Milestone: Align eligibility criteria across Medicaid, CHIP, the basic health program, and federal tax credits to avoid gaps in coverage
As families’ and individuals’ income fluctuates, their eligibility for state health subsidy programs will change. Simplified and aligned eligibility criteria will help ensure continuous coverage for consumers across programs and plans.
*Full name: Align eligibility criteria across Medicaid, CHIP, the basic health program, if adopted, and federal tax credits through the Exchange to avoid gaps in eligibility for coverage regardless of income or changes in income.
*Relevance to the ACA:
The ACA requires Medicaid, CHIP and tax-subsidized Exchange coverage to use modified adjusted gross income (MAGI) to determine eligibility for most individuals. These provisions and others relevant to the alignment of eligibility criteria include:
§1411 – Eligibility determination procedures for the Exchange and federal tax credits.
§1413 – Requirements around data exchange and data matching for eligibility determinations in state health subsidy programs.
§2002 – Eligibility determination for Medicaid using MAGI.
§2101 – Eligibility determination for CHIP using MAGI.
§2201 – Requirements for coordination across Medicaid, CHIP and Exchange plans,
-- All health subsidy programs must screen and enroll applicants in or transfer applicants to the appropriate program.
-- All health subsidy programs must use secure electronic interfaces to allow for eligibility determinations across programs.