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Summary of Federal Medicaid Eligibility Rule Changes

* Impacts and options for California are italicized.

  1. The new federal Medicaid rules do the following:
      • Set the Medicaid minimum income eligibility at 133% of FPL for non-disabled adults
      • Collapse Medicaid eligibility categories into four groups: children, pregnant women, parents and all other adults
      • Modernize eligibility verifications to rely on electronic data sources
      • Streamline income rules for Medicaid (Medi-Cal) and CHIP (Healthy Families)
      • Coordinate Medicaid, the Exchange and CHIP to assure no eligibility gaps, and
      • Their effective date is 1/1/2014
  2. 42 CFR 435.119 provides that adults (19-64), not in Medicare with household incomes less than 133% of FPL are eligible for Medicaid; this includes parents. California currently does not cover the medically indigent adults (MIAs) and does cover parents with incomes up to 100% of FPL. California will need to amend state statutes and regulations to cover MIAs and parents up to 133% of FPL.
  3. 42 CFR 435.218 gives states an option to create a medically needy program for individuals (including children and pregnant women under age 65 with incomes in excess of 133% of FPL). California currently has a medically needy program with a medically needy income level (MNIL) of 67% of FPL. This new option could coordinate with Exchange coverage for services not covered through Exchange plans, such as long term care.

The full document is available below:
Summary of Federal Medicaid Eligibility Rule Changes Summary of Federal Medicaid Eligibility Rule Changes.pdf

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