Healthcare Reform Act Medicaid

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The Affordable Care Act (ACA) makes improvements to both Medicaid and the State Children’s Health Insurance Program (CHIP). These include expanding Medicaid coverage, controlling costs and improving Medicaid service delivery for beneficiaries, including patients with liver disease. These changes are in the process of being implemented and are outlined below: Medicaid •

Eligibility Expansion. Eligibility is expanded and all individuals with incomes at or below 133 percent of the federal poverty level will be eligible for coverage as of January 1, 2014. The mandatory Medicaid-­‐eligibility level for children ages 6-­‐19 increases from 100 to 133 percent of the federal poverty level. This expansion means that non-­‐elderly, non-­‐pregnant adults without children will be eligible for Medicaid based on their incomes for the first time, and this is the primary mechanism of the ACA to expand access to insurance. Medicaid Benefits. Those newly eligible for Medicaid will be eligible for “benchmark” or “benchmark-­‐equivalent” plans, which was defined by the Deficit Reduction Act of 2005. Benchmark plans can either be full Medicaid benefits or a more limited package of benefits. However, all states will be required to provide at least the same essential health benefits required of coverage purchased through an exchange. A complete explanation can be found here. Maintenance of Eligibility. Prior to the Medicaid expansion on January 1, 2014, states are required to maintain the eligibility standards in effect on the date ACA was enacted into law. All individuals who met the state’s eligibility rules as of that date will remain eligible for full Medicaid coverage, not a benchmark plan. However, states providing coverage to beyond those who are pregnant or disabled with incomes above 133 percent of poverty can scale back eligibility for those beneficiaries during that time. Medical Homes. As of January 1, 2011, states have had the option of enrolling Medicaid beneficiaries with at least two chronic conditions, like liver disease, into a health home composed of a team of health providers that would provide comprehensive, care coordination services.

American Liver Foundation  39 Broadway, Suite 2700, New York, NY 10006-3003  Tel: 212-668-1000  Fax: 212-483-8179 HelpLine: 800-GO-LIVER (800-465-4837)  www.liverfoundation.org


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