Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 2. Medicaid Eligibility, Services, and Enrollment Strategies

08/20/2014

Chapter 2 Highlights

For decades, people have qualified for Medicaid benefits based on categorical eligibility. The two most common eligibility categories have been as follows:

  • The Covered Families and Children population--parents, children, and pregnant women whose household income is at or below the income eligibility levels established by states, which vary widely.

  • The Aged, Blind, and Disabled population--elderly and disabled individuals who qualify if they meet the age and disability criteria for receiving Supplemental Security Income (SSI) or the disability criteria for Social Security Disability Insurance (SSDI) and whose incomes are low enough to qualify for Medicaid.

In anticipation of the Affordable Care Act of 2010's expansion of Medicaid eligibility in 2014 to households with incomes below 133 percent of the federal poverty level, some states expanded Medicaid eligibility early in the two ways explained below:

  • Connecticut, Minnesota, and the District of Columbia used the Affordable Care Act's authority to implement early expansion of income-based Medicaid eligibility for some or all of the people who would become eligible in 2014 based on income.

  • California and Illinois used Section 1115 demonstration authority to waive certain Medicaid requirements in order to expand coverage. States have long been able to use Section 1115 Research and Demonstration waiver programs to define specific groups of Medicaid beneficiaries, who then receive a package of services appropriate to their needs even if they do not meet categorical eligibility criteria. Under these waiver programs, states receive federal Medicaid funds to match their own outlays at the Federal Medical Assistance Percentage assigned to their state. California and Illinois took advantage of Section 1115 authority to create low-income health plans to serve all or most of the low-income population that would become eligible for Medicaid in 2014 and create a "bridge to reform" for public health and "safety net" hospital systems.

For people experiencing chronic homelessness or living in permanent supportive housing, the importance of Medicaid eligibility based on income cannot be overstated. Expansion offers health insurance coverage to thousands in this population who have not otherwise met categorical eligibility criteria.

Services available under Medicaid include the Medicaid state plan (the array of services that anyone qualifying for Medicaid on a categorical basis would be able to receive) and Alternative Benefit Plans (the basic array of covered services that states must provide to those newly eligible for Medicaid based on income alone). These plans may be different than the Medicaid state plan but must include the ten essential health benefits specified in the Affordable Care Act.

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