Description and Assessment of State Approaches to Diversion Programs and Activities Under Welfare Reform. Notes


1. HCFA has issued two letters to the state Medicaid directors, dated February 1, 1997 and September 22, 1997, that provide substantial guidance to the states about how to establish the new eligibility groups under Section 1931.


2.  States now have the option to terminate Medicaid for adults and heads of households who fail to meet the TANF work requirement. Poverty-level pregnant women and children who are not heads of household are specifically exempted from this option.

3. The recently-enacted federal Children's Health Insurance Program (CHIP) helps states provide health insurance for children under 19 in families whose income does not exceed 200 percent of federal poverty level.

4. States with implemented 1115 waivers: Alabama, Arizona, Arkansas, Delaware, Hawaii, Kentucky, Maryland, Massachusetts, Minnesota, New Jersey, New York, Ohio, Oklahoma, Oregon, Rhode Island, Tennessee, Vermont. Not all of these waiver programs are statewide. Delaware, Hawaii, Minnesota, Oregon, Rhode Island, and Tennessee have expanded eligibility to certain categories of low-income adults.

5. On August 7, 1998, a final regulation, sponsored by HCFA and ACF, was published that revised the existing "100 hour rule" and thereby allowed states the option of providing Medicaid coverage to two parent families in which the principal wage earner was working more than 100 hours per month. In an August 17, 1998 letter to state Medicaid directors, Sally Richardson noted that this regulatory change gives states another tool to coordinate the two programs (i.e., Medicaid and TANF) and that this change allows states to provide Medicaid to virtually all TANF recipients and to continue that health coverage after a parent has found employment.

6. Louisiana is the only state with only a separate application for Medicaid. Rhode Island, and perhaps Massachusetts, Mississippi, and some California counties, have developed both a joint and separate application.

7. This would be true in states that have opted not to cover either older poverty-level children or Ribicoff kids.

8. HCFA letters to state Medicaid directors dated February 5, 1997 and September 22, 1997.

9. HCFA letter to state Medicaid directors dated February 5, 1997.

10. See Note 5.

11. One of the commonly-waived deprivation requirements is the so-called "100 hour rule." Thirty states had waived this requirement under their existing welfare reform demonstrations and, to the extent that states choose to continue this waiver under their TANF programs, such states would have greater flexibility to expand Medicaid eligibility under Section 1931. Now all states can, if they so choose, provide Medicaid to two parent families in which the principal wage earner works more than 100 hours per month by virtue of the federal regulation promulgated on August 7, 1998.

12. HCFA letter to state Medicaid directors dated September 22, 1997

13. It is possible, however, that existing Title XIX waivers will not benefit persons who have not received TANF assistance as the terms of these waiver refer to receipt and loss of cash assistance as the trigger for transitional Medicaid. Existing Title XIX waivers and Section 1931 may provide guarantees of transitional Medicaid to two different populations. Conversations with Cindy Mann at the Center for Budget and Policies Priorities in May 1998 and Joan Peterson, Health Care Financing Administration, May 1998.

14. At the time the waiver was submitted, Medicaid was provided categorically to persons who received cash assistance under AFDC. Failure to receive AFDC would terminate categorical eligibility.

15. Prior to the 1996, persons were not required to participate in the JOBS program until they became recipients.