The Affordable Care Act fills in current gaps in coverage for the poorest Americans by creating a minimum Medicaid income eligibility level across the country. Beginning in January 2014, individuals under 65 years of age with income below 133 percent of the federal poverty level (FPL) will be eligible for Medicaid. For the first time, low-income adults without children will be guaranteed coverage through Medicaid in every state without need for a waiver, and parents of children will be eligible at a uniform income level across all states. Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment will be much simpler and will be coordinated with the newly created Affordable Insurance Exchanges.

See current information on eligibility.

Section-by-Section Summary – Exchange/Medicaid/CHIP Eligibility, Notices and Appeals, and Alternative Benefit Plans Proposed Rule:To assist you in your review and understanding of our latest proposed rule addressing a range of policy issues including eligibility appeals and notices, alternative benefit plans, cost sharing, and continued streamlining of Medicaid and CHIP eligibility rules, we have developed the attached “section-by-section summary” of the rule. As a reminder, the comment period for this NPRM closes on February 21, 2013.

• Section-by-Section Summary – Exchange/Medicaid/CHIP Eligibility, Notices and Appeals, and Alternative Benefit Plans Proposed Rule

Medicaid and CHIP Eligibility and Enrollment: Creating a streamlined system of affordable coverage for Medicaid, CHIP, and the Affordable Insurance Exchanges (Effective 2014). On March 16, 2012, CMS released its eligibility and enrollment final rule to assist States in implementing the Affordable Care Act Medicaid coverage expansion. 

• Medicaid Eligibility Final Rule 42 CFR Parts 431, 433, 435, and 457 “Medicaid Program: Eligibility Changes Under the Affordable Care Act of 2010”-3/16/12
• Final Rule Regulatory Impact Analysis
• Final Rule Fact Sheet
• Press Release announcing the release of the Final Rule
• Final Rule Section-by-Section Summary
• Webinars on the Final Rule
• Information about the Exchange Final Rule
• Proposed Rule 42 CFR Parts 431, 433, 435, and 457 "Medicaid Program: Eligibility Changes Under the Affordable Care Act of 2010" - 8/17/11
• Conference Calls Regarding Affordable Care Act Medicaid/CHIP Eligibility Proposed Rules
• Section 2001 under Title II Role Of Public Programs

On January 14, 2013, CMS put on display a proposed rule that builds on its Medicaid and CHIP eligibility and enrollment final rule released in March 2012.  The proposed rule would lay out a structure and options for coordinating Medicaid, CHIP, and Exchange eligibility notices and appeals; provide additional benefits and cost-sharing flexibility for state Medicaid programs; and codify several provisions included in the Affordable Care Act and Children’s Health Insurance Program Reauthorization Act (CHIPRA).

Early Option to Provide Medicaid to Adults Prior to 2014: Providing federal funding to states that expand Medicaid eligibility, between April 1, 2010 and January 1, 2014, to individuals with incomes below 133 percent of the FPL.

• Section 2001 under Title II Role Of Public Programs
• State Medicaid Director Letter SMDL#10-005 - 4/9/10

Maintenance of Effort: Maintaining existing coverage for adults until the implementation of coverage changes effective in January 2014 and for children through September 2019.

• Section 2001 under Title II Role Of Public Programs
• State Medicaid Director Letter SMDL#1-009 - 8/5/11
• State Medicaid Director Letter SMDL#11-001 - 2/25/11
• CMCS Informational Bulletin - 2/26/11

Former Foster Care Children: Establishing eligibility for children who have aged-out of the foster care system and had previously received Medicaid while in foster care, until they turn 26. Foster care children will remain eligible for the full scope of Medicaid benefits (Effective January 1, 2014).

• Section 2004 under Title II Role Of Public Programs

Family Planning: Establishing a new Medicaid eligibility group and the option for states to begin providing medical assistance for family planning services and supplies.

• Sections 2303 and 2001 under Title II Role Of Public Programs
• State Medicaid Director Letter SMDL#10-013 - 7/2/10
• CMCS Informational Bulletin - 7/9/10

Presumptive Eligibility in Hospitals: Permitting hospitals to make presumptive eligibility determinations for all Medicaid eligible populations.

• Section 2202 under Title II Role Of Public Programs