Healthcare providers will be challenged next year to define who is eligible for Medicaid and who is not as some states look to drop existing Medicaid patients while at the same time expanding the program to others.

Kaiser Health News reports that at least four states–Maine, Rhode Island, Vermont, and Wisconsin–are seeking to cut Medicaid by moving current patients off the program and, in some cases, directing them to federal-subsidized health insurance via the exchanges.

Each state will make different changes to its Medicaid program to achieve those cuts:

  • Rhode Island will drop the eligibility rate for parents with minor children from 175 percent of federal poverty limits to 138 percent, which will drop 6,700 individual from Medicaid.
  • Maine also cut the eligibility guidelines for families to 138 percent (it had formerly been 140 percent of FPL), and in 2014 will eliminate childless adults from the program, affecting 35,000.
  • Vermont will end two demonstration programs that provided Medicaid to those up to 300 percent of FPL, affecting 19,000.
  • Wisconsin has proposed cuts that will affect 92,000, most of them parents and guardians with incomes above the FPL.

All the states, except for Maine, will be expanding Medicaid per the Affordable Care Act, creating a dynamic and shifting landscape for providers who must ascertain who is eligible and who is not. For these four states and others, Jan. 1, 2014 will represent a watershed for coverage, and therefore patient financial services professionals should consider the following:

  • Become familiar now with any changes in Medicaid eligibility guidelines in your state that will begin in 2014.
  • Over the next few months, determine all patients’ Medicaid eligibility, both present and future, and advise patients of their status and how their status may or may not change.
  • For those patients who will transition off Medicaid, make a special effort to help them acquire insurance via the exchanges which are to open Oct. 1.
  • Make any uninsured patients who will qualify for Medicaid in 2014 aware of that fact and how it will change their healthcare options.


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