Milestone: Develop systems specifications necessary for new and continuing Medicaid eligibility categories and CHIP conversion to MAGI
The ACA requires a new income based (MAGI) test for CHIP and Medicaid, although categorically eligible groups remain and federal match varies by old and new eligibility categories. While simplifying, states need to have systems to capture these differences.
*Full name: Develop systems specifications necessary to determine eligibility for new and continuing Medicaid eligibility categories and CHIP conversion to MAGI.
*Relevance to the ACA:
The ACA simplifies eligibility rules for those eligible based on their income, requiring use of a common income standard, modified adjusted gross income (MAGI). States need to set eligibility system specifications to accommodate these new eligibility rules while maintaining systems for those Medicaid eligibility categories (such as for the disabled) that are not eliminated under the ACA. Provisions relevant to system specifications for eligibility rules in the ACA include:
§2001 – Medicaid expansion to cover individuals with incomes at or below 133% of the federal poverty line.
-- Differential Federal funding for newly eligible individuals – FMAP for newly eligible individuals for most states begins at 100% in 2014, decreasing to 90% in 2020 and for the years following.
§2002 – Eligibility determination for Medicaid using MAGI.
§2101 – Eligibility determination for CHIP using MAGI.less