CMS rule shines light on Medicaid cost sharing, eligibility and appeals process as Obamacare rolls out

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The Centers for Medicare & Medicaid Services has proposed a rule to clarify ways in which Medicaid will be coordinated under the Affordable Care Act rollout.

The rule, released Monday, describes how the eligibility notification and appeals process might operate. Applicants and beneficiaries would receive a single notice regarding their eligibility status for Medicaid, Children's Health Insurance Program or a qualified Exchange health plan, generated by just one of those agencies.

In an effort to give states flexibility in the eligibility appeals process, the rule provides two options for how appeals might work, including allowing states to handle appeals. Applicants would retain the right to appeal to the federal level.

The rule would give states the ability to eliminate cost sharing limits for non-emergency use of emergency departments for certain Medicaid enrollees. States could also increase cost sharing related to non-preferred drugs.

Click here to read the rule. It will be published in the Federal Register on January 22.

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