The Affordable Care Act created new national income standards for publicly funded health programs: modified adjusted gross income for Medicaid and the Children’s Health Insurance Program (CHIP), and advance premium tax credits and cost-sharing reductions for newly established insurance exchanges. To prepare for these new income standards, many states are modifying their eligibility systems – both for existing Medicaid and CHIP programs and future insurance exchanges. In doing so, states can leverage an enhanced federal financial participation (FFP) match of 90 percent that is available for design, development, and implementation of eligibility determination systems through 2015. Additionally, for ongoing maintenance and operations of eligibility systems, states are eligible to receive 75 percent FFP.
This brief and companion chart review the cost allocation methodologies for integrating Medicaid and exchange eligibility systems outlined in the Implementation Advance Planning Documents/ Implementation Advance Planning Documents Updates (IAPD/IAPDU) of California, Massachusetts, Minnesota, Nevada, Oregon, and Rhode Island. This resource was prepared by CHCS through the Robert Wood Johnson Foundation’s State Health Reform Assistance Network to guide additional states in developing suitable methodologies for eligibility system integration efforts as they prepare for ACA implementation.