HHS proposes new rules for Medicaid, exchanges under ACA

Rule would aid determination of eligibility for coverage, HHS says

WASHINGTON — The Department of Health and Human Services is proposing a new rule that it said would promote consistent policies and processes for eligibility notices in Medicaid, the Children's Health Insurance Program and the health insurance exchanges mandated under the Patient Protection and Affordable Care Act.

"Before the healthcare law was passed, millions of Americans were unable to obtain or afford quality health coverage," HHS secretary Kathleen Sebelius said. "Today, we are proposing a rule to provide Americans with access to affordable, high-quality health coverage and give states more flexibility to implement the law in a way that works for them."

The newly proposed rules, HHS said, would help make it easier for consumers to determine if they are eligible for Medicaid or tax credits that make insurance more affordable. Starting in 2014, the ACA provides Medicaid eligibility for adults earning up to 133% of the poverty level — $14,865 for an individual or $30,656 for a family of four. Others will be able to buy insurance through a health insurance exchange. The rule would also include information on how consumers can receive coordinated communications on eligibility determinations and appeal them while giving states flexibility in designing benefits and determining cost sharing in the Medicaid program, and allowing them to choose to rely on HHS for verifying whether a person has employer-sponsored coverage and conducting some types of appeals.

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