Medicaid Expansion Effects Health Insurance Exchanges | CHOICE ...

In the Supreme Court decision last month to uphold the Patient Protection and Affordable Care Act (PPACA), the justices also ruled that expansion of the Medicaid program must be implemented only as an option and not be tied to current Medicaid funding. Industry experts say that this ruling adds another layer of complexity to many states? efforts to develop their Health Insurance Exchanges.

This new twist makes developing the eligibility rules for participation in the Exchanges more challenging. Patrick Howard, a health care consultant commented, ?You?re going to have a few more complicated business rules that are going to be state-specific depending on what they opt in or opt out of.?

The PPACA set out a new income definition for determining Medicaid eligibility ? called MAGI for Modified Adjusted Gross Income. Howard says that most states had a handle on the MAGI math as it presented a fairly standard set of rules across the country. Now that states have the option of opting out of the Medicaid expansion, they will need a new set of rules to determine eligibility that may not be so cut and dry.

The National Association of Medicaid Directors sent the Obama administration a letter last week requesting clarification on a number of issues including floating the idea of a partial opt-out of Medicaid expansion, which could result in even more complex eligibility calculations.

Despite these and other pressing questions, the January 1, 2014 deadline for state Health Insurance Exchange implementation required in the PPACA is still in place, meaning that many states will need to fast-track development in order to get their Exchange up and running in time.

Source: http://www.choiceadminexchanges.com/index.php/medicaid-expansion-effects-health-insurance-exchanges/

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