Thursday, March 23, 2017

What’s at Stake if Essential Health Benefits are Scrapped? Pediatric Benefits, Protection from Lifetime Limits


As House leaders scramble to get enough votes to send the American Health Care Act to the Senate, there is a lot of horse-trading going on. None of it to the benefit of kids enrolled in Medicaid or private insurance. The most recent Affordable Care Act provision on the chopping block is the Essential Health Benefits package.

As my colleague, Joan Alker wrote, the new Medicaid block grant option would allow states to gut benefits for kids – even those critical development screening and treatment services that help nip problems in the bud before they turn into learning disabilities or other struggles in school. Now it appears that House leaders are willing to do that with private insurance by eliminating the requirement that plans cover the 10 basic categories of coverage, known as Essential Health Benefits (EHB). Notably, one of the ten categories is “pediatric services”, but what’s at risk is broader than that.

So what’s at stake?

Preventive Care – The EHB standard for preventive health care for kids is based on the American Academy of Pediatricians’ Bright Futures. Bright Futures establishes guidelines for screenings at set intervals to check for healthy development and to detect early and treatable issues with hearing, vision, and social and emotional development. If preventive care is no longer required, plans won’t even have to cover basic well-child checkups or immunizations.

Vision and Oral Health Care – Vision and oral health care are specifically included in pediatric services under the EHB. These services are not typically part of private insurance packages. But they are essential to children’s health and success in school.

Habilitative Services – The ACA established specific requirements for states to ensure that plans covered habilitative services for kids. These services are essential for kids with special health care needs who may need extra services such as physical, occupational or speech therapy to help them achieve their full potential.
But there’s more. It’s not just the types of services included in the EHB that are at stake.

Lifetime and Annual Maximum Limits – Prior to the ACA, insurers could set limits on the total amount of benefits that a plan would cover in a person’s lifetime. This was often set at $1 million, a cap that can easily be exceeded by a child who has cancer or needs a life-saving transplant. Children with disabilities who need extensive services are also at risk for exceeding a lifetime or annual maximum. But because these caps are only associated with EHB, they too would be cut.

Out-of-Pocket Caps – The ACA also sets limits on the amount of cost-sharing that can be passed on to an individual or family. Without these protections, low-income families will struggle with medical debt that puts their children’s health and family’s economic security at risk.

In less than a week, the AHCA has gone from bad to worse. What emerges from behind closed-door negotiations is likely to be even more devastating to children’s health and well-being. Government is supposed to protect the vulnerable and disadvantaged in society. To paraphrase Hubert Humphrey: “It was once said that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the disabled.” The AHCA doesn’t pass that moral test.

reposted from: http://ccf.georgetown.edu/2017/03/23/whats-at-stake-if-essential-health-benefits-are-scrapped-pediatric-benefits-lifetime-limits-out-of-pocket-caps-and-more/

Dropping Essential Health Benefits Would Lead to Health Plans that Cover Little

from Center on Budget and Policy Priorities:
The White House and House Republican leaders are reportedly negotiating with House Freedom Caucus members to eliminate federal minimum benefit (“Essential Health Benefits”) standards for individual and small-group market plans as part of the House health bill.
That would leave many people with pre-existing conditions unable to find the coverage they need at any price, much less an affordable one; would result in women being charged more than men; and expose many people with health insurance to unaffordable bills, and possibly even putting them at risk for medical bankruptcy.
What’s more, eliminating Essential Health Benefit standards could weaken the ACA’s core protections even for people with coverage from large employers.
The ACA’s prohibition on annual and lifetime limits is tied to the definition of Essential Health Benefits. Thus, repeal of Essential Health Benefit standards could make this protection meaningless, putting almost all Americans with private health insurance coverage — not just those with individual or small-group market coverage — at risk.
Find out what is included in Essential Health Benefits with our interactive feature.

