Eligibility

MACPAC has released its June 2022 Report to Congress on Medicaid and CHIP. The report recommends measures that Congress can take to better monitor access to care for Medicaid beneficiaries, improve the oversight and transparency of managed care directed payments, increase access to vaccines for adults enrolled in Medicaid, encourage the uptake of health information technology in behavioral health, and better integrate care for Medicaid and Medicare dual-eligibles. The commission also offers policy levers that states and the federal government can use to promote equity in Medicaid.

This CMCS informational bulletin provides an update on the 2022 Supplemental Security Income (SSI) and Spousal Impoverishment Standards. Certain Medicaid income and resource standards are adjusted annually in accordance with changes in the SSI federal benefit rate (FBR) and the Consumer Price Index (CPI). These include some of the standards described in section 1924 of the Social Security Act, which describes the financial eligibility rules that apply when married individuals seek coverage of certain long-term services and supports. Included with this informational bulletin is the revised 2022 SSI and Spousal Impoverishment Standards chart that displays the updated MMMNA and Community Spouse Monthly Housing Allowances.

When the federal declaration of a public health emergency (PHE) expires, many of the flexibilities initiated during COVID-19 will need to be rolled back, including changes in Medicaid enrollment and eligibility. ACL has developed a fact sheet to help grantees prepare for these changes ahead and continue to support older adults and people with disabilities who currently rely on Medicaid Coverage.

This brief shares data on state policy choices about Medicaid HCBS, including target populations, functional eligibility criteria, financial eligibility criteria, waiver waiting lists, benefit packages, out-of-pocket costs, use of capitated managed care, self-direction opportunities, covered provider types, electronic visit verification systems, and provider reimbursement rates.

COVID-19 is a long-lasting and complex disaster situation involving a public health emergency and an economic crisis, with particularly acute impacts for older adults, people with disabilities, and others with certain health conditions. States are responding with changes in policies and procedures to ensure individuals have access to public benefit programs (e.g. Medicare Savings Programs, LIS/Extra Help, SNAP, and LIHEAP). ADvancing States has a new brief highlighting where states are with benefit access and enrollment since the onset of the COVID-19 pandemic. Results in the brief comes from the 2021 ADvancing States Membership Survey: COVID-19 Benefits Access and Enrollment, a follow-up to the 2020 survey.

CMS released a SHO letter with updated guidance to assist states in planning for resuming normal state Medicaid, CHIP, and BHP operations for the eventual end of the public health emergency. The SHO provides updated guidance regarding the extended timeframe for states to complete pending work in eligibility and enrollment to up to 12 months after the PHE ends and redetermination of eligibility requirements states must complete after the PHE for all beneficiaries before taking adverse actions.

NCOA has partnered with the Medicare Rights Center to develop a toolkit for counselors who work with dual eligibles and beneficiaries themselves. This toolkit was created following interviews and focus groups with counselors and will be updated continually.

ATI Advisory, supported by the Robert Wood Foundation, has conducted research to create a package of recommended legislative and administrative reforms around LTSS and the caregiving workforce. The goal of the reforms is to increase access to HCBS, reduce the institutional bias in Medicaid, and create a strong caregiving workforce.

In this blog post, ACAP and CHCS share survey results that detail how Community Affiliated Plans (ACAP), including Dual Eligible Special Needs Plan (D-SNP) and Medicare-Medicaid Plans, are addressing existing and new health-related social needs of their dually eligible enrollees during the COVID-19.

This resource was developed for human service agency leadership whose role is directing the organization and delivery of services and supports. The five competency domains include: Strengths-Based, Culturally Informed, Whole Person-Focused; Cultivating Connections Inside the System and Out; Rights, Choice, and Control; Partnership, Teamwork, Communication, and Facilitation; and Documentation, Implementation, and Monitoring.