Eligibility

This checklist prepared by the National Academy for State Health Policy (NASHP) highlights the ACA Medicaid requirements that will take effect in the next two years, nearly all of which will apply to states regardless of whether the state chooses to expand Medicaid eligibility.

This brief examines Medicaid's key role in meeting the long-term care needs of seniors in the United States, particularly those with limited incomes. Medicaid is the nation's primary payer of long-term services and supports, and state Medicaid programs provide a range of long-term care services. The brief includes state-by-state data on Medicaid enrollment and expenditures for elderly beneficiaries.

As 2014 approaches, many states are preparing for implementation of the major provisions of the Affordable Care Act (ACA) law, including a new streamlined Medicaid enrollment system and, at states' option, the expansion of Medicaid. It has been found that nearly all states are pressing forward with information technology and process improvements to develop faster, streamlined Medicaid enrollment systems, whether or not the state elects to expand Medicaid coverage under the law.

This brief provides a short summary of Medicaid eligibility and benefits for people with disabilities today and explains how they will be affected by the ACA in light of CMS's new regulations. Provisions of the new Exchange regulations are discussed briefly to the extent that they related to Medicaid eligibility determinations for people with disabilities.

This brief provides a summary of the CMS’s March 23, 2012 final rule to implement the ACA provisions relating to Medicaid eligibility and enrollment coordination. The rule (effective Jan. 1, 2014) lays out procedures for states to implement expansion and streamline and integrate eligibility and enrollment system. Achieving this goal will require substantial process and system changes among state Medicaid agencies and close coordination between Medicaid and other insurance affordability programs.

The purpose of this literature review is to better understand the various pathways to Medicare-Medicaid eligibility, how and why and individual becomes eligible for both programs. Also, this report presents examples of federal government- and state-sponsored programs and supports aimed at delaying or preventing a descent into functional decline and/or poverty. The ways to simplify the enrollment process for those who quality and need Medicare and Medicaid benefits are discussed as well.

This study focuses on new Medicare-Medicaid enrollees in Maryland and the circumstances that shaped their initial eligibility for both programs. This report details the demographic and programmatic characteristics of new enrollees. Specifically, it serves as the vehicle for establishing an initial operational definition of new enrollees and developing the terminology needed to describe the circumstances surrounding initial Medicare-Medicaid eligibility.

Section 1115 waivers provide states an avenue to test new approaches in Medicaid that differ from federal program rules. Waivers can provide states significant flexibility in how they operate programs and can have a significant impact on program financing. As such, waivers have important implications for beneficiaries, providers, and states. This brief provides an overview of Section 1115 waiver authority, the waiver approval process, and recent waiver activity and discusses the implications.

In 2014, most homeless people will become Medicaid-eligible under the Affordable Care Act. Many homeless people have physical and behavioral health conditions for which they seek care through frequent use of emergency rooms and inpatient hospitalization, at considerable cost in public resources. Medicaid reimbursement is an important source of funding for services that help homeless people succeed in housing and stop such inappropriate use of crisis health services.

Autism spectrum disorders are among the fastest-growing developmental disability diagnosis in the US. This growing number highlights the need to learn more about the services & supports that are currently available for adults with ASD, & consider those that will be needed throughout their adult lifespan. The purpose of the study was to investigate how people with ASD are being served across states in HCBS, including service eligibility, state trends specific to autism services & lessons learned.