Snapshot of Key ACA Policies: Findings From a 50-State Survey

The Affordable Care Act (ACA) completed its second official year last month in January. And many key guidelines regarding Medicaid and CHIP eligibility, enrollment, renewal, and cost-sharing policies have changed. The 14th annual 50-state survey from the Kaiser Family Foundation identified all the major changes that have occurred in 2015 as a result of the ACA.

Medicaid and CHIP remained the central sources of coverage for low-income children and pregnant women nationwide during 2015.

Through the ACA’s maintenance of effort provisions, states will not be making any reductions in children’s eligibility through 2019. As of January 2016, 48 states cover children with incomes at or above 200% Federal Poverty Line (FPL), with 19 states extending eligibility to at least 300% FPL, while 33 states cover pregnant women with incomes at or above 200% FPL. Some states have expanded access by eliminating waiting periods that required children to be uninsured for a period of time before enrolling in CHIP.

Medicaid’s role for low-income adults continued to grow through the ACA Medicaid expansion.

As of January 2016, 31 states have expanded Medicaid eligibility to parents and other non-disabled adults with incomes up to at least 138% FPL. This count reflects the adoption of the Medicaid expansion in three states—Alaska, Indiana, and Montana. However, in the 20 states that have not expanded, median eligibility levels are 42% FPL for parents and 0% FPL for other adults, leaving many poor adults in a coverage gap since they earn too much to qualify for Medicaid but not enough for tax credit subsidies to purchase Marketplace coverage, which begin at 100% FPL.

As of January 2016, individuals can apply for Medicaid online or by phone in nearly all states as envisioned by the ACA.

All states, except Tennessee, have an online Medicaid application available either through the state Medicaid agency or an integrated portal. Two states (Arkansas and Florida) began accepting telephone applications for Medicaid in 2015, bringing the total count of states doing so to 49 as of January 2016. Also, 37 states report they can make real-time Medicaid eligibility determinations for children, pregnant women, and non-disabled adults.

States expanded functionalities of online applications and accounts.

A number of states expanded account functionalities, enabling consumers to report changes, view notices, upload documentation, renew coverage, and more. Furthermore, in 2015, most states caught up on renewals and many made gains in implementing streamlined renewal procedures. As of January 2016, 47 states are up to date in processing renewals for Medicaid

Conclusion

Together, the findings show that, during 2015, several changes are helping to connect eligible individuals to Medicaid coverage more quickly and easily and to keep eligible people enrolled as well as contributing to increased administrative efficiencies.

Moreover, the modernized systems offer new options to support program management. For example, states may have increased data reporting capabilities and expanded options to connect Medicaid with other systems. However, implementation varies across states, and lingering challenges remain.