Wednesday, March 22, 2017

Update on ACA Repeal and Medicaid Proposals

from National Family Voices:

ACA Repeal and Medicaid Restructuring
Last week, the House Budget Committee merged two committee-approved pieces of legislation into a "reconciliation" bill,the American Health Care Act (AHCA), H.R. 1628. (See the March 15 Update for a description of the legislation.) On Wednesday, March 22, the House Rules Committee will meet to decide how the bill can be amended. The bill is expected to move to the House Floor for a vote on Thursday, March 23 (exactly 7 years after President Obama signed the Affordable Care Act into law). If the bill passes the House, Senate Majority Leader Mitch McConnell (R-KY), hopes to bring it up for a vote next week. If it passes the Senate, any differences between the House and Senate bills (theoretically) could be resolved the following week, and the bill could become law by April 8.
 
IMPORTANT: On Monday evening, the House Energy and Commerce Committee and House Ways and Means Committee released summaries and the text of their "managers amendments" to the bill (one for technical changes and one for policy changes). The policy amendments would: allow states to receive federal Medicaid funds through a block grant, rather than a per capita cap mechanism, for covering low-income children and/or traditional (non-expansion, non-disabled, non-elderly) adults (i.e., parents and pregnant women); impose a work requirement on "able-bodied adults" without dependents (with certain exceptions); prevent new states from opting in to the ACA's Medicaid expansion; accelerate the repeal of ACA taxes by one year (to 2017); increase the annual inflation rate in per capita caps for the elderly and disabled Medicaid populations; and decrease the threshold for deducting medical expenses to 5.8 percent of income (from the 10 percent threshold established by the ACA).
 
States choosing a block-grant arrangement would have to cover only the mandatory populations of children and pregnant women. They would not have to follow current law with respect to benefits, except that they would have to provide "hospital care; surgical care and treatment; medical care and treatment; obstetrical and prenatal care and treatment; prescribed drugs, medicines, and prosthetic devices; other medical supplies and services; and health care for children under 18 years of age." These terms are not defined, but it seems fairly clear that the bill eliminates the requirement that children are entitled to Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services. Moreover, states choosing the block grant would no longer have to accept willing providers (i.e., they could decide not to cover specialists, or even pediatricians), and would no longer have to provide services on a statewide basis. States would have to opt for the block grant in 10-year increments. Because of the great flexibility states would have, and the way federal funding would flow to states over the years, it may be tempting for states to take up this option.
 
Some of the managers' amendments are intended to placate the far right end of the spectrum, while others are intended to placate the more moderate Republicans. It is not clear that they will address the concerns of the Senators on each end of the Republican spectrum in that body.
 
The Congressional Budget Office is expected to issue new cost and coverage estimates for the amended bill prior to the House vote, which could influence the outcome of the vote.
 
More Information Related to Health Care Reform
In anticipation of new health care proposals, a number of organizations released resources about current insurance coverage for children, families and people with disabilities; how Medicaid restructuring and other anticipated changes might affect states, families, and health care providers; and how to evaluate proposals for change.
 
NEW:

Tuesday, March 21, 2017

Updated ACA Repeal Bill Deepens Damaging Medicaid Cuts for Low-Income Families

from Center on Budget and Policy Priorities:
The updated House Republican plan to repeal the Affordable Care Act (ACA) takes an already damaging plan – the previous version of this House GOP legislation – and makes it even more harmful for the tens of millions of children, seniors, people with disabilities, and other adults who rely on Medicaid.
By effectively ending the Medicaid expansion and converting Medicaid to a per capita cap, the previous version of the House Republican plan would have cut federal Medicaid spending by $880 billion over the next ten years and reduced Medicaid enrollment by 14 million people in 2026, the Congressional Budget Office (CBO) estimated. The updated version makes additional changes to Medicaid that are even more damaging overall.
The bill would:
  • Give states the option to convert the Medicaid programs into block grants;
  • Impose onerous work requirements on adult beneficiaries; and
  • Freeze enrollment in the ACA’s Medicaid expansions starting in 2020.
These provisions would likely add to the millions of people who would have Medicaid coverage under the ACA but would become uninsured under this legislationThey would also cut needed care still more deeply for many who keep their Medicaid coverage. 


