Cover lawfully residing immigrant children and pregnant women through Medicaid and CHIP
For more information and to see what your state does, click here
Evaluating Your State Medicaid Program
Every state’s Medicaid program is different, so developing a proactive policy agenda should start with an evaluation of current policies and processes. This tool, though not meant to be a checklist or comprehensive list of potential improvements, highlights key areas to consider.
- Restrictions
- Getting Covered
- Staying Covered
- Benefits
- Access
- Additional Services
- Managed Care
- Initiatives
Maximizing Eligibility and Avoiding Eligibility Restrictions
Increase eligibility and/or eliminate or reduce asset tests for seniors and people with disabilities, and where resource tests apply, allow for self-attestation
For more information and to see what your state does, click here
Provide 12 months of post-partum coverage
Expand children’s Medicaid or CHIP eligibility above the minimum federally required levels
To see your state’s eligibility threshold for children, click here
Expand Medicaid eligibility to adults under age 65
To see your state’s eligibility threshold for adults, click here
Making It Simple to Enroll
Allow people to enroll, report changes, and submit information upon renewal by phone and/or through an online platform that is accessible on mobile devices
Allow people to apply for Medicaid and other programs, like SNAP, at the same time
Maximize use of electronic databases to verify eligibility and minimize documentation requests
For more information on verifying Medicaid eligibility, click here
Enable people involved with the criminal justice system to maintain Medicaid coverage
Making It Simple for Eligible People to Stay Enrolled
Provide 12 months of continuous eligibility to children
For more information on continuous eligibility and to see whether your state is implementing it for children, click here
Provide 12 months of continuous eligibility to adults
Minimize requests for information during the eligibility period
Conduct a streamlined renewal process, including ex parte renewals to the greatest extent possible
For best practices, click here
Providing All the Benefits That People May Need
Adult dental, vision, and other optional benefits
Comprehensive home- and community-based services without waiting lists
For more information on home- and community-based services, click here
To see how your state compares with other states with respect to waiting lists, click here
Prescription drugs without non-clinical restrictions (e.g., prescription limits)
To see whether your state imposes prescription limits, click here
No other non-clinical restrictions (e.g., limits on bed days in health care facilities)
To see whether you state limits bed days in health care facilities, click here
Facilitating Access to Needed Care
Accessible, up-to-date provider directories
Non-emergency medical transportation
Three months of retroactive coverage
To see whether your state has obtained a waiver to drop this protection, click here
Language access services for people with limited English proficiency
To see what your state does, click here
Ensure children’s access to Medicaid’s Early Periodic Screening, Diagnostic and Treatment (EPSDT) benefit
For more information, click here
Providing Additional Services for People with Specific or Complex Needs
Health homes for people with chronic physical or behavioral health conditions
A full continuum of care for people with substance use disorders and mental health conditions
For information on what your state does, click here
In-reach and coordination services for people involved with the criminal justice system
Holding Managed Care Plans Accountable
(if your state provides coverage through managed care plans)
Regularly report quality measures stratified by health plan and population demographics
Require plans to meet a quality measurement threshold (e.g., the national average)
For more information about managed care quality requirements, click here
Publicly post annual model contracts
Require remittances from plans that fail to meet their annual medical loss ratio
For more information and to see what your state does, click here
Initiatives to Improve the Health Care Delivery System
While there are no simple, off-the-shelf approaches in this area, states are experimenting with a variety of options, including:
Testing new ways to pay for care, such as bundled payments for certain conditions
Identifying ways to improve care for specific conditions or groups, such as reducing maternal mortality, racial/ethnic disparities in access or outcomes, etc.
Investing in infrastructure to coordinate care across providers within the health care system (e.g., behavioral health) and across other sectors (e.g., housing, nutrition, child welfare)
