Medicare Rights Center

The Affordable Care Act outlined Medicaid expansion guidelines for states to include nondisabled, single adults under 65 years old with incomes up to 138% of the federal poverty level.

States that adopted the Medicaid provision began using a modified system to determine eligibility for and expand coverage to those persons who would now qualify. However, for approximately 700,000 Medicaid enrollees in New York State who are also eligible for Medicare—known as dual eligibles —federal health reform left intact more complicated eligibility rules that can exclude them from accessing seamless coverage available on the NY State of Health Marketplace, the State’s health benefit exchange. In 2010, NYHealth awarded Medicare Rights Center a grant to ensure that the needs of dual eligibles were considered as the new Marketplace was planned.

MRC completed the following activities:

• Conducted legal and regulatory analysis to determine the State’s ability to extend program simplifications and participation in the exchange to non-MAGIs;
• Analyzed the fiscal implications of extending MAGI program rules to non-MAGIs;
• Prepared and distributed a final report for policymakers;
• Convened roundtables and briefings to educate policymakers and other stakeholders about recommendations; and
• Informed national understanding and rulemaking regarding the non-MAGIs.