Sets a new mandatory Medicaid eligibility threshold, effective January 1, 2014, for non-elderly (under age 65), non-pregnant individuals whose income does not exceed 133% of the FPL. (This includes childless adults; certain parents; and children ages 6-19 for whom mandatory Medicaid coverage rises from 100% to 133% of the FPL).
Provides that the newly-eligible group be covered under benchmark or benchmark-equivalent plans pursuant to section 1937 of the SSA and that such coverage contain the essential health benefits (EHBs) required under the Exchange (refer to section 1302 of the ACA), in addition to prescription drugs and mental health services. With respect to the latter, the provision specifies requirements relative to mental health services parity.
Stipulates that, with respect to the states’ costs to cover the newly-eligible population, as revised by section 1201(1)(B) of the HCERA, states are to receive 100% FMAP in 2014-2016; 95 percent% in 2017; 94% in 2018; 93% in 2019; and 90% in 2020 and beyond.
With respect to federal funding for “expansion states” – which are defined as having already expanded, as of March 23, 2010, Medicaid to individuals with income at least 100% of the FPL – as revised by section 10201(c) of the Senate Manager’s Amendment, specifies an alternate FMAP that is increased by the number of percentage points equal to a “transition percentage” – i.e., 50% in 2014; 60% in 2015; 70% in 2016; 80% in 2017; 90% in 2018 – so that by 2019 and beyond, the expansion sate FMAP would be the same as that of the newly-eligible FMAP. Regarding expansion state requirements, see section 10201(c) of the Senate Manager’s Amendment, which delineates certain requirements relative to the type of coverage that must be offered by the state (e.g., includes inpatient hospital services; is not limited to premium assistance; etc.).
Delineates definitional clarification around the term “newly eligible” to refer to individuals between the ages of 19 to 64 who are enrolled in the new adult group and who would not have been eligible for full benefits or benchmark or benchmark-equivalent coverage as of December 1, 2009. Clarifies that an individual may also be deemed “newly-eligible” if such individual would have been eligible but could not have been enrolled for such benefits or coverage due to limited or capped enrollment under a waiver program as of December 1, 2009.
With respect to the maintenance of effort (MOE) requirement, stipulates that states must, as of the date of March 23, 2010, maintain eligibility standards for all adults until the Exchange is fully operational (i.e., through December 31, 2013). The ACA requires that the MOE requirements extend to children (under age 19 unless the state elects to cover higher) under Medicaid and CHIP (see section 2101) until October 1, 2019. Provides certain exceptions for states currently experiencing or projected to experience a budget deficit for specified years.
Requires annual state reports on Medicaid enrollment beginning January 2015.
As revised by section 10201(b) of the Senate Manager’s Amendment, beginning April 1, 2010, sets forth a new State Plan Amendment (SPA) option to allow states to cover individuals at or below 133% of the FPL in advance of the broader expansion that takes effect on January 1, 2014, provided certain requirements are met (e.g., children must have coverage for parents to be eligible).
Within certain parameters, effective January 1, 2014, allows states to extend Medicaid coverage to certain individuals whose income exceeds 133% of the FPL as an optional categorically needy group.