By Nellie Bristol, CQ HealthBeat Associate Editor
January 18, 2012 -- States generally maintained Medicaid and Children's Health Insurance Program (CHIP) eligibility levels in 2011 despite recession-related budget pressures. But coverage for poor adults remains far below that for children, a new 50-state survey concluded.
The survey by the Kaiser Commission on Medicaid and the Uninsured and the Georgetown University Center for Children and Families credits the health overhaul (PL 111-148, PL 111-152) for its maintenance of effort requirements and the health care law and other federal actions for providing options for technological improvements.
"Amid state fiscal challenges, the requirement in the Affordable Care Act (ACA) that states maintain their eligibility levels and enrollment and renewal procedures was essential to preserving coverage during 2011," the report says. "In addition, some states made targeted eligibility expansions and many used technology to boost program efficiency and make it easier for families to enroll."
The health law requires as a condition of receiving federal Medicaid funding that states maintain eligibility, enrollment and renewal policies that were in place as of March, 2010. Exemptions include coverage of adults above 133 percent of poverty if the state can document a budget deficit. States also are not required to renew expiring waivers or continue coverage that is fully state-funded.
Reflecting policies adopted over the year, the study found that 25 states simplified enrollment or renewal procedures and 11 expanded eligibility. No state restricted enrollment or renewal while two restricted eligibility. Most states did not impose additional cost-sharing, the report adds.
Beyond annual premium adjustments, only one state, Colorado, increased enrollment fees for children's programs. Two others, Texas and Utah, increased copayments. In programs for parents and other adults, Washington state decreased premiums while Alaska, Massachusetts, Minnesota and Nebraska increased copayments for parents in Medicaid.
Eight of 11 eligibility expansions related to children's coverage. But New Jersey, Washington, and Minnesota also increased Medicaid coverage for low-income adults. Two other states, Arizona and Nevada, cut back on adult coverage. Arizona froze enrollment for adults without dependent children and Nevada discontinued coverage for some parents and pregnant women, the report says. Neither change was subject to health law requirements. Overall, only 18 states cover parents with full Medicaid benefits at or above the poverty level while 17 states limit full coverage to parents earning less than half the poverty level.
In another notable trend, the report says 25 states used information, technology and expanded matching funds from the federal government to update sometimes decades old enrollment systems.
"These improvements have the dual benefit of reducing paperwork requirements for families and eligibility workers while streamlining program administration," the researchers said. "Moreover, these actions assisted states in balancing the competing demands of increased case loads and decreased staffing, while also helping them to prepare for the new eligibility changes that will take effect in 2014 under the ACA." Actions taken included using Social Security Administration data to verify citizenship, simplifying renewal options, enhancing online application functions and eliminating interviews for parents.
The expense involved "has long prevented many states from upgrading to new technology," the report says. In response, the Centers for Medicare and Medicaid Services in April 2011 offered a temporary 90 percent federal matching rate, up from 50 percent, for states to upgrade or replace systems to prepare for enrollment increases anticipated with the health overhaul. As of January this year, 18 states have been approved for system upgrades while another 11 have submitted plans to CMS, the report says.
The report highlighted the enrollment procedures in Oklahoma as the first "fully-automated, real-time" system. Individuals can apply on line and receive an immediate decision on their applications. Subsequently, they can review coverage or update information. "Using this system, the state processes more than a thousand applications per day, and 90 percent receive on-the-spot eligibility decisions, even when state offices are closed," the report says.