On February 21st, 2014, the Centers for Medicare & Medicaid Services (CMS) released a State Medicaid Directors Letter (SMDL) addressing the application of liens, adjustments and recoveries, transfer-of-assets rules, and post-eligibility income rules to individuals eligible for Medicaid under Modified Adjusted Gross Income (MAGI) eligibility rules. MAGI rules apply to the Medicaid adult expansion population, and this much-awaited federal guidance addresses the issue of whether Medicaid estate recovery applies to this group. According to the guidance estate recovery does apply to some individuals age 55 and older whose eligibility is determined using MAGI methodologies, including the expansion population. CMS, however, recognizes the law is a potential barrier to enrollment and intends to explore options to eliminate recovery of Medicaid benefits for items or services other than long-term care and related services for MAGI beneficiaries. In the meantime, CMS reminds states that they have the option to limit recovery to what is federally required.
The Affordable Care Act (ACA) requires states starting in 2014 to provide Medicaid to youth who were in foster care on their 18th birthday or later and to keep them on Medicaid until they turn 26. This Lessons from California, highlights how the state has implemented this new program for the benefit of thousands of vulnerable former foster youth.
This issue of the Health Advocate provides an overview of Medicaid Home and Community Based Services (HCBS). HCBS programs are intended to support states in creating a comprehensive system of long-term care services in the community, as is consistent with the community integration mandate established by the Supreme Court in the Olmstead v. L.C. case in 1999.
New and Updated. The Affordable Care Act (ACA) established new rules for counting income and family size to determine eligibility for insurance affordability programs, including subsidized health insurance through the Marketplaces, Medicaid and CHIP. These new income counting rules, known as Modified Adjusted Gross Income (MAGI), are applicable nationwide, are quite complex and differ significantly from prior Medicaid/CHIP rules. NHeLP’s Advocate’s Guide to MAGI is our free resource designed to help advocates understand and apply these new income counting rules. The Guide explains in detail how MAGI works, including who is and who is not subject to MAGI, the types of income counted and excluded, and how to figure out who is in an applicant’s “household” for determining eligibility. In addition, the Guide contains a number of helpful charts and hypothetical examples to demonstrate how the new rules work.
Q&A: Home and Community-Based Services-Final RulesMedicaid-funded home and community-based services are critical to community integration for older adults and individuals with disabilities. Defining the types of settings in which these services are provided is important in ensuring the services are not provided in settings that are institutional in nature, but instead promote access to the community. This Q&A discusses the new rules, the definition of home and community-based settings, the transition process, advocacy opportunities, and other new features for Medicaid waivers and programs under these new rules.
The National Health Law Program and the Western Center on Law & Poverty are pleased to present our input on Covered California’s draft applications and regulations for Qualified Health Plans. We appreciate the hard work that you and your staff have put into crafting applications that ensure high quality health plans participate in Covered California.
This issue brief discusses the Mental Health Parity and Addiction Equity Act (MHPAEA) and the final regulations for the MHPAEA. This issue brief provides information on the mental health parity generally, how parity is measured under the MHPAEA, transparency requirements, enforcement, and how the MHPAEA provisions interact with the Affordable Care Act, CHIP, and Medicaid managed care organizations. The issue brief also discusses some of the limits to mental health parity and potential areas of advocacy.
California’s streamlined paper application, modeled off of the federal application, was revised based on advocates’ recommendations. Yet California did not receive federal approval for its application until after open enrollment began which has delayed the availability of translated applications.
Amicus brief by the National Health Law Program supporting the Affordable Care Act’s (ACA) birth control benefit, urging the Supreme Court to uphold the law.
Order and opinion issued by the court. In the first case of its kind, Missouri vs. St. Louis Effort for AIDS, a federal district court has ruled that states that opt to have the federal government run their health insurance Exchange must leave its operation to the federal government, and cannot impose additional requirements or limitations on the Exchange.