sharing Subsidies

Health Insurance Premium Tax Credits and Cost-Sharing Subsidies Health Insurance Premium Tax Credits and Cost-Sharing Subsidies Bernadette Fernandez Specialist in Health Care Financing April 24, 2018 Congressional Research Service 7-5700 www.crs.gov R44425 Summary

More information

Understanding the Health Insurance Marketplace. August 2013

Understanding the Health Insurance Marketplace. August 2013 Understanding the Health Insurance Marketplace August 2013 Objectives This session will help you Explain the Health Insurance Marketplace Identify who will benefit Define who is eligible Explain the enrollment

More information

Subsidized Health Coverage through MNsure

Subsidized Health Coverage through MNsure INFORMATION BRIEF Research Department Minnesota House of Representatives 600 State Office Building St. Paul, MN 55155 Randall Chun, Legislative Analyst 651-296-8639 Updated: October 2018 Subsidized Health

More information

Diving Deep on Commonly Encountered Eligibility and Enrollment Issues

Diving Deep on Commonly Encountered Eligibility and Enrollment Issues Diving Deep on Commonly Encountered Eligibility and Enrollment Issues Center on Budget and Policy Priorities February 26, 2014 2 Part I: COBRA COVERAGE OPTIONS 3 Open Enrollment: Annual Period When All

More information

Start Overview What You Need to Know When You Apply Former Foster Care Youth (FFCY)

Start Overview What You Need to Know When You Apply Former Foster Care Youth (FFCY) Start Overview What You Need to Know When You Apply Social Security numbers (SSNs) for applicants who are U.S. citizens. Lawfully present immigrants will also need document information if they are applying

More information

Standardized MAGI Conversion Methodology- General Questions

Standardized MAGI Conversion Methodology- General Questions Standardized MAGI Conversion Methodology- General Questions Q1. What are the reasons that a marginal (25 percentage points of FPL) method was chosen instead of the average disregard approach? A1. The marginal

More information

Health Insurance Premium Tax Credits and Cost-Sharing Subsidies: In Brief

Health Insurance Premium Tax Credits and Cost-Sharing Subsidies: In Brief Health Insurance Premium Tax Credits and Cost-Sharing Subsidies: In Brief Bernadette Fernandez Specialist in Health Care Financing February 10, 2017 Congressional Research Service 7-5700 www.crs.gov R44425

More information

Health Coverage Programs 2018

Health Coverage Programs 2018 Health Coverage Programs 2018 Neil Cronin Basic Benefits Training February 13, 2018 1 Affordable Care Act (ACA) changes in MassHealth & Connector in 2014 2 2014 ACA Improvements in MA MassHealth eligibility

More information

County: Auditor: Date of Review: Case Name:

County: Auditor: Date of Review: Case Name: Eligibility Review Document Medicaid/NC Health Choice (Pages of the Eligibility Review Document may be copied and used to review each case file. Attachments provide information about some verifications.)

More information

THE AFFORDABLE CARE ACT Frequently Asked Questions

THE AFFORDABLE CARE ACT Frequently Asked Questions THE AFFORDABLE CARE ACT Frequently Asked Questions We are providing basic information on the ACA in order for you to best prepare for your tax appointment. While we strive to give you complete and accurate

More information

2016 Instructions for Form 8965

2016 Instructions for Form 8965 Department of the Treasury Internal Revenue Service 2016 Instructions for Form 8965 Health Coverage Exemptions (and Instructions for Figuring Your Shared Responsibility Payment) For each month you must

More information

Marketplace Model Eligibility Notice for 2016 Coverage Special Enrollment Verification Process

Marketplace Model Eligibility Notice for 2016 Coverage Special Enrollment Verification Process Marketplace Model Eligibility Notice for 2016 Coverage Special Enrollment Verification Process Special Enrollment Periods provide an important pathway to coverage for consumers who experience qualifying

More information

Affordable Care Act Update. Agenda. Maximum Out of Pocket Costs for /1/2015. July 1, 2015

Affordable Care Act Update. Agenda. Maximum Out of Pocket Costs for /1/2015. July 1, 2015 Affordable Care Act Update July 1, 2015 Agenda ACA Individual Mandate What is needed for the Application Process What is Minimum Essential Coverage Changes that occur in the tax year Form 1095 A for 2015

