Medicaid Eligibility and Enrollment for Elderly People and Persons With Disabilities (EPD): Status and Simplification
June 29, 2011


Judith D. Moore


The National Health Policy Forum convened a technical workshop to consider the processes used to enroll elderly people and people with disabilities (EPD) in the Medicaid program. The far-ranging discussion covered current enrollment procedures, as well as changes that will be required in 2014 when state and federal officials implement the Patient Protection and Affordable Care Act of 2010 (PPACA). The workshop discussion centered on problems, issues, and prospects for change that might streamline eligibility and enrollment processes for EPD. Ideas emerged about the need for a future analytic agenda that could more fully illuminate these challenging issues.

A strong, analytic review of the potential for redesign of eligibility systems for EPD would contribute to a substantially better understanding of the problems and prospects for change. Such an analysis could explore:

  • whether there can be a "no wrong door" process for EPD, especially those seeking Medicaid eligibility for long term services and supports, and how to build it, 
  • how electronic systems can deal with assets, annuities, and functional status measures, and how to expedite their construction and enable financing for such systems, 
  • the extent to which changes to streamline or otherwise improve eligibility processes or criteria would require amending federal or state statutes or more simply past policies or practices, 
  • consideration of critical program safeguards, so that streamlined processes do not sacrifice program integrity,
  • lessons learned from the MMA (the Medicare Prescription Drug, Improvement, and Modernization Act)/Low Income Subsidy procedures adopted by and between the Social Security Administration, the Centers for Medicare & Medicaid Services, and states to identify any potential for replication,
  • consideration of the potential benefits of  using the MAGI (Modified Adjusted Gross Income) methodology required for new PPACA-covered eligibles to simplify EPD applications, especially for individuals with disabilities who are working, and
  • ideas for simplifying enrollment for some portions of the EPD population before others, including suggestions for the most efficient sequencing of change so that actions build upon each other.

Related Materials

See also the report by the Julie Stone of the Congressional Research Service, "Medicaid Eligibility for Persons Age 65+ and Individuals with Disabilities: 2009 State Profiles," 7-5700, published June 28, 2011.

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