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2013 Health Budget Restructures Medicaid Eligiblity

05 Feb, 2013

The Proposed 2013-2014 Health Budget contains sweeping changes to Medicaid eligibility and enrollment as required to implement the Affordable Care Act (ACA).  The numerous existing population categories are consolidated into two groups - those whose eligibility will be determined according to the new Modified Adjusted Gross Income (MAGI) budgeting, and those whose eligibility will continue to be determined according to existing Medicaid rules (the non-MAGI).  Electronic verification and online application modalities are created, and 12 month continuous coverage is implemented.

The Proposed Budget also extends coverage in a couple of ways not mandated by the ACA.  The spend down, or medically needy program would become available to childless and single adults for the first time.  In addition, pregnant women would become eligible for full Medicaid between 138 and 200% of the federal poverty level.

The Proposed Budget continues the shift toward managed care for all Medicaid beneficiaries by providing the Commissioner of Health with the authority to mandate further expansion of managed care programs, and creating a broad new program of fully integrated dual advantage (FIDA) program for dual eligibles. 

The Proposed Budget moves to restricts coverage and/or servicesby eliminating the spousal refusal budgeting option for Medicaid applicants and eliminating Immediate Needs Medicaid.  For more specific information, read Empire Justice Center Testimony on the Health Budget.

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