Monday, March 20, 2017

How the Wrong Medicaid Reforms Could Devastate Young People with Complex Medical Needs

By Sophia Jan, Ahaviah Glaser, Rebecca Kim of Children’s Hospital of Philadelphia (CHOP) Policy Lab

Current proposals to simultaneously repeal the Affordable Care Act (ACA) and reform the federal Medicaid program would be devastating to children and young adults with disabilities and complex medical needs. Even if the final ACA replacement plan continues to allow young people to stay on their parents’ insurance plans until they turn 26 – which is a benefit largely supported on both sides of the political aisle – the most medically complex among them rely on Medicaid because of the extraordinary level and cost of care needed.
Today, Medicaid covers 10.2 million adults and children with serious illnesses or disabilities whose health needs create significant financial burden for patients and their families. For example:
  • Medicaid pays for physical therapy, occupational therapy and speech therapy that children with cerebral palsy and other developmental disabilities may receive through school.
  • Medicaid covers private-duty nursing and assistive technology — such as ventilators, feedings tubes and communication devices — that children with disabilities may need to attend school and avoid placement in institutional settings.
  • Medicaid frequently fills in coverage gaps for privately insured children with disabilities since over one-third of insured children with disabilites report inadequate coverage.
These individuals and their families have much to lose with the Medicaid reform proposal currently on the table.

The Switch to Medicaid Per Capita Caps
The ACA replacement plan now moving through the U.S. House of Representatives would convert Medicaid to a “per capita cap” program, which would provide states with a predetermined amount of funding for each Medicaid enrollee. This type of proposal also gives states more flexibility to decide Medicaid eligibility and service options. Far from a new idea, proposals to reform Medicaid in this way go back at least as far as 1981. Supporters have always presented these proposals as a way for the federal government to save billions of dollars and give states more control. Sounds good, so what’s the catch?
First, per capita caps endanger funding for medically complex children. Under a Medicaid per capita cap, the federal government will likely determine the limit of reimbursement for each child enrolled in Medicaid based on the average health care cost of a child eligible for Medicaid today. It is reasonable to assume that the reimbursement rate per child will be set fairly low, since children make up 50 percent of the Medicaid population, but only contribute to 20 percent of the program’s costs. This may leave insufficient funding for medically complex children whose health care costs are significantly higher than those of other children.
To illustrate, a Medicaid-eligible child costs Pennsylvania $3,561 per year on average. By contrast, a family with a child who has suffered spinal cord injuries may require over $7,000 per month for the mechanical ventilation keeping their child alive. Medicaid per capita caps would not account for the differential health care needs of this family and would shrink both states’ overall budget and ability to care for all children regardless of their health care needs.

Loss of EPSDT
Additionally, all children covered by Medicaid are at risk of losing essential health services they are currently guaranteed. Today, to receive federal funds for their Medicaid programs, states must provide insurance coverage and Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services to all children under 21 who qualify for Medicaid based on their health status or family income. EPSDT is a comprehensive set of screenings and preventive services that catch problems early, before they have the chance to escalate. States must also guarantee children have access to all treatment services that Medicaid providers deem medically necessary from these screenings and services.
EPSDT services, which were designed to meet the unique health care needs of children, could be eliminated with major cuts to Medicaid spending through per capita caps. This is because the financial burden of keeping people covered would fall to the states, which would have more flexibility to decide who qualifies for Medicaid and which services to cover. Medicaid coverage would, therefore, be on the negotiating table when states are faced with difficult budgetary decisions. Children with disabilities could lose access to essential services and, in all likelihood, would be left with no affordable insurance options that meet their health care needs. In Pennsylvania alone, over 13,000 people with intellectual disabilities are already waiting to receive Medicaid-funded services.

Impact on therapies children receive in school
For decades, Medicaid has also allocated funding to schools that provide special education and certain medically necessary services to children with disabilities under the Individuals with Disabilities Education Act (IDEA). By reducing federal spending and eliminating the possibility of adjusting funding levels based on changing needs, per capita caps would likely force school districts to compete with hospitals and health care centers for precious Medicaid dollars, and they’d likely take the most significant hit. Schools would be forced to pay for special education programs with funds allocated for general education, potentially reducing the amount of money available to pay for teachers, counselors, nurses and extracurricular programming for all students.

