HHS Proposes Guidance For Health Insurance Exchanges, CHIP

The Department of Health and Human Services (HHS) has issued a proposed rule that would promote consistent policies and processes for eligibility notices and appeals in Medicaid, the Children’s Health Insurance Program (CHIP), and health insurance exchanges. The proposed rule is scheduled to be published in the January 22 Federal Register.

Beginning in 2014, the Patient Protection and Affordable Care Act (ACA) 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 exchange, where many will be eligible for tax credits to make coverage more affordable. The proposed rules will help develop systems that will make it easy for consumers to determine if they are eligible for Medicaid or tax credits through the exchanges.

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

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