More information

AFFORDABLE CARE ACT SURVIVAL KIT

AFFORDABLE CARE ACT SURVIVAL KIT AFFORDABLE CARE ACT SURVIVAL KIT This tool was developed to help VITA/TCE volunteers understand the ACA-related tax provisions and how to complete a return in TaxWise. Approaching the ACA Ask each person

More information

Medicaid Madness BadgerCare +

Medicaid Madness BadgerCare + Medicaid Madness BadgerCare + Ryan Farrell Disability Rights Wisconsin Martin Schroeder ABC for Health What is Badger Care Plus? A Medical Assistance program for children up to age 19, parents and caretaker

More information

2018 Instructions for Form 8965

2018 Instructions for Form 8965 Department of the Treasury Internal Revenue Service 2018 Instructions for Form 8965 Health Coverage Exemptions (and Instructions for Figuring Your Shared Responsibility Payment) Section references are

More information

Understanding the Affordable Care Act:

Understanding the Affordable Care Act: Understanding the Affordable Care Act: Six Ways It Will Affect Low Income People in Massachusetts in 2014 May 1, 2013 The Affordable Care Act (ACA) was enacted in 2010. While some of its provisions have

More information

Basic Information 1. What is the individual shared responsibility provision?

Basic Information 1. What is the individual shared responsibility provision? Affordable Care Act Topics Individuals and Families Employers Other Organizations For Tax Pros What's Trending News Health Care Tax Tips Questions and Answers Legal Guidance and Other Resources Affordable

More information

Other Taxes and Payments

Other Taxes and Payments Other Taxes and Payments TaxSlayer provides all the forms and schedules you need in order to figure and report these taxes, and in most cases, performs the calculations. Self-Employment Tax Entered automatically

More information

Medical Assistance Eligibility Manual

Medical Assistance Eligibility Manual Medical Assistance Eligibility Manual Grateful acknowledgement to Rebecca Wright, Stacey Coggins, and S. Mita Chatterjee for their work on previous editions of this manual. Copyright March 2018 About PHLP

More information

OVERVIEW OF THE AFFORDABLE CARE ACT. September 23, 2013

OVERVIEW OF THE AFFORDABLE CARE ACT. September 23, 2013 OVERVIEW OF THE AFFORDABLE CARE ACT September 23, 2013 Outline The New Continuum of Coverage Medicaid and CHIP Are Changing The New Marketplaces Insurance Affordability Programs Shared Responsibility Requirement

More information

Taxes and Consumer Education

Taxes and Consumer Education Outreach and Enrollment Distance Learning Series Taxes and Consumer Education August 13, 2015 Welcome to the Outreach and Enrollment Webcast Series All lines are muted. Please use chat to ask a question

More information

Minnesota Health Care Programs

Minnesota Health Care Programs Minnesota Health Care Programs Eligibility Policy Manual This document provides information about additions and revisions to the Minnesota Department of Human Service s Minnesota Health Care Programs Eligibility

More information

Medicaid Eligibility Factors in 2014

Medicaid Eligibility Factors in 2014 Medicaid Eligibility Factors in 2014 Countdown to Coverage Webinar Series Medicaid 101 July 3, 2013 Karin Kramer Eligibility, Policy and Service Delivery Purpose and Objectives Purpose: This presentation

More information

Policy Memo. RE: Policy Implementation Instructions and Program(s): All Medical Assistance Programs

Policy Memo. RE: Policy Implementation Instructions and Program(s): All Medical Assistance Programs Policy Memo KDHE-DHCF POLICY NO: 2014-11-01 From: Jeanine Schieferecke, Senior Manager Date: November 3, 2014 KEESM/KFMAM Reference: N/A RE: Policy Implementation Instructions and Program(s): All Medical

More information

Determining Households and Income Coverage Year 2018

Determining Households and Income Coverage Year 2018 Part II: Determining Households and Income Coverage Year 2018 Center on Budget and Policy Priorities September 21, 2017 Why Household Size Matters Why Household Size and Composition Matter 3 Necessary

More information

General Guidance on Federally-facilitated Exchanges

General Guidance on Federally-facilitated Exchanges 1 General Guidance on Federally-facilitated Exchanges Center for Consumer Information and Insurance Oversight Centers for Medicare & Medicaid Services May 16, 2012 2 Contents I. Background... 3 II. State

