Admin and Procedural Barriers Archive

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May 2, 2016
Q&A: Differences Between Marketplace and Medicaid MAGI
Wayne Turner Issue Brief
This Q&A outlines a common error made by states when determining eligibility under Modified Adjusted Gross Income (MAGI), leading to unlawful Medicaid denials. MAGI rules differ for Marketplace and Medicaid eligibility determinations. Because of those differences, there may be instances in which an individual seemingly is financially ineligible for…
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February 1, 2016
NHeLP Comments: CMS-Applications to Support Eligibility Determinations for Enrollment Through Health Benefits Exchanges, Medicaid and CHIP
Mara Youdelman and dfitzgerald Comments
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September 10, 2015
Ensuring that Assessment Tools are Available to Enrollees
Jane Perkins Issue Brief
The amount of Medicaid services for enrollees, particularly home and community based services, is increasingly being determined through prior authorization processes that use assessment tools and clinical coverage criteria. These assessment documents may not be made available to the enrollee. However, Medicaid law and due process call for disclosure…
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April 9, 2015
Fact Sheet – IRS Updated Guidance on HCBS Difficulty of Care Payments
Wayne Turner Issue Brief
Last year, the IRS announced that payments received by in-home, individual care providers under Medicaid Home and Community Based (HCBS) waiver programs can be treated as "difficulty of care" payments and excluded from the care provider's gross income. In a recently updated Q&A, the IRS clarifies that payments from…
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March 4, 2015
HCA Letter to Covered California Appeals
dfitzgerald Letter
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February 27, 2015
Letter to California Health Care Services: Improper Terminations and Application
dfitzgerald Letter
Letter from the Health Consumer Alliance requesting DHCS to halt the improper application of the MAGI income rules to the non-MAGI beneficiaries at annual renewal of their ongoing eligibility for Medi-Cal, and to direct the counties not to terminate coverage for any of these individuals until the counties review…
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Admin and Procedural Barriers Archive

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Q&A: Differences Between Marketplace and Medicaid MAGI

NHeLP Comments: CMS-Applications to Support Eligibility Determinations for Enrollment Through Health Benefits Exchanges, Medicaid and CHIP

Ensuring that Assessment Tools are Available to Enrollees

Fact Sheet – IRS Updated Guidance on HCBS Difficulty of Care Payments

HCA Letter to Covered California Appeals

Letter to California Health Care Services: Improper Terminations and Application