For the third year, the Kaiser Commission on Medicaid and the Uninsured teamed up with CCF to conduct an annual survey of state Medicaid and CHIP eligibility, enrollment, renewal, and cost-sharing practices. This year’s report, “Getting into Gear for 2014,” clearly shows that states continue to simplify and modernize Medicaid and CHIP in ways that increase access to coverage, promote continuous coverage and improve government efficiency.
A total of 26 states made improvements to their programs. Eleven (11) of them took advantage of ACA or CHIPRA options to remove the 5-year waiting period for lawfully-residing immigrant children or to eliminate restrictions disallowing dependents of state employees from enrolling in CHIP. One state, Colorado, even expanded coverage to low-income adults. Twenty-three (23) states streamlined their procedures primarily through the use of technology. For example, 11 states added or enhanced the use of web-based tools such as electronic applications and online accounts. Nine (9) states diversified renewal options, with almost one-third of the states now offering the full array of renewal methods that will be required in 2014: online, phone, in-person or via mail/fax.
Although there is still much work to be done, states are moving closer to the ACA’s goal of transforming the Medicaid enrollment experience to a real-time, electronically based process the minimizes administrative burdens on individuals and eligibility offices. The survey reflects that nearly every state is pressing forward with major information technology (IT) and process improvements necessary to achieve a web-based, paperless system that will be required in 2014. Moreover, there is a growing repository of products, resources and knowledge gained from states leading the way in harnessing technology that will accelerate the learning curve for states that got a late start.This year’s report reaffirms that Medicaid and CHIP continue to be the bedrock of coverage for pregnant women and children, thanks to the Affordable Care Act’s requirement that states maintain coverage. The median coverage level for children stands at 235 percent of the federal poverty level (FPL). Unfortunately, parents and childless adults have not fared as well. Over the years, coverage for parents, at a median eligibility level of 61 percent of the FPL, has lagged far behind that of their children, and adults without dependent children have few opportunities to access Medicaid.
Thus, the most striking finding of this year’s report is the considerable gap in coverage that will persist for the lowest-income adults if states fail to take advantage of the ACA’s generous federal funding to extend Medicaid to more parents and other adults. This year’s survey does not offer any insight into the final outcome as states weigh the option to expand Medicaid given to them by Supreme Court ruling that upheld the ACA but effectively removed any penalty for states that do not comply. But as we’ve seen from the recent announcement that Arizona will expand Medicaid, it’s too early to cross any state off the list as legislatures and governors actively discuss both the financial and coverage implications of expanding Medicaid to complete the continuum of coverage envisioned by the ACA.
