CMS clarifies Medicaid eligibility requirements under the Affordable Care Act

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The Centers for Medicare & Medicaid Services announced a final rule clarifying eligibility and income standards for the expansion of Medicaid under the Affordable Care Act.

Under the final rule, people who have disabilities or need long-term services and supports may enroll in an existing Medicaid eligibility category to ensure that they find coverage that best meets their needs, CMS Deputy Administrator and Director of the Center for Medicaid and CHIP Services Cindy Mann said Friday. Mann said CMS provided this clarification upon receiving several questions on the proposed rule.

As expected, CMS finalized income eligibility standards for the expansion of Medicaid under the ACA in 2014. Medicaid will be available to those between ages 19 and 64 with incomes up to 133% of the federal poverty level – currently $14,856 for an individual and $30,656 for a family of four.

Not addressed in the final rule is the federal matching rate that the government will pay each state under the ACA. Mann said CMS officials are working with state Medicaid programs to determine the rates, and that the agency will issue guidance on this provision later this year.

Medicaid currently pays for more than 40% of long-term care received in a nursing home.

Click here for more information on the final rule.