New Medicaid Rules Are Being Proposed. Here's What You Should Know

• Author: Jacob Greene
• Posted: 2024-07-18

Millions of Americans rely on Medicaid to meet their healthcare needs every year and even more are still in need of the program, but lack the ability to technically qualify for it. On August 31st, the Biden administration announced that they're planning to significantly increase people's ability to access Medicaid, which will have major implications for countless people.

Here's what you need to know about the potential changes.

How Exactly Does Medicaid Work?

Medicaid is a combined federal and state program that helps lower-income individuals pay for medical care. The program has been around since around 1965 and has been through a considerable amount of updating over the years.

On a federal level, Medicaid is officially available to individuals whose income is at 138% of the poverty level or lower, but actual availability varies from state to state.

Medicaid acts as a form of health insurance and usually requires enrollees to pay some sort of cost, usually in the form of copayments or deductibles, but also sometimes a highly limited premium depending on the circumstances. However, the bulk of actual health insurance costs are paid by state and federal authorities.

There is a great deal of discretion healthcare providers can use to determine whether or not they accept Medicaid, so it's often hit or miss when it comes to Medicaid acceptance. For instance, dentists very rarely accept Medicaid, but a great number of hospitals, doctor's offices, and nursing homes do, so there's a lot of variability.

What Measures Are Being Proposed?

As part of several government attempts to reduce the impact of inflation, the Biden Administration is attempting to increase access to programs like the Children's Health Insurance Program (CHIP) and Medicaid.

Specifically, changes made by the Department of Health and Human Services (HHS) aim to remove limitations on enrollees in two major ways. First, is to eliminate mandatory waiting periods for CHIP and also remove lifetime caps on coverage; both of which can be significant hurdles to program admission. Second, the Center for Medicare and Medicaid Services (CMS) will require applicants to fill out much less paperwork and simplify the application process.

This second change, especially, is incredibly important as Medicaid is notorious for being incredibly complicated, with there being a ton of confusing income, wealth, and age requirements that vary considerably from place to place.

How Will Medicaid Eligibility Be Impacted?

Overall, the intended measures will do quite a lot to help millions of people receive Medicaid coverage as well as maintain it, especially in the case of children.

With the new rules, lower income children will be able to pretty comprehensive health insurance coverage in perpetuity and parents will have a much easier time enrolling them in Medicaid.
As for other individuals, the new Medicaid rules will allow for people enrolled in Medicare, specifically those with part D coverage, to also receive some Medicaid coverage, which traditionally has been a coverage combination that's been extremely hard to get except when it comes to nursing home care.

These measures will also do quite a lot to improve the fortunes of disabled individuals, who traditionally have had an extremely tough time receiving adequate levels of coverage. It's been quite common for people to be denied Medicaid coverage due to an inability to properly establish their medical conditions through paperwork, which is incredibly complex.

Additionally, these developments will come in handy in the near future due to changes in federal mandates relating to the COVID-19 pandemic. Due to the pandemic, extra federal funds became available to state Medicaid programs; funds that will soon be exhausted, at which point states will likely rollback Medicaid coverage, leaving many people uninsured.

Keeping an Eye Out

Medicaid is an incredibly useful program that gets millions of people the healthcare they need to live happy and productive lives.

Historically, despite how important it is, Medicaid has been a difficult program to qualify for due to the numerous technical details involved. With these new proposed rules by the HHS, it's likely the entire Medicaid process will become a lot more streamlined, to the benefit of a lot of people.