Potential Solutions
One way to decrease the potentially devastating impact that per capita caps will have on children with disabilities is to place children with disabilities and other medically complex conditions into a different category from their healthier peers, essentially creating a “high-risk pool” for Medicaid-eligible children. Alternatively, Medicaid-eligible children with disabilities could be grouped together with adults who also qualify for Medicaid due to disability, which may minimize loss of Medicaid coverage — and the requisite delivery of medical and nursing care services — that frequently occurs when emerging adults with disabilities transition from pediatric to adult health care services.

Lawmakers will confront many difficult decisions in the coming weeks and months, but whether to pursue reforms that will inevitably cut access to care for our most vulnerable populations should not be one of them. As Dr. Ezekiel Emmanuel wrote this week in his New York Times op-ed, “this would be even worse than going back to the days before the Affordable Care Act.” Sweeping cuts to a program that nearly half of all U.S. children — and most children with very complex medical conditions — rely upon for the health care they need to survive and thrive is not the answer. We must find thoughtful ways to improve the efficiency and quality of health care in order to achieve the shared goals of bringing down health care costs and improving health outcomes for everyone.

reposted from: http://ccf.georgetown.edu/2017/03/14/how-the-wrong-medicaid-reforms-could-devastate-young-people-with-complex-medical-needs/

Friday, March 17, 2017

Do You Speak Repeal and Replace? Learn the terms

Have questions about the terminology being used in the debate over health care legislation? Click on the bubbles above to learn more. (Illustration by Lynne Shallcross; photo by Mandel Ngan/AFP/Getty Images)
President Donald Trump and many congressional Republicans campaigned on repealing the Affordable Care Act and replacing it with their own plan to overhaul the nation’s health care system. As the GOP develops its offering, its representatives are tossing around wonky health policy terms to describe their core strategies.
Below you’ll find some brief definitions. Click on the word bubbles in the photo above for KHN’s fuller translation of what each phrase means — for U.S. health care and for ongoing efforts to replace the ACA.
MEDICAID BLOCK GRANTS AND PER-CAPITA CAPS: The federal government gives states a set amount of money to pay for coverage for Medicaid recipients. This would be a shift from the current Medicaid program, where the federal government matches state Medicaid spending on a percentage basis. Learn more.
HEALTH SAVINGS ACCOUNTS: Also known as HSAs, these allow consumers to put money away on a tax-free basis as long as they use it for medical expenses. Learn more.
BUDGET RECONCILIATION: Legislative process that allows measures to pass with a simple majority in Congress. Budget reconciliation bills can’t be filibustered but must focus on provisions that have a budgetary impact. Learn more.
ESSENTIAL HEALTH BENEFITS: ACA-mandated categories of benefits that health plans must cover. They include emergency services, hospitalization and maternity care. Learn more.
INDIVIDUAL MARKET: Where people who do not have health coverage through the government or their employer purchase a plan directly from an insurer. It is sometimes called the non-group market. Learn more.
TAX CREDITS/SUBSIDIES: Financial assistance to help consumers purchase health insurance. Learn more.
HIGH-RISK POOLS: Insurance groups that cover individuals with high health insurance costs, such as people who have a past serious illness or a chronic condition. Learn more.
Visit Repeal & Replace Watch for more KHN coverage of the health law debate.
Reposted from http://khn.org/news/do-you-speak-repeal-and-replace/?utm_campaign=KHN%3A+Daily+Health+Policy+Report

Wednesday, March 15, 2017

Little-Noticed Medicaid Changes in House Plan Would Worsen Coverage for Children, Seniors, and People with Disabilities and Increase Uncompensated Care

