Designing the Infrastructure for Medicaid and CHIP Eligibility

Designing the Infrastructure for Medicaid & CHIP Eligibility

The Centers for Medicare & Medicaid Services are developing an electronic infrastructure that States can integrate to implement the Modified Adjusted Gross Income method for determining eligibility for Medicaid & CHIP required under the Affordable Care Act.

Under the Affordable Care Act (ACA), an estimated 30 million additional Americans will gain access to affordable insurance coverage by 2014. The ACA sets the income eligibility threshold for Medicaid to 133% of the Federal Poverty Level (FPL) in all States and territories. Currently two-thirds of the non-elderly uninsured are low-income, therefore this standardization of the FPL eliminates the gaps in eligibility for individuals under age 65.  By January 2014, States must convert existing methods for determining eligibility for affordable insurance programs to the Modified Adjusted Gross Income (MAGI) approach, which determines income, household composition and family size to comply with ACA.

In partnership with the Robert Wood Johnson Foundation’s State Health Reform Assistance Network, External Entrepreneurs Zac Jiwa and Chris Lunt and Internal Entrepreneurs Julie Boughn, Jessica Kahn, Henry Chao and Elaine Olin from the Centers for Medicare & Medicaid Services,  have developed the “MAGI in the Cloud”, an open source tool that States can use to facilitate Modified Adjusted Gross Income (MAGI) eligibility determination.  This is a huge step in providing the necessary infrastructure to States in implementing key requirements of the Affordable Care Act, which sets a new baseline for eligibility. The new “MAGI in the Cloud” platform reduces the risk of States missing the January 2014 deadline and maximizes resources by minimizing duplication of effort among States.  This project also provides an example of how it is possible to go outside of government to partner with another organization to solve a problem and develop a solution outside of government constraints. 

INTERNAL ENTREPRENEURS
Julie Boughn, Centers for Medicare & Medicaid Services
Jessica Kahn, Centers for Medicare & Medicaid Services
Henry Chao, Centers for Medicare & Medicaid Services
Elaine Olin, Centers for Medicare & Medicaid Services

EXTERNAL ENTREPRENEURS
Zac Jiwa
Chris Lunt

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