Digging Into the Final Eligibility Rule? Working on Comments Due Monday? Let Us Help

The final Medicaid/CHIP eligibility rule and health insurance exchange rules are full of critical information for states preparing their eligibility systems for 2014. But it’s a lot to dive into. Where should a state start? Taking a page from David Letterman’s “Top Ten,” the Maximizing Enrollment staff at NASHP have prepared a memo highlighting the top ten things states need to know about the eligibility rule.
Items made it into our top ten because they represent: (1) a major change from current policy or practice, (2) a significant modification from the proposed rules, or (3) a new important opportunity for states.  The memo is not intended to be a complete summary of the rule, but an outline for state officials and others to use as they dig into the rule in earnest.
In no particular order, here are five of the top ten items for states to consider. For the rest, check out the memo here.
1. You can still comment on some provisions until Monday:  The final rule included a number of interim final provisions on which CMS is still seeking comments by Monday, May 7, 2012.  Click here to go to where you can comment.  Although the deadline is quickly approaching, there is still a chance to provide comments on several provisions that are not yet finalized, including: timeliness and performance standards, safeguarding eligibility information, and specific Medicaid agency responsibilities.
2. Verification standards become clearer: To achieve the ACA’s vision of seamless enrollment, states will need to obtain electronic data from “useful” sources that are listed in the final rule, such as the State Wage Information Collection Agency (SWICA). States are also directed to create a verification plan, which will be the basis for error measurement. The rule also describes new standards for determining reasonable compatibility between data sources.
3. Special CHIP provisions: The final rules align CHIP eligibility standards with Medicaid.  The rules also highlight states’ flexibility in charging premiums for children with family members enrolled in a qualified health plan (QHP), because these family members will have additional cost sharing responsibilities.  Pay close attention to the requirement that when children lose Medicaid eligibility as a result of the elimination of income disregards, those children must be covered in a separate CHIP program, regardless of whether a separate program is in place or what are the separate CHIP eligibility requirements.
4. Clarifications on alignment among Medicaid, CHIP and the exchange:  The rule clarifies areas of similar requirements for determining eligibility for Medicaid, CHIP and advance premium tax credit (APTC) and cost sharing reductions (CSR). However, full alignment is not achieved as eligibility standards for these programs include differences. Although all programs start by using IRS definitions for income and household to determine MAGI, the final rule outlines the allowable exceptions for Medicaid and CHIP in counting income and household composition that are not permitted in determining the APTC or CSR.
5. New waiver opportunities to promote streamlined eligibility:  The final rule signals new opportunities for states to seek waivers under Section 1115 of the Social Security Act. These waivers will support states seeking 12-month continuous eligibility, Express Lane Eligibility for adults, or other policy goals that CMS doesn’t have explicit ACA statutory authority to include within the final rule.
Check out the full top ten memo to see the other five items on our list.  We hope it is helpful as states spend late nights working to implement the new rule and set up new systems.
When you take a breather, let the State Refor(u)m community know what rises to the top of your state’s list of things to focus on within the recent eligibility rules?  What is your state doing to prepare for and implement the changes required in the rule? Is your state considering a waiver to implement a simplification that isn’t explicitly included in the rule?  Tell us on the eligibility rule discussion page or in the comments below.