Medicaid Program; Eligiblity Changes Under the Affordable Care Act of 2010

SUMMARY: This final rule implements several provisions of the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). The Affordable Care Act expands access to health insurance coverage through improvements to the Medicaid and Children's Health Insurance (CHIP) programs, the establishment of Affordable Insurance Exchanges ("Exchanges"), and the assurance of coordination between Medicaid, CHIP, and Exchanges. This final rule codifies policy and procedural changes to the Medicaid and CHIP programs related to eligibility, enrollment, renewals, public availability of program information and coordination across insurance affordability programs.

EFFECTIVE DATE: Effective Date: These regulations are effective on January 1, 2014.

Comment Date: Certain provisions of this final rule are being issued as interim final. We will consider comments from the public on the following provisions: SEC 431.300(c)(1) and (d), SEC 431.305(b)(6), SEC 435.912, SEC 435.1200, SEC 457.340(d), SEC 457.348 and SEC 457.350(a), (b), (c), (f), (i), (j), and (k).

To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. Eastern Standard Time (EST) on May 7, 2012.

ADDRESSES: In commenting, please refer to file code CMS-2349-F. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission.

You may submit comments in one of four ways (please choose only one of the ways listed)

1. Electronically. You may submit electronic comments on this regulation to http://www.regulations.gov. Follow the "Submit a comment" instructions.

2. By regular mail. You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-2349-F, P.O. Box 8016, Baltimore, MD 21244-8016.

Please allow sufficient time for mailed comments to be received before the close of the comment period.

3. By express or overnight mail. You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-2349-F, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.

4. By hand or courier. Alternatively, you may deliver (by hand or courier) your written comments ONLY to the following addresses prior to the close of the comment period: a. For delivery in Washington, DC--Centers for Medicare & Medicaid Services, Department of Health and Human Services, Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue SW., Washington, DC 20201.

(Because access to the interior of the Hubert H. Humphrey Building is not readily available to persons without Federal government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.)

b. For delivery in Baltimore, MD--Centers for Medicare & Medicaid Services, Department of Health and Human Services, 7500 Security Boulevard, Baltimore, MD 21244-1850.

If you intend to deliver your comments to the Baltimore address, call telephone number (410) 786-7195 in advance to schedule your arrival with one of our staff members.

Comments erroneously mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period. For information on viewing public comments, see the beginning of the " SUPPLEMENTARY INFORMATION " section.

FOR FURTHER INFORMATION CONTACT: Sarah delone, (410) 786-0615. Stephanie Kaminsky, (410) 786-4653.

SUPPLEMENTARY INFORMATION:

Inspection of Public Comments: All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following Web site as soon as possible after they have been received: http://regulations.gov. Follow the search instructions on that Web site to view public comments.

Comments received timely will be also available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, at the headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, phone 1-800-743-3951.

In addition, several sections in this final rule are being issued as interim final rules and we are soliciting comment on those sections. Given the highly connected nature of these provisions, we are combining provisions that are being issued as an interim final rule and provisions that are being issued as a final rule into a single document so that a reader will be able to see the context and interrelationships in the overall regulatory framework.

Table of Contents

I. Executive Summary

II. Background

III. Summary of Proposed Provisions and Analysis of and Responses to Public Comments

A. Changes to Medicaid Eligibility

B. Financial Methodologies for Determining Medicaid Eligibility Based on MAGI Under the Affordable Care Act ( SEC 435.603)

C. Residency for Medicaid Eligibility Defined ( SEC 435.403)

D. Timeliness Standards ( SEC 435.912)

E. Application and Enrollment Procedures for Medicaid ( SEC 435.905, SEC 435.907, and SEC 435.908)

F. MAGI Screen ( SEC 435.911)

G. Coverage Month ( SEC 435.917)

H. Verification of Income and Other Eligibility Criteria ( SEC 435.940, SEC 435.945, SEC 435.948, SEC 435.949, SEC 435.952, and SEC 435.956)

I. Periodic Renewal of Medicaid Eligibility ( SEC 435.916)

J. Coordination of Eligibility and Enrollment Among Insurance Affordability Programs--Medicaid Agency Responsibilities ( SEC 435.1200)

K. Single State Agency ( SEC 431.10 and SEC 431.11)

L. Implementing Application of MAGI to CHIP ( SEC 457.10, SEC 457.301, SEC 457.305, SEC 457.315, and SEC 457.320)

M. Residency for CHIP Eligibility ( SEC 457.320)

N. CHIP Coordinated Eligibility and Enrollment Process ( SEC 457.330, SEC 457.340, SEC 457.343, SEC 457.348, SEC 457.350, SEC 457.353, and SEC 457.380)

O. FMAP for Newly Eligible Individuals and for Expansion States ( SEC 433.10, SEC 433.206, SEC 433.210, and SEC 433.212)

IV. Provisions of the Final Rule

V. Waiver of Proposed Rulemaking

VI. Collection of Information Requirements

VII. Summary of Regulatory Impact Analysis

I. Executive Summary

The legal authority for this final rule comes from the Patient Protection and Affordable Care Act (Pub. L. 111-148, enacted on March 23, 2010), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152, enacted on March 30, 2010), and together referred to as the Affordable Care Act of 2010 (Affordable Care Act).

This final rule implements several provisions of the Affordable Care Act related to Medicaid eligibility, enrollment and coordination with the Affordable Insurance Exchanges (Exchanges), the Children's Health Insurance Program (CHIP), and other insurance affordability programs. It also simplifies the current eligibility rules and systems in the Medicaid and CHIP programs. This final rule: (1) Reflects the statutory minimum Medicaid income eligibility level of 133 percent of the Federal Poverty Level (FPL) across the country for most non-disabled adults under age 65; (2) eliminates obsolete eligibility categories and collapses other categories into four primary groups: children, pregnant women, parents, and the new adult group; (3) modernizes eligibility verification rules to rely primarily on electronic data sources; (4) codifies the streamlining of income-based rules and systems for processing Medicaid and CHIP applications and renewals for most individuals; and (5) ensures coordination across Medicaid, CHIP, and the Exchanges.

Several provisions of this rule are issued on an interim final basis. As such, we will consider comments from the public on the following provisions:

SEC 431.300(c)(1) and (d) and SEC 431.305(b)(6)--Safeguarding information on applicants and beneficiaries.

SEC 435.912--Timeliness and performance standards for Medicaid.

SEC 435.1200--Coordinated eligibility and enrollment among insurance affordability programs.

SEC 457.340(d)--Timeliness standards for CHIP.

SEC 457.348--Coordinated eligibility and enrollment among CHIP and other insurance affordability programs.

SEC 457.350(a), (b), (c), (f), (i), (j), and (k)--Coordinated eligibility and enrollment among CHIP and other insurance affordability programs.

II. Background

--This is a summary of a Federal Register article originally published on the page number listed below--

Final rule; Interim final rule.

CFR Part: "42 CFR Parts 431, 435, and 457"

RIN Number: "RIN 0938-AQ62"

Citation: "77 FR 17144"

Document Number: "CMS-2349-F"

Federal Register Page Number: "17144"

"Rules and Regulations"