More information

Health Insurance Exchanges Under the Patient Protection and Affordable Care Act (ACA)

Health Insurance Exchanges Under the Patient Protection and Affordable Care Act (ACA) Health Insurance Exchanges Under the Patient Protection and Affordable Care Act (ACA) Bernadette Fernandez Specialist in Health Care Financing Annie L. Mach Analyst in Health Care Financing October 10,

More information

Presumptive Eligibility for Pregnant Women. Carolyn McClanahan, DMA Sheila Platts, DMA Liz O Dell, DMA

Presumptive Eligibility for Pregnant Women. Carolyn McClanahan, DMA Sheila Platts, DMA Liz O Dell, DMA Presumptive Eligibility for Pregnant Women Carolyn McClanahan, DMA Sheila Platts, DMA Liz O Dell, DMA 1 Agenda Overview Presumptive Eligibility for Pregnant Women Qualified Presumptive Provider Requirements

More information

CENTERS FOR MEDICARE AND MEDICAID SERVICES SPECIAL TERMS AND CONDITIONS. Indiana Family and Social Services Administration

CENTERS FOR MEDICARE AND MEDICAID SERVICES SPECIAL TERMS AND CONDITIONS. Indiana Family and Social Services Administration CENTERS FOR MEDICARE AND MEDICAID SERVICES SPECIAL TERMS AND CONDITIONS NUMBER: 11-W- 00296/5 TITLE: Healthy Indiana Plan (HIP) 2.0 AWARDEE: Indiana Family and Social Services Administration I. PREFACE

More information

ACA LEARNING SERIES. Impact on Massachusetts & Implementation Activities to Date. Federal and State Subsidies available through the Health Connector

ACA LEARNING SERIES. Impact on Massachusetts & Implementation Activities to Date. Federal and State Subsidies available through the Health Connector ACA LEARNING SERIES Impact on Massachusetts & Implementation Activities to Date Federal and State Subsidies available through the Health Connector Massachusetts Health Care Training Forum (MTF) Conference

More information

About These Materials

About These Materials About These Materials Families USA developed these materials under contract with DC Health Link, the District of Columbia's Health Benefits Exchange, for a training program for DC eligibility workers.

More information

RHODE ISLAND GOVERNMENT REGISTER PUBLIC NOTICE OF PROPOSED RULEMAKING

RHODE ISLAND GOVERNMENT REGISTER PUBLIC NOTICE OF PROPOSED RULEMAKING AGENCY: Department of Administration (DOA) DIVISION: HealthSource RI (HSRI) RULE IDENTIFIER: R23-1-1-ACA, ERLID No. 8400 RHODE ISLAND GOVERNMENT REGISTER PUBLIC NOTICE OF PROPOSED RULEMAKING REGULATION

More information

BASIC ELIGIBILITY CRITERIA BASIC ELIGIBILITY CRITERIA OVERVIEW

BASIC ELIGIBILITY CRITERIA BASIC ELIGIBILITY CRITERIA OVERVIEW 2201 - BASIC ELIGIBILITY CRITERIA POLICY STATEMENT Basic Eligibility Criteria are non-financial requirements the Assistance Unit (AU) members must meet in order to qualify for Medicaid. BASIC CONSIDERATIONS

More information

Quickfinder. Health Care Reform Quickfinder Handbook (2018 Edition) Updates for the Tax Cuts and Jobs Act of 2017 and Other Recent Guidance

Quickfinder. Health Care Reform Quickfinder Handbook (2018 Edition) Updates for the Tax Cuts and Jobs Act of 2017 and Other Recent Guidance Quickfinder Health Care Reform Quickfinder Handbook (2018 Edition) Updates for the Tax Cuts and Jobs Act of 2017 and Other Recent Guidance Instructions: This packet contains marked up changes to the pages

More information

In this chapter, the following terms have the meanings indicated.

In this chapter, the following terms have the meanings indicated. 14.35.07 - Eligibility Standards for Enrollment in a Qualified Health Plan, Eligibility Standards for APTC and CSR, and Eligibility Standards for Enrollment in a Catastrophic Qualified Health Plan in the

More information

Special Enrollment Period Reference Guide July 31, 2014

Special Enrollment Period Reference Guide July 31, 2014 July 31, 2014 Disclaimer: The content contained within this guide is proprietary information. Proprietary Information is not for use/disclosure outside of Health Care Service Corporation and its affiliated

More information

An online marketplace where Minnesotans can find, compare, choose, and get quality health care coverage that best fits your needs and your budget.

