On January 1, the Affordable Care Act changed the rules states use to determine whether people can get most types of Medicaid or Children’s Health Insurance Program (CHIP) coverage. Here’s a list of some of the more significant changes:
Medicaid and CHIP Eligibility
As of January 1, states must use federal tax rules when calculating a family’s income and size. This means that people listed on a person’s tax return as dependents will be included when determining the size of the family; others living in the household might not be included.
HHSC will continue to collect information about what kind of vehicles applicants own and how much money they have in the bank, but federal law will prohibit states from using this information to exclude someone from Medicaid or CHIP.
Most programs will have a 12-month certification period under the new law. Previously, most Medicaid programs had a six-month coverage period before the person had to complete a renewal application.
If someone applies for Medicaid or CHIP and is not eligible for those programs, the state will send their information to the federal Marketplace.
Medicaid for the Elderly and Disabled Persons, SNAP food benefits and TANF cash assistance are not affected by these changes.
Movement from CHIP to Medicaid
Some children will move from CHIP to Medicaid because of changes in the income limits for Medicaid. The CHIP income limit remains at 200 percent of the federal poverty level (FPL). Children are first screened for Medicaid. Those in families earning above the Medicaid limits are then screened for CHIP eligibility.
Age Former Medicaid Limit New Medicaid Limit
Newborns 185% of the FPL 185% of the FPL
1-5 years 133% of the FPL 133% of the FPL
6-18 years 100% of the FPL 133% of the FPL
Children with CHIP coverage who now qualify for Medicaid will be moved to that program when it’s time to renew their coverage, or they may apply for Medicaid coverage before that date. HHSC estimates that more than 280,000 children will move from CHIP to Medicaid by August 31, 2015. This change is expected to cost the state about $47 million due to the differences between Medicaid and CHIP. Medicaid doesn’t have enrollment fees or co-pays but covers more services than CHIP, including transportation to and from medical appointments and expanded dental coverage.
In Touch: Affordable Care Act brings changes to Medicaid, CHIP.