MARCH 15, 2017 
House Republicans’ American Health Care Act would radically restructure Medicaid financing and effectively phase out the Affordable Care Act’s (ACA) Medicaid expansion, cutting federal Medicaid spending by $880 billion over the next ten years and enrollment by 14 million low-income people.[1] It would also make other, little noticed, changes to Medicaid that together would cut Medicaid spending by an additional $19 billion over ten years, significantly affecting coverage and financial security for over 70 million low-income Americans — including children, seniors, and people with disabilities — while also increasing uncompensated care for hospitals.[2] The bill would:
  • Roll back Medicaid coverage for children ages 6 to 18.  The ACA raised Medicaid’s minimum income eligibility limit for these children from 100 to 133 percent of the poverty line, the level already in place for children under 6.  This change enables all children with family incomes below 133 percent of the poverty line — regardless of age — to be covered by Medicaid, a better coverage option for these children than the Children’s Health Insurance Program (CHIP, which provides somewhat narrower coverage and carries higher out-of-pocket costs).[3]  The House plan would take a step backwards by lowering the eligibility level back to 100 percent of poverty, potentially affecting about 1.5 million children in 21 states.[4]
  • Make it harder for seniors and people with disabilities to qualify for Medicaid and get care in their homes and communities.  The House plan would require ten states and the District of Columbia to lower the amount of home equity they disregard when determining Medicaid eligibility for seniors and people with disabilities, which would threaten people’s ability to stay in their homes and get care.  The plan also would remove a financial incentive in the ACA for states to provide home- and community-based services — a lower-cost alternative to institutional care — that help people with daily living activities like bathing and getting dressed.  Eight states have adopted this ACA incentive.
  • Increase the likelihood of medical bankruptcy for low-income people and increase uncompensated care for safety net hospitals.  The House plan would repeal an ACA provision requiring state Medicaid programs to help people pay medical bills they incurred in the three months before enrolling in Medicaid if they were Medicaid-eligible during that period.  The plan would also remove an ACA option enabling states to enroll uninsured adults in Medicaid immediately if they need acute medical care.  These changes would not only harm Medicaid beneficiaries, but increase uncompensated care costs for hospitals, particularly safety net hospitals that treat a disproportionate share of the most vulnerable people.
  • Speed up effective repeal of the ACA’s Medicaid expansion by requiring states to redetermine the eligibility of expansion beneficiaries every six months.  States now redetermine eligibility for expansion adults once a year.  More frequent eligibility redeterminations lead significant numbers of eligible people to lose coverage or experience coverage gaps, because they often have recently moved and didn’t get their redetermination paperwork in time.  Moreover, such coverage losses and coverage gaps would become much more problematic for low-income people affected under the House bill, because starting in 2020, states would no longer receive a higher level of federal matching funds for people seeking to enroll in expansion coverage after having been off Medicaid for one month or more.  As a result, coverage gaps caused by more frequent redeterminations would accelerate the bill’s cost shift to states, likely inducing states to initiate more Medicaid cuts.
Table 1 shows how these changes would affect individual state Medicaid programs.

Rolling Back Children’s Medicaid Coverage

Before the ACA, state Medicaid programs had to cover children under age 6 with family incomes below 133 percent of the poverty line.  They didn’t, however, have to cover older children and teenagers with family incomes above the poverty line, and only a minority of states did so.[5]  This split in children’s coverage between Medicaid and CHIP, known as “stairstep” eligibility, sometimes disrupted care when children moved between the two programs.  Moreover, it caused children in the same family to have different coverage sources (Medicaid versus CHIP), with different benefit packages, providers, and cost-sharing. 
The ACA simplified this system: it eliminated “stairstep” eligibility by requiring state Medicaid programs to cover all children up to age 18 with incomes below 133 percent of poverty.  Accordingly, 21 states moved nearly 1.5 million children from CHIP to Medicaid by January 1, 2014.[6]  On average, about 28 percent of children enrolled in CHIP moved to Medicaid, though in some states (like Mississippi, Oregon, and Utah), more than half did so, and California and New Hampshire moved their entire CHIP population into Medicaid.[7] 
In addition to eliminating the burden on families that different sources of coverage can create, ending “stairstep” eligibility strengthened benefit and cost-sharing protections for low-income children.  All children in families with incomes below 133 percent of the poverty line now have guaranteed access to a strong set of comprehensive and preventive health services, such as screenings, hearing, vision, dental, mental health, and developmental services under Medicaid’s mandatory Early Periodic Screening Diagnostic and Treatment (EPSDT) benefit.  EPSDT ensures that adolescents have access to services to treat emerging conditions such as mental illness.  (In 2015, 12.5 percent of adolescents aged 12 to 17 experienced a major depressive episode.)[8]  Medicaid also provides greater cost-sharing protection than CHIP for children and their families, with no premiums and modest co-payments. 
The House bill would roll back these stronger benefits and cost-sharing protections.  Parents would once again have to deal with additional challenges when managing their children’s health because in many families, children would have different sources of coverage.