An online marketplace where Minnesotans can find, compare, choose, and get quality health care coverage that best fits your needs and your budget. December 6, 2012 1 An online marketplace where Minnesotans can find, compare, choose, and get quality health care coverage that best fits your needs and your budget. Uninsured Medicaid/CHIP Eligible Enrollee

More information

Outreach and Enrollment Regional Training & Networking Meetings

Outreach and Enrollment Regional Training & Networking Meetings Outreach and Enrollment Regional Training & Networking Meetings May and June, 2014 Julie Tatko, MSW Lydia Ormsby, MSW Michigan Primary Care Association www.mpca.net Coverage Progress Report Marketplace

More information

MEDI-CAL 101 T I F F A N Y H U Y E N H - C H O H E A L T H C O N S U M E R C E N T E R B A Y A R E A L E G A L A I D

MEDI-CAL 101 T I F F A N Y H U Y E N H - C H O H E A L T H C O N S U M E R C E N T E R B A Y A R E A L E G A L A I D MEDI-CAL 101 T I F F A N Y H U Y E N H - C H O H E A L T H C O N S U M E R C E N T E R B A Y A R E A L E G A L A I D October 5, 2018 HEALTH CONSUMER CENTER Statewide legal hotline providing free assistance

More information

CHAPTER 8: MID-YEAR ELIGIBILITY UPDATES AND RENEWALS

CHAPTER 8: MID-YEAR ELIGIBILITY UPDATES AND RENEWALS CHAPTER 8: MID-YEAR ELIGIBILITY UPDATES AND RENEWALS TABLE OF CONTENTS A. Overview of Mid---Year Updates and Redeterminations... 1 B. Mid---Year Eligibility Updates... 1 1) Mid---Year Eligibility Updates...

More information

Overview of the New Change in Circumstances Functionality

Overview of the New Change in Circumstances Functionality Overview of the New Change in Circumstances Functionality Center for Consumer Information and Insurance Oversight February 7, 2014 Reportable Changes Type of Life Change/Change in Circumstance New person

More information

Family Medicaid. Class of Assistance Desk Guide

Family Medicaid. Class of Assistance Desk Guide Family Medicaid Class of Assistance Desk Guide Table of Contents Family Medicaid Continuing Medicaid Determination Order... 2 Newborn Medicaid... 3 Parent/Caretaker with Child(ren) Medicaid... 4 Transitional

More information

VITA/TCE Basic Certification Topics on Affordable Care Act. Current as of November 20, 2017

VITA/TCE Basic Certification Topics on Affordable Care Act. Current as of November 20, 2017 VITA/TCE Basic Certification Topics on Affordable Care Act Current as of November 20, 2017 MEC & SRP REFRESHER What does the ACA require? 3 or or Coverage Exemption SRP Minimum Essential Coverage (MEC)

More information

Carrier Enrollment & Payment Process Guide

Carrier Enrollment & Payment Process Guide Carrier Enrollment & Payment Process Guide Individual Market FebruaryAugust 20176 Version 3.0.1 TABLE OF CONTENTS 1 Introduction... 3 1.1 Affordable Care Act... 3 1.2 Washington Health Benefit Exchange...

More information

Special Enrollment Periods

Special Enrollment Periods Special Enrollment Periods Center on Budget and Policy Priorities March 3, 2016 Open Enrollment 2 Annual Period When Someone Can Enroll in a Qualified Health Plan Marketplaces will determine eligibility

More information

Oklahoma Health Care Authority

Oklahoma Health Care Authority Oklahoma Health Care Authority SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration 11-W-00048/6 Application for Extension of the Demonstration, 2016 2018 Submitted to the Centers for Medicare and

More information

MAGI for Navigators. Sam Salganik Rhode Island Parent Information Network September 2018

MAGI for Navigators. Sam Salganik Rhode Island Parent Information Network September 2018 MAGI for Navigators Sam Salganik Rhode Island Parent Information Network 401-270-0101 September 2018 About RIPIN: Helping Families Founded 27 years ago (1991) by parents of children with disabilities Statewide

More information

Questions and Answers on the. Individual Shared Responsibility Provision. January 30, 2013

Questions and Answers on the. Individual Shared Responsibility Provision. January 30, 2013 Questions and Answers on the Individual Shared Responsibility Provision January 30, 2013 Basic Information 1. What is the individual shared responsibility provision? Under the Affordable Care Act, the

More information

Some Basics on the Individual Mandate, Subsidies, and Medicaid Expansion Lisa Klinger, J.D.

