Office for the Aging


Health and Human Services Secretary Kathleen Sebelius proposes guidance for Medicaid, health insurance marketplaces

Implementation of the Affordable Care Act will assure that millions of Americans receive quality, affordable health care through Medicaid and the new health insurance marketplaces (also known as the Exchanges) in 2014.

Affordable Insurance Exchanges are designed to make buying health coverage easier and more affordable. Starting in 2014, Exchanges will allow individuals and small businesses to compare health plans, get answers to questions, find out if they are eligible for tax credits for private insurance or health programs like the Children's Health Insurance Program (CHIP), and enroll in a health plan that meets their needs. These State-based, competitive marketplaces will provide millions of Americans and small businesses with "one-stop shopping" for affordable coverage.

The Department of Health and Human Services (HHS) has released a proposed rule implementing key Affordable Care Act provisions relating to Medicaid and the Exchanges. This proposed rule codifies statutory eligibility provisions, lays out a structure and options for coordinating Medicaid, the Children's Health Insurance Program (CHIP), and Exchange eligibility notices and appeals. It also proposes to modify existing benchmark benefits regulations for low-income adults, and codify several of the provisions included in the Children's Health Insurance Program Reauthorization Act (CHIPRA).

This proposed rule includes information on how consumers will receive coordinated communications on eligibility determinations and can appeal eligibility determinations. It gives states flexibility in designing benefits and determining cost sharing in the Medicaid program. The proposed rule also provides flexibility to state-based Exchanges by allowing them to opt to rely on HHS for verifying whether an individual has employer-sponsored coverage and conducting some types of appeals.

Beginning in 2014, the health care law provides new opportunities for Medicaid coverage for adults who earn up to 133 percent of poverty -- $14,865 for an individual or $30,656 for a family of four. Other Americans looking for coverage will be eligible to buy it through a health insurance marketplace, where many will be eligible for tax credits to make coverage more affordable. The rules proposed today will help develop systems that will make it easy for consumers to determine if they are eligible for Medicaid or tax credits that make insurance more affordable.

This rule is available for public comment. Comments must be received by CMS no later than 5:00 PM on February 13, 2013.

You may submit your comments electronically at (External Link) by following "Submit a comment" instructions. Instructions on how to mail comments is available at the following link: Link)

Additional information on this proposed rule can be found at: Link)