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HHS Issues Final Rule on Medicaid Expansion Effective 2014

Posted on 3/20/2012 by NTOCC ® in Public Policy Updates

Last Friday, February 16, 2012, the Department of Health and Human Services (HHS) released its final rule for the expansion of the Medicaid program under the Affordable Care Act. Under the health law, individuals between ages 19 and 64 with incomes below 133 percent of the federal poverty level will be eligible for Medicaid coverage starting in 2014.

HHS issued a proposed rule on the Medicaid expansion in August of 2011, and received feedback from a wide variety of stakeholders.  As a result of these comments, the final rule provides additional protections for consumers, as well as additional flexibilities and options for states.  Some of these provisions include making it easier for eligible individuals and families to enroll in Medicaid and the Children’s Health Insurance Program (CHIP) by eliminating bureaucratic hurdles and coordinating enrollment with the new Affordable Insurance Exchanges.   In addition, the final rule creates a “single, streamlined, online application” which will allow states to determine applicants' eligibility for either Medicaid or health insurance provide in the state-based exchanges.  However, CMS has stated that it will issue a separate final rule for the three previously proposed methodologies that states will use to calculate the newly expanded Federal Medical Assistance Percentage (FMAP).   CMS states that it is “working with states to better understand which approaches will ensure an accurate method for implementing FMAP”. For more information on the final Medicaid Expansion rule and related fact sheets, please click here.