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July 08, 2013 at 09:22 AM
Officials in California say federal Patient Protection and Affordable Care Act (PPACA) regulations could help Medicaid planners squeeze more money out of Medicaid nursing home benefits programs.
The officials at the California Department of Health Care Services and Covered California, the state’s PPACA exchange program, talk about their fear in a comment sent to the federal Centers for Medicare & Medicaid Services (CMS).
The California officials were writing about the draft version of a new set of final CMS regulations, “Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment” (CMS-2334-F).
CMS officials developed the regulations to explain how they think state Medicaid programs and other state health programs, such as the Children’s Health Insurance Program (CHIP), ought to interpret the PPACA “essential health benefits” (EHB) standards.
CMS officials have set “alternative benefit plan” (ABP) benefits standards for Medicaid and CHIP plans that are similar to commercial plan EHB standards but different in some respects.
PPACA opponents continue to try to block or delay implementation of the law. If the law takes effect on schedule and works as backers hope, it will provide extra money for states that agree to expand eligibility for Medicaid health programs to moderate-income adults.
When adults become eligible for Medicaid simply because of Medicaid expansion, states can use their older, possibly less generous benefits standards for those newly eligible adults rather than the EHB-like ABP standards.
But PPACA drafters exempted some groups of new enrollees, including “medically frail” people, from the provision that gives states flexibility about which benefits standard to use.
Medically frail adults who become eligible for Medicaid can choose whether to use a state’s old Medicaid benefits package standard or the new ABP standard, CMS officials said in a preamble to the new final rule.
Another PPACA provision requires exchanges and Medicaid programs to base program eligibility decisions solely on applicants’ income, without consideration of assets.
