Q&A: Medicaid Eligibility and Enrollment Through the Exchanges

Topics: Health Care Reform, Exchanges, Medicaid


Welcome to American Health Line's new Q&A feature, Expert Explanations, where we ask experts to provide insight on a health policy issue.

For our first Q&A, Urban Institute Health Policy Center Senior Research Associate Matthew Buettgens discusses Medicaid eligibility and coverage in relation to the Affordable Care Act's insurance exchanges.

When a consumer finds out he/she is eligible for Medicaid, what is the process they need to follow to enroll for coverage?

Under both the statute and regulations, a consumer is supposed to submit their application once, to either Medicaid or the exchange, and have their eligibility determined automatically, without needing to take any additional steps. However, when that requirement is met will likely depend on their state. Most states that run their own exchanges are working towards implementing this "no wrong door" policy in the relatively near future.

(For more details on this issue, using Connecticut as an example, click here.)

In the federally facilitated exchanges, on the other hand, those found potentially eligible for Medicaid or CHIP on HealthCare.gov will have their information forwarded to the state agency for further processing. People may need to then interact with the Medicaid agency in order to be enrolled. The federal government has not set a target date for having greater integration between the marketplaces and Medicaid.

If their state is expanding Medicaid – or not expanding Medicaid, how would they be impacted? How is an applicant's date of coverage determined?

If they are eligible under current rules, they can get coverage immediately (actually, retroactively to three months before the month of application).  If they will gain eligibility only under the expansion, their coverage cannot start until Jan. 1, 2014.

Would their coverage take effect on Jan. 1, 2014? (If they have signed up before Dec. 15, 2013, like for the exchange plans.)

The Dec. 15 date only applies to premium payments for marketplace coverage.  They can sign up for Medicaid any time before Jan. 1 to get coverage that starts on Jan. 1, although their eligibility will depend on their income in January.

Would their coverage take effect at a later date?

Not if they enroll by Jan. 1.

If their state is not expanding Medicaid, how would they be impacted?

There will be new enrollment among those currently eligible.  In many states not expanding, parents are ineligible if their income exceeds very low amounts and childless adults are ineligible for Medicaid, no matter how poor, unless they are severely disabled, pregnant or elderly. By contrast, eligibility thresholds for children are at 200% of poverty or higher in all but two states. Most of this new "welcome mat" -- or "coming out of the woodwork" -- effect enrollment will be among children states not expanding Medicaid eligibility.


(For more details on this issue, using Alaska as an example, click here. Scroll to Figure 3 and Figure 5.)

Buettgens Bio

Compiled by Santosh Rao, Associate Editor