Making it Harder for Seniors and People with Disabilities to Qualify for Medicaid and Get Home-Based Care

Two provisions of the House plan would make it harder for seniors and people with disabilities to qualify for Medicaid and disrupt how they get care.  These changes threaten individuals’ ability to obtain needed long-term care — especially home- and community-based care, which is less costly and better for their health and well-being.
The first change would eliminate states’ existing flexibility to establish how much of a home’s value to count as an asset when determining eligibility for seniors and people with disabilities.  Current federal guidelines set a range, which is updated each year to reflect the change in the consumer price index for all urban consumers (CPI-U).  In 2017, the range is between $560,000 and $840,000.[9]  A state using the minimum level, for example, would count home value exceeding $560,000 as an asset for purposes of determining Medicaid eligibility.[10] 
The House plan would require all states to use the $560,000 minimum home equity limit.[11]  This change would make it harder for seniors and people with disabilities in states whose home value limit exceeds that minimum amount to qualify for Medicaid: California, Connecticut, the District of Columbia, Hawaii, Idaho, Maine, Massachusetts, New Jersey, New Mexico, New York, and Wisconsin.[12]  This could force people in these states to sell their homes, and cause a delay or even a stop in their care until their house is sold.
The second change would eliminate an ACA incentive to promote home- and community-based services (HCBS), which offer an alternative to nursing homes and other institutions by providing patient-centered services that help people perform daily activities.  In 2013, for the first time in Medicaid’s history, the majority of Medicaid spending on long-term care was for HCBS, and the share has steadily increased since then.[13]  The ACA furthered this progress by giving states new incentives and options to implement HCBS programs.  One such option is Community First Choice (CFC), which provides personal attendant services, like help with bathing and getting dressed.  CFC also allows states to help beneficiaries cover the costs of transitioning from a nursing home back to their home or community by helping cover the first month’s rent and utilities or paying for bedding and basic kitchen supplies.
To encourage states to take up this option, the ACA gives them an enhanced federal match of 6 additional percentage points for CFC services and supports.  (For example, a state whose regular Medicaid matching rate is 50 percent would be reimbursed for 56 percent of CFC services it provides.)  The additional federal funds allow states to strengthen their HBCS programs by reinvesting the additional funding and providing new or more comprehensive benefits.  The House plan would eliminate the enhanced federal match for CFC services beginning in 2020, resulting in a loss of $12 billion of federal funding over the next ten years.[14]  This proposal places the CFC program in jeopardy in the eight states that have taken it up and makes it less likely that other states will adopt it.[15]

Reducing Financial Security for Low-Income People and Increasing Uncompensated Care for Hospitals

