Under the Affordable Care Act, states will have
considerable flexibility, within federal guidelines, to design Medicaid benefit
packages and cost-sharing rules that are appropriate for newly-eligible adult
beneficiaries. The often-extensive health care needs and very low incomes of
the newly-eligible adults are important considerations for states as they put the new law into effect, according to a new issue brief written by CCF and the
Kaiser Commission on Medicaid and the Uninsured.
Half of all uninsured adults below 133 percent FPL have
income below 50 percent FPL. When it comes to their health status, about
one-third have a diagnosed chronic condition, such as hypertension or
depression, and about 1 in 6 are in fair or poor health. Given the limited income and
often-extensive health care needs of newly-eligible adult Medicaid
beneficiaries, it will be critical that they be provided with benefits designed
to reflect their unique needs if health reform is to work as intended.
Both the federal and state governments will play
important roles in making sure the new law works for newly-eligible adult
Medicaid beneficiaries. The issue brief identified two key areas for policyakers to consider as they move forward on implementing the new law:
- Benefit Packages: The content of the coverage provided
to the millions of low-income adults slated to secure Medicaid coverage under
the health reform law will depend, in part, on how the federal government
addresses key issues, such as the definition of “essential health benefits.” In
addition to covering these essential benefits, the coverage for the newly
eligible must be equal to coverage provided under one of three “benchmarks.”
Importantly, states can also provide additional benefits on top of the
benchmark. - Continuity of Care: Given that changes in income,
health status, and other factors are common, coordination and consistency of
coverage between Medicaid groups and over time are key aims. Because
individuals may also shift between eligibility for Medicaid and Exchange
coverage, identifying ways in which states can promote continuity of care
between the two systems is a priority.
The responsibility of creating a coherent program that
provides the full range of groups served by the Medicaid program with the
benefits that they need when they need them falls mainly to the states.
Thankfully, the federal government has helped make it easier on the states by making
a commitment to finance the full cost of care for the newly-eligible Medicaid
adults for the first three years of reform and at least 90 percent of the cost
thereafter.
Hope for uninsured low-income adults is on the
horizon. Let’s hope policymakers
finish the job by making wise choices in how they design the benefit packages
and address the need for continuity of care for newly eligible Medicaid
beneficiaries.