Overlapping Eligibility and Enrollment: Human Services and Health Programs Under the Affordable Care Act. Participation in human services programs could help establish eligibility for Medicaid

12/23/2013

As noted earlier, a Medicaid applicant’s attestation of financial eligibility can be verified by data that are reasonably compatible with those attestations, including data showing the receipt of human services benefits.13 Moreover, when a Medicaid beneficiary’s coverage period is coming to an end, if reliable data demonstrate continuing eligibility, the beneficiary’s eligibility is renewed administratively.14 Such data matches can play an important role in determining eligibility for Medicaid, since financial eligibility is established whenever income is at or below 138 percent FPL, which can frequently be verified based on determinations already made by human services programs.15

Table 1 shows, for children, parents, and childless adults, the probability of eligibility for Medicaid that is established by receipt of various human services benefits. This information could help states determine when data matches with human services programs eliminate the need for documentation from Medicaid applicants or from beneficiaries up for renewal. For example, a LIHEAP recipient who is a child or adult has a 94 percent or 78 percent likelihood of Medicaid eligibility, respectively. A state could thus verify a Medicaid applicant’s attestation of financial eligibility through a data match establishing receipt of LIHEAP, whether such applicant is a child or adult. Eliminating the need for consumers to present and for states to evaluate paper documentation is likely to increase eligible consumers’ Medicaid participation levels, reduce administrative costs, and lower the risk of manual error in determining eligibility.

Verification based on human services receipt could streamline enrollment and retention for numerous Medicaid-eligible consumers. Among people who will qualify for Medicaid if all states expand eligibility:16

  • 49 percent receive SNAP;
  • 18 percent receive LIHEAP;
  • 17 percent either receive WIC or have a sibling or spouse who receives WIC;
  • 9 percent receive housing subsidies;
  • 6 percent receive TANF; and
  • 3 percent either receive child care subsidies or have a sibling or spouse who receives such subsidies.

Table 1. Likelihood of Medicaid eligibility for various recipients of human services benefits under age 65

  Children Adults Total
SNAP 98% 94% 96%
WIC 90% 67% 81%
TANF 100% 95% 99%
LIHEAP 94% 78% 86%
Child care subsidies 92% 75% 86%
Housing subsidies 96% 86% 91%

Source: TRIM3, 2012. Notes: Assumes that all states expand Medicaid eligibility for adults to 138 percent FPL. Medicaid eligibility categories are limited to MAGI-based eligibility up to 138 percent FPL, receipt of SSI, and children’s eligibility for Medicaid (whether funded through Title XIX or Title XXI of the Social Security Act) under their state’s pre-2014 rules. Estimates do not include people with disabilities who receive Medicare. Child care and WIC estimates include immediate family members of recipients. For more information about our methodology, see Appendix III.

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