Getting MAGI right: a primer on differences that apply to Medicaid and CHIP
- Collection:
- Health Policy and Services Research
- Author(s):
- Brooks, Tricia, author
- Contributor(s):
- Georgetown University. Health Policy Institute. Center for Children and Families, issuing body.
- Publication:
- Washington, DC, : Center for Children and Families, Health Policy Institute, Georgetown University, January 2015
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Medicaid Eligibility Determination United States State Children's Health Insurance Program (U.S.)
- Genre(s):
- Technical Report
- Abstract:
- The Affordable Care Act (ACA) brought about the most significant transformation of eligibility and enrollment in Medicaid since its enactment fifty years ago. These changes are intended to align access to health coverage across multiple health insurance affordability programs, including Medicaid, the Children's Health Insurance Program (CHIP), and premium tax subsidies to help purchase qualified health plans in the health insurance Marketplaces. However, this makeover for Medicaid (and CHIP) effectuates major changes to how income and household size are determined, requiring states to re-engineer their business rules and procedures, update their eligibility systems, and re-train staff. All states must implement the new Modified Adjusted Gross Income (MAGI) standards for determining eligibility, regardless of whether the state has opted to expand Medicaid. However, MAGI-based standards apply only to certain eligibility categories of Medicaid, including children, pregnant women, parents and the new adult expansion group. To facilitate the move to MAGI, states are taking advantage of substantial federal funding to replace outdated eligibility and enrollment computer systems. The end goal is for high performing, interconnected systems to verify eligibility in "real-time" using trusted electronic sources of data. However, designing and deploying a new information technology (IT) infrastructure while overhauling the fundamental policies on which the system is based has been equated to "building the plane while flying it." Until these systems are fully implemented and fine-tuned, states may continue to rely on human resources--state and county workers--to use their knowledge and judgment in making eligibility decisions. Although Medicaid, CHIP, and tax subsidies in the Marketplaces share a common method for determining eligibility, there are several exceptions that apply only to specific circumstances in Medicaid and CHIP. These exceptions add complexity to the MAGI rules, both in terms of precisely documenting the business rules needed for system development and in training eligibility workers in states where temporary and less automated strategies are used while systems are under development. This brief covers the basics of MAGI with a focus on how it impacts Medicaid and CHIP. It identifies specific eligibility policies that have created confusion for eligibility workers, consumers, and the navigators and certified application counselors who provide enrollment assistance.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (23 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101676190 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101676190