Improving Benefit Access in States, ACA Opportunities and Challenges

1. Improving Benefit Access in States, ACA Opportunities and Challenges Working Families Success Network Conference Shelby Gonzales, Center on Budget and Policy Priorities November 7, 2013

2. New Health Coverage Landscape in 2014 FPL Unsubsidized 400% 300% 250% Subsidized 185% 200% 133% 100% 61% Coverage Gap Current Medicaid / CHIP Eligibility Expansion 37% 0% Pregnant Women Childless Adults Children Working Parents Jobless Parents Medicaid and CHIP coverage, based on 2012 eligibility levels in a typical state Source: Kaiser Commission on Medicaid and the Uninsured

3. About Half the States Are Likely to Expand Medicaid in 2014 As of October 30, 2013

4. Vision for Streamlined Enrollment $ Data Hub # HEALTH INSURANCE Medicaid CHIP Exchange Single Application for Multiple Health Programs Use of Electronic Data to Verify Eligibility Multiple Ways to Enroll Real-Time Eligibility Determinations Dear ______, You are eligible for… Source: Kaiser Family Foundation

5. New Application Requirements Pose Opportunities and Challenges • New standards that can provide key protections • Multi-benefit applications must be approved • A lot of new information is requested from consumers

6. Most SNAP Households Will Have Members Eligible For Medicaid Under Health Reform Note: This Figure considers SNAP households that contain at least one member who is not elderly or receiving SSI. The percentages shown here are the shares of those households in which the household members who aren’t elderly or on SSI will be financially-eligible for Medicaid under the ACA’s Medicaid expansion. Source: CBPP analysis of Census Bureau data.

7. States Have the Option to Administratively Enroll SNAP Participants in Medicaid • States can apply for a waiver (an easy waiver that is processed quickly) to fast track eligibility for SNAP participants: • States identify SNAP applicants and participants that can be fast-tracked • Minimal additional work to complete the Medicaid eligibility process: • Consumers consent to enroll • Citizenship can be verified electronically

8. States Taking the Option Are Seeing Impressive Results • 65,000 have consented to enroll in AR • 45,500 have consented to enroll in IL • 67,000 have consented to enroll in OR • 52,000 have consented to enroll in WV

9. Connecting People to Health Benefits and More • Buzz around health can be a mechanism to enroll families in other programs • Systems can be designed to be integrated or interoperable to avoid duplication – look to 2015 • Community based assistance can bridge systems that are siloed • Consider setting and measuring expectations for coverage, e.g. 100% of poor children enrolled in SNAP and Medicaid.

10. Resources • CMS Guidance on Administrative Enrollment: CMS State Health Official Letter Facilitating Medicaid and CHIP Enrollment and Renewal in 2014 http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/SHO-13-003.pdf • CBPP Paper on SNAP Administrative Enrollment: State Medicaid Agencies Can Now Easily and Efficiently Enroll Several Million SNAP Participants Who Are Eligible for Medicaid http://www.cbpp.org/files/SNAPMedicaidStreamline.pdf • CBPP ACA Toolkit: Coordinating Human Services Programs with Health Reform Implementation: A Toolkit for State Agencies http://www.cbpp.org/files/6-6-12health.pdf • CBPP Website on ACA Policies: Beyond the Basics http://www.healthreformbeyondthebasics.org/