MACPAC Urges 12-Month Medicaid Eligibility, Improved Alignment of Pregnancy Coverage

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By Ralph Lindeman  

March 14 --The Medicaid and CHIP Payment and Access Commission (MACPAC) March 14 recommended that Congress allow states to provide low-income adults with 12 months of continuous eligibility for Medicaid and take steps to better align coverage options for low-income pregnant women.

Both recommendations in the semiannual report from MACPAC, a congressional advisory commission, are aimed at addressing issues arising from increased coverage available in 2014 as a result of the Affordable Care Act's Medicaid expansion and the launch of state and federal insurance marketplaces.

“Assuring a stable source of health care coverage over the course of a year is essential to connecting people to the care they need.”  
--MACPAC Chair Diane Rowland

The recommendations were in MACPAC's statutorily required March report to Congress.

“Assuring a stable source of health care coverage over the course of a year is essential to connecting people to the care they need,” MACPAC Chair Diane Rowland said in a statement.

Continuous Eligibility

Providing adults a year of continuous Medicaid eligibility would help reduce so-called churning between health programs when an enrollee's income changes, the commission said.

It cited research showing that 23 percent of Medicaid-eligible enrollees would have an increase in income, making them ineligible for Medicaid within four months of joining the program. Of those, about a third (34 percent) would see their income drop back to lower levels, making them eligible for Medicaid again by the end of the year.

To promote coverage continuity, the commission reaffirmed a recommendation in its March 2013 report that Congress extend a statutory option for states to provide 12 months of continuous eligibility for adults in Medicaid, parallel to the current state option for children in Medicaid.

Alignment of Pregnancy Coverage

The report noted that the ACA expands Medicaid coverage to previously uninsured women with income up to 138 percent of the federal poverty level (FPL) in states expanding Medicaid.

In addition, uninsured women with income above 100 percent of the FPL are eligible for subsidized coverage, which includes maternity care, on the state or federal insurance marketplaces.

Under current law, all states are required to provide certain health services to pregnant women at or below 138 percent of the FPL, the report noted. However, states aren't required to provide full Medicaid coverage and may limit services to those related to pregnancy.

In addition, subsidized coverage available on state or federal health insurance marketplaces to women with income between 100 percent and 400 percent of the FPL includes both maternity and nonmaternity benefits.

“This means that higher-income pregnant women with such coverage may receive a broader benefit package [on the marketplaces] than lower-income pregnant women with Medicaid coverage,” the report noted.

The commission recommended that Congress require states to provide the same benefits to pregnant women who are eligible for Medicaid (on the basis of their pregnancy) that are furnished to women whose Medicaid eligibility is based on their status as parents of a dependent child. It also recommended that women enrolled in qualified health plans on a state or federal marketplace be allowed to retain their coverage, even if their pregnancy makes them eligible for Medicaid.

Updated Medicaid, CHIP Data

The report also updated data, called MACStats, including state-specific information about enrollment in Medicaid and the Children's Health Insurance Program (CHIP); spending; eligibility levels; benefits covered; and federal matching rates.

The updated MACStats said:

• Total Medicaid spending grew by about 6 percent in fiscal year 2013, to $460 billion.

• Total CHIP spending grew by about 8 percent, to $13 billion.

• The number of individuals covered by Medicaid at some point during the year remained steady at an estimated 72.7 million in FY 2013, compared with 72.2 million in FY 2012.

• CHIP enrollment also remained steady at 8.4 million in FY 2013.

• The Medicaid and CHIP programs accounted for 15.4 percent of national health expenditures in calendar year 2012, and their share is projected to reach about 17 percent in the next decade.


The commission's next report to Congress is due in June.


To contact the reporter on this story: Ralph Lindeman in Washington at

To contact the editor responsible for this story: Nancy Simmons at

The MACPAC report is at

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