The Patient Protection and Affordable Care Act (PPACA) contains major changes to the two big health entitlement systems--Medicare and Medicaid. Medicare has been more prominently featured in the discussion over reform. However, Medicaid is a significant part of the PPACA's full impact on the health system. Medicaid is the jointly-funded system to provide health care for low-income and disabled persons. The reformed program encompasses changes in coverage, administration, and oversight. Here are many of the Medicaid provisions that are either now or soon to be in effect that will impact states, patients, providers and suppliers.

Eligibility and Coverage

--One of the most immediate changes is a mandate that current state standards of eligibility for Medicaid cannot change until insurance exchanges are established and operational. Standards for children's eligibility cannot change through 2019.
--The most significant change is expansion of eligibility. States will be allowed to expand coverage to non-pregnant adults under 65 through a state amendment plan, with a current matching rate of federal funds. Coverage can be phased in based on income, as long as the state phases in lower-income persons first.

--The biggest expansion of coverage will take place in 2014 when non-Medicare eligible adults under 65, whose income does not exceed 133 percent of the poverty level, will be eligible. Income eligibility will be based upon adjusted gross income, with no assets or resources tests. During that 2014 period, Federal medical assistance percentage (FMAP) funding for states will reach 100 percent. States can also expand eligibility to those whose income exceeds 133 percent if their income does not exceed the highest income eligibility level established under the state plan.

--The enrollment process for Medicaid will be simplified in 2014. States will establish an online means of applying for Medicaid and the Children's Health Insurance Program (CHIP) for the first time or to renew a plan, including the ability to use an electronic signature.

--Starting this year, coverage will be applied to freestanding birth centers. These centers are state-licensed non-hospital facilities where women give birth outside the home, often with attending midwives.

Quality Standards

--Medicaid plans will be required to have a "benchmark" of benefits of essential coverage. This benchmark will include equal coverage for mental health treatment. In addition, starting this year the Department of Health and Human Services (HHS) will identify and measure a set of health quality measures for Medicaid-eligible adults. Following those measures, HHS will establish a Medicaid Quality Measurement Program, and continue to recommend changes to the initial core set of quality measures.

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