Health and Human Services (HHS) Secretary Kathleen Sebelius has released a proposed rule that promotes consistent policies and processes for eligibility notices and appeals in Medicaid, the Children's Health Insurance Program (CHIP), and Exchanges and gives states more flexibility when operating their Medicaid programs.
“Before the health care law was passed, millions of Americans were unable to obtain or afford quality health coverage,” Secretary Sebelius said. “Today, we are proposing a rule to provide Americans with access to affordable, high quality health coverage and give states more flexibility to implement the law in a way that works for them.”
Beginning in 2014, the health care law provides new opportunities for Medicaid coverage for adults who earn up to 133 percent of poverty — $14,865 for an individual or $30,656 for a family of four. Other Americans looking for coverage will be eligible to buy it through a health insurance marketplace, where many will be eligible for tax credits to make coverage more affordable. The rules proposed will help develop systems that will make it easy for consumers to determine if they are eligible for Medicaid or tax credits that make insurance more affordable.
The proposed rule includes information on how consumers will receive coordinated communications on eligibility determinations and can appeal eligibility determinations. It gives states flexibility in designing benefits and determining cost sharing in the Medicaid program. The proposed rule also provides flexibility to state-based Exchanges by allowing them to choose to rely on HHS for verifying whether an individual has employer-sponsored coverage and conducting some types of appeals.