CMS: State Medicaid Expansion May Pay for Private Marketplace Coverage
April 1—The federal government has issued guidance for states that wish to use Medicaid expansion funds to allow eligible beneficiaries to buy private insurance through state insurance marketplaces (exchanges).
The Centers for Medicare & Medicaid Services (CMS) issued the guidance after the state of Arkansas explored options using the enhanced federal Medicaid matching funding for premium assistance for individuals up to 133 percent of the federal poverty level, who are newly eligible for Medicaid under the Affordable Care Act.
CMS has decided such arrangements would be allowed if cost-effective, if beneficiaries have a choice of at least two qualified health plans, and if the state makes arrangements with the private plans to provide any necessary wrap-around benefits and cost sharing.
The U.S. Department of Health and Human Services (HHS) will consider approving a limited number of premium-assistance demonstrations, since their results would inform policy for the State Innovation Waivers that begin in 2017, according to the CMS statement. The CMS guidance reiterated that partial expansion will not be allowed under the state Medicaid expansion funding.
Publication Date: Monday, April 01, 2013