Affordable Care Act Will Provide Help to States In Preparing for 2014 Medicaid Program

Affordable Care Act Will Provide  Help to States

In Preparing for 2014 Medicaid Program Improvements

Overview

States needing to overhaul their computer systems to handle the changes in Medicaid enrollment under the Affordable Care Act will have 90 percent of the cost paid by the federal government, according to a new rule published today by the Centers for Medicare & Medicaid Services (CMS).

This important investment will allow States to overhaul their Medicaid information technology (IT) systems for the 21^st century, while preparing for new Medicaid enrollment rules and the development of the new Insurance Exchanges.

Federal assistance will ease the financial stressors many states are facing and smooth the transition to the more inclusive Medicaid eligibility rules and the significantly streamlined Medicaid enrollment procedures ushered in by the Affordable Care Act.

 Medicaid Program Improvements

 Under the new law, most Americans whose income is up to 133 percent of the federal poverty level (FPL) will be eligible for Medicaid in 2014, and existing gaps in eligibility for very low income adults will be eliminated. For 2011, 133 percent of the FPL for an individual is $14,484. 

Just as significant, the rules for determining eligibility and the process for enrolling people will be vastly simplified.  Dramatic system transformations will likely be needed in most states to accommodate the new and expanded availability of health care to millions of currently uninsured Americans,  not just through a modernized Medicaid program, but the new health insurance exchanges as well.  If they are to receive the enhanced funding, states must meet certain performance standards including seamless coordination with the exchanges

Under this new rule, states  may receive a 90 percent federal matching rate to assist states in the design, development, installation or enhancement of eligibility determination systems through December 31, 2015.  After that, states may be able to continue to receive enhanced federal support at the 75 percent match rate for maintenance and operations of the new systems.

Prior to this rule, only a 50 percent matching rate was available for state eligibility determination systems.  The new regulation will also ensure that state and federal investments in technology are efficient and high-performing by requiring that to qualify for an enhanced federal match, systems must meet current information technology industry best practice standards.  The standards and conditions will ensure these technology investments promote efficiency and accuracy through flexible, modular design and support high-quality performance and customer experience. 

The final regulation, CMS-2346-F, will be published in  the Federal Register on April 19, 2011.