August 16, 2011: The Department of Health and Human Services (HHS) and the Department of the Treasury filed three proposed rules last week to assist states as they develop health insurance exchanges under the Affordable Care Act.
- The proposed Medicaid eligibility rule comes from HHS and addresses (1) the expansion of Medicaid to childless adults up to 133 percent of the federal poverty level (FPL) with the support of new federal matching rates; (2) the simplification of Medicaid eligibility through the use of the modified adjusted gross income (MAGI) definition; and (3) the promotion of seamless health insurance coverage and streamlined enrollment by means of coordinating the eligibility systems for Medicaid and the Children’s Health Insurance Program with those of the exchanges.
- The proposed rule on exchange eligibility and employer standards also comes from HHS and details the standards and process for enrollment in qualified health plans and “insurance affordability programs” (i.e., Medicaid, CHIP, the Basic Health Plan, premium tax credits, and/or reduced cost-sharing). The rule also outlines basic standards for employer participation in the Small Business Health Options Program (i.e., “SHOP” exchanges).
- The proposed premium tax credit rule was issued by the Treasury and establishes a framework for calculating health insurance premium tax credits for individuals and families with incomes at or below 400 percent of the federal poverty level.
Official publication of the proposed rules in the Federal Register will take place tomorrow.