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      The  Affordable  Care  Act  (ACA)  makes  improvements  to  both  Medicaid  and  the  State  Children’s  Health   Insurance  Program  (CHIP).    These  include  expanding  Medicaid  coverage,  controlling  costs  and  improving   Medicaid  service  delivery  for  beneficiaries,  including  patients  with  liver  disease.    These  changes  are  in   the  process  of  being  implemented  and  are  outlined  below:       Medicaid   •

 

Eligibility  Expansion.    Eligibility  is  expanded  and  all  individuals  with  incomes  at  or  below  133   percent  of  the  federal  poverty  level  will  be  eligible  for  coverage  as  of  January  1,  2014.    The   mandatory  Medicaid-­‐eligibility  level  for  children  ages  6-­‐19  increases  from  100  to  133  percent  of   the  federal  poverty  level.    This  expansion  means  that  non-­‐elderly,  non-­‐pregnant  adults  without   children  will  be  eligible  for  Medicaid  based  on  their  incomes  for  the  first  time,  and  this  is  the   primary  mechanism  of  the  ACA  to  expand  access  to  insurance.     Medicaid  Benefits.    Those  newly  eligible  for  Medicaid  will  be  eligible  for  “benchmark”  or   “benchmark-­‐equivalent”  plans,  which  was  defined  by  the  Deficit  Reduction  Act  of  2005.     Benchmark  plans  can  either  be  full  Medicaid  benefits  or  a  more  limited  package  of  benefits.     However,  all  states  will  be  required  to  provide  at  least  the  same  essential  health  benefits   required  of  coverage  purchased  through  an  exchange.    A  complete  explanation  can  be  found   here.     Maintenance  of  Eligibility.    Prior  to  the  Medicaid  expansion  on  January  1,  2014,  states  are   required  to  maintain  the  eligibility  standards  in  effect  on  the  date  ACA  was  enacted  into  law.    All   individuals  who  met  the  state’s  eligibility  rules  as  of  that  date  will  remain  eligible  for  full   Medicaid  coverage,  not  a  benchmark  plan.    However,  states  providing  coverage  to  beyond  those   who  are  pregnant  or  disabled  with  incomes  above  133  percent  of  poverty  can  scale  back   eligibility  for  those  beneficiaries  during  that  time.     Medical  Homes.  As  of  January  1,  2011,  states  have  had  the  option  of  enrolling  Medicaid   beneficiaries  with  at  least  two  chronic  conditions,  like  liver  disease,  into  a  health  home   composed  of  a  team  of  health  providers  that  would  provide  comprehensive,  care  coordination   services.    

American Liver Foundation Ÿ 39 Broadway, Suite 2700, New York, NY 10006-3003 Ÿ Tel: 212-668-1000 Ÿ Fax: 212-483-8179 HelpLine: 800-GO-LIVER (800-465-4837) Ÿ www.liverfoundation.org

Prescription  Drug  Coverage.    The  ACA  reduces  the  Medicaid  programs  prescription  drug  costs.     Programs  will  be  eligible  for  increased  drug  rebates  between  2  and  8  percent  depending  on  the   drug.    This  was  effective  upon  enactment.         • Streamlined  Enrollment.    To  simply  the  complicated  enrollment  process,  the  ACA  requires  states   to  establish  a  website  or  a  health  insurance  exchange  through  which  individuals  may  apply  for   Medicaid  and  CHIP.     • Dual  Eligibles.        There  are  low-­‐income  seniors  and  people  with  disabilities  are  eligible  for  both   Medicare  and  Medicaid  and  rely  on  Medicaid  to  fill  the  gaps  in  Medicare  coverage.    To  improve   access  to  services  for  these  individuals,  the  ACA  created  an  Office  of  Coordination  for  Dual   Eligible  Beneficiaries  to  align  the  policies  of  the  two  programs,  integrate  the  programs;  benefits,   improve  continuity  of  care  and  enhance  coordination  between  the  federal  and  state   governments.    More  information  can  be  found  here.     • Federal  Share  Increased.    The  federal  government  funds  a  large  part  of  the  Medicaid  expansion.     It  will  provide  100  percent  of  the  matching  costs  for  the  newly  eligible  in  2014-­‐16,  95  percent  in   2017,  94  percent  in  2018,  93  percent  in  2019  and  90  percent  in  2020  and  thereafter.         • Payments  for  Primary  Care.    To  address  concerns  about  the  ability  of  Medicaid-­‐eligible   individuals  to  find  primary  care  physicians  who  accept  Medicaid,  the  ACA  raises  Medicaid   reimbursement  for  primary  care  services  to  equal  Medicare  reimbursement  for  the  same   services.    This  increase  is  authorized  for  only  2013  and  2014.     IMPORTANT  NOTE:    The  recent  Supreme  Court  decision  on  the  ACA  maintained  the  Medicaid   expansion,  but  limited  the  Secretary’s  authority  to  enforce  it.    This  means  that  a  state  can  choose  not  to   implement  the  expansion,  but  the  Secretary  cannot  without  existing  federal  program  funds.     State  Children’s  Health  Insurance  Program  (CHIP)     The  ACA  extends  the  existing  CHIP  program  for  two  years  through  September  30,  2015  and  makes  the   changes  outlined  below.     • Increases  the  federal  share.        Beginning  on  October  1,  2013  and  ending  September  30,  2015,   the  federal  matching  percentage  for  CHIP  by  23  percent  (not  to  exceed  100  percent).     • Ensures  maintenance-­‐of-­‐eligibility  standards.      The  standards  in  effect  on  the  date  of  ACA   enactment  must  be  maintained.     •

 

American Liver Foundation Ÿ 39 Broadway, Suite 2700, New York, NY 10006-3003 Ÿ Tel: 212-668-1000 Ÿ Fax: 212-483-8179 HelpLine: 800-GO-LIVER (800-465-4837) Ÿ www.liverfoundation.org

Screens  children  for  other  eligibility.    In  the  event  the  CHIP  allotments  prove  insufficient  to   cover  all  eligible  children,  the  state  must  also  have  procedures  to  screen  children  for  Medicaid   eligibility  and  ensure  those  ineligible  for  Medicaid  receive  coverage  through  the  Exchange.     State  option  for  CHIP  coverage  to  children  of  state  employees.    Children  of  state  employees   who  are  eligible  for  health  benefits  are  no  longer  precluded  from  participation  in  the  CHIP   program.  

 

 

American Liver Foundation Ÿ 39 Broadway, Suite 2700, New York, NY 10006-3003 Ÿ Tel: 212-668-1000 Ÿ Fax: 212-483-8179 HelpLine: 800-GO-LIVER (800-465-4837) Ÿ www.liverfoundation.org


Healthcare Reform Act Medicaid