The House plan would repeal two provisions that protect low-income people from debt and reduce hospitals’ uncompensated care — one enacted as part of the ACA, the other a longstanding Medicaid protection.  These changes would likely drive more low-income people into bankruptcy due to medical costs and would raise uncompensated care costs for hospitals.
 The first change would end Medicaid payments for medical costs that beneficiaries incurred up to three months before enrolling in Medicaid if they were eligible for Medicaid during that period.  This retroactive coverage helps prevent medical bankruptcy.  It also reimburses hospitals and other safety net providers for care they have provided during the period, helping them continue to meet their daily operating costs and maintain quality of care.  While this Medicaid protection may only affect a small number of individuals, the amounts can be significant.  For example, data from Indiana showed that, on average, individuals with medical bills incurred prior to enrollment owed $1,561 to providers, which Medicaid would pay.[16]
The second change would bar states from immediately enrolling uninsured adults (other than pregnant women) into temporary Medicaid coverage while they complete the Medicaid eligibility determination process.  Before the ACA, states had the option to provide immediate temporary Medicaid coverage to pregnant women and children to improve their access to timely care.  The ACA extended this option, called presumptive eligibility, to also help enroll uninsured adults newly eligible for Medicaid under the ACA’s Medicaid expansion.  Uninsured adults can enroll immediately in coverage by answering a set of questions at the hospital or other safety net provider.  If the individual appears eligible, the hospital can make a “presumptive” eligibility determination, which helps prevent a delay in care while the state conducts a full eligibility determination.  During this temporary coverage period, providers (including hospitals, doctors, and pharmacies) receive full Medicaid reimbursement for services they provide, even if the individual is later found ineligible for Medicaid.  

Speeding Up Effective Repeal of the Medicaid Expansion

Medicaid requires most beneficiaries to renew their coverage once a year.  Many consumers do not complete renewals on time, and lose coverage despite remaining eligible, for reasons that include changes in address and lack of time to comply with processes that can be confusing and may require documentation that beneficiaries may not have on hand.  Beneficiaries often re-apply for Medicaid after a short break in coverage.
Increasing the frequency of renewals can reduce enrollment and increase the frequency of these breaks in coverage.  In 2003, Washington State adopted a policy requiring children to renew eligibility every six months, along with other process changes; the number of children participating in Medicaid fell by 30,000 over the next two years.  When the state restored 12-month eligibility, children’s enrollment rose back by 30,000 within a year.[17]     
The House plan would require states, starting in October 2017, to renew Medicaid eligibility every six months for adults enrolled through the ACA’s Medicaid expansion.  This change appears intended to accelerate the reduction in the number of expansion enrollees; under the House plan, starting in 2020 states would no longer receive enhanced federal matching funds for people eligible under the expansion who lose coverage at renewal — even if just for one month — and subsequently return to the program.  As a result, additional coverage gaps due to more frequent redeterminations would accelerate the bill’s cost shift to states.  Moreover, many or most states would likely respond to the House bill by seeking waivers to close their Medicaid expansions to applicants for whom the state wouldn’t receive the enhanced match.  If that occurs, individuals who fail to complete the redetermination process on time could end up permanently uninsured.
TABLE 1
House Plan Would Require Changes in Every State’s Medicaid Program
StatePotentially Affected by Change in Children’s Medicaid CoverageChange in Home Value LimitEnd of enhanced match for Community First Choice (Home- and Community- Based Services)End of Retroactive Coverage & Presumptive EligibilityMore Frequent Renewals for Expansion Adults
AlabamaX  X 
Alaska   XX
ArizonaX  XX
Arkansas   XX
CaliforniaXXXXX
ColoradoX  XX
Connecticut XXXX
DelawareX  XX
District of Columbia X XX
FloridaX  X 
GeorgiaX  X 
Hawaii X XX
Idaho X X 
Illinois   XX
Indiana   XX
Iowa   XX
KansasX  X 
Kentucky   XX
Louisiana   XX
Maine X X 
Maryland  XXX
Massachusetts X XX
Michigan   XX
Minnesota   XX
Missouri   X 
MississippiX  X 
Montana  XXX
Nebraska   X 
NevadaX  XX
New HampshireX  XX
New Jersey X XX
New Mexico X XX
New YorkXXXXX
North CarolinaX  X 
North DakotaX  X 
Ohio   XX
Oklahoma   X 
OregonX XXX
PennsylvaniaX  XX
Rhode Island   XX
South Carolina   X 
South Dakota   X 
TennesseeX  X 
TexasX XX 
UtahX  X 
Vermont   XX
Virginia   X 
Washington  XXX
Wisconsin X X 
West VirginiaX  XX
WyomingX  X 
 
reposted from http://www.cbpp.org/research/health/little-noticed-medicaid-changes-in-house-plan-would-worsen-coverage-for-children