Some Basics on the Individual Mandate, Subsidies, and Medicaid Expansion Lisa Klinger, J.D. Some Basics on the Individual Mandate, Subsidies, and Medicaid Expansion Lisa Klinger, J.D. www.leavitt.com/healthcarereform.com 10-23- 2013 As of January 1, 2014, the Patient Protection and Affordable

More information

Carrier Enrollment & Payment Process Guide

Carrier Enrollment & Payment Process Guide Carrier Enrollment & Payment Process Guide Individual Market August 2017 Version 5.0 TABLE OF CONTENTS 1 Introduction... 35 1.1 Affordable Care Act... 35 1.2 Washington Health Benefit Exchange... 35 1.3

More information

The Indiana Family and Social Services Administration 2014 Disability Eligibility Changes (1634 Transition)

The Indiana Family and Social Services Administration 2014 Disability Eligibility Changes (1634 Transition) The Indiana Family and Social Services Administration 2014 Disability Eligibility Changes (1634 Transition) Stakeholder Briefing January 30, 2014 Introduction 2 June 1, 2014: Indiana implements eligibility

More information

CRC Memorandum MEDICAID ELIGIBILITY

CRC Memorandum MEDICAID ELIGIBILITY Governmental Research Since 1916 No. 1074 A A publication of the of the Citizens Research Council of of Michigan July 2003 This CRC Memorandum was made possible by grants from the W.K. Kellogg Foundation

More information

Eligibility and Enrollment 2014: Underserved and Special Populations

Eligibility and Enrollment 2014: Underserved and Special Populations HEALTH REFORM IN WASHINGTON Eligibility and Enrollment 2014: Underserved and Special Populations A webinar for the Washington Association of Community & Migrant Health Centers June 10, 2013 Janet Varon

More information

Eligibility & Application

Eligibility & Application Eligibility & Application Non-Financial Requirements Age... 2.1 Virginia Residence... 2.1 Assignment of Third Party Payment Rights... 2.1 Social Security Number... 2.1-2.2 US Citizenship or Immigration

More information

HealthSource RI Policy Manual

HealthSource RI Policy Manual HealthSource RI Policy Manual 2017-2018 TABLE OF CONTENTS Chapter 1: Introduction: Provides an overview of the HealthSource RI Policy Manual Chapter 2: Eligibility for Qualified Health Plans: Lays out

More information

Health Care Reform Reference Guide

Health Care Reform Reference Guide Health Care Reform Reference Guide The Patient Protection and Affordable Care Act (ACA) vs. American Health Care Act (AHCA) May 11, 2017 On May 4, 2017, the House of Representatives voted 217-213 to pass

More information

kaiser medicaid and the uninsured commission on December 2012

kaiser medicaid and the uninsured commission on December 2012 I S S U E kaiser commission on medicaid and the uninsured December 2012 P A P E R Medicaid Eligibility and Enrollment for People with Disabilities Under the Affordable Care Act: The Impact of CMS s March

More information

Where Eligibility Starts: Modified Adjusted Gross Income (MAGI)

Where Eligibility Starts: Modified Adjusted Gross Income (MAGI) Where Eligibility Starts: Modified Adjusted Gross Income (MAGI) 1 Where Eligibility Starts: Modified Adjusted Gross Income (MAGI) Monday, Sept. 26, 2016 2:30 to 3:30 p.m. Before we get started Recording

More information

Program Eligibility by Federal Poverty Level

Program Eligibility by Federal Poverty Level Program Eligibility by Federal Poverty Level BIANCA VARGAS Policy, Eligibility & Research Division 12.18.2018 OutreachandSales@covered.ca.gov FEDERAL POVERTY LEVEL (FPL): CHART 2 AGENDA 1) FPL Rules for

More information