U.S. Department of Health and Human Services Office on Women's Health
News Release (HHS)
January 14, 2013
Administration proposes guidance for Medicaid, health insurance marketplaces
Because of the Affordable Care Act, millions of Americans will be newly eligible to receive quality, affordable health care through Medicaid and the new health insurance marketplaces (also known as the Exchanges) in 2014. Health and Human Services (HHS) Secretary Kathleen Sebelius today released a proposed rule that promotes consistent policies and processes for eligibility notices and appeals in Medicaid, the Children's Health Insurance Program (CHIP), and Exchanges and give states more flexibility when operating their Medicaid programs. HHS encourages all Americans to review and submit comments on the proposed rule.
"Before the health care law was passed, millions of Americans were unable to obtain or afford quality health coverage," Secretary Sebelius said. "Today, we are proposing a rule to provide Americans with access to affordable, high quality health coverage and give states more flexibility to implement the law in a way that works for them."
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.
Today's 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 choose to rely on HHS for verifying whether an individual has employer-sponsored coverage and conducting some types of appeals.
For more information on this proposed rule, please visit: