Frequently Asked Questions

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Top Questions

Who is eligible for BHP?
Individuals are eligible for BHP coverage if they:• Are state residents and either a citizen, or a lawfully p... (more)

Can individuals with disabilities and other long-term care needs (who are not eligible in the mandatory gro...
Yes. People with disabilities or who need long term care services and supports may qualify under the new adult grou... (more)

What is the Basic Health Program (BHP)?
The Basic Health Program (BHP) is an optional health benefits coverage program for low-income individuals (defined as in... (more)

With respect to MAGI conversion, how will the 5% disregard be applied? 
The Affordable Care Act established an income disregard equal to five percentage points of the FPL disregard “for... (more)

What is premium assistance in Medicaid?
The Medicaid statute provides several options for states to pay premiums for adults and children to purchase covera... (more)

What are some examples of income that is not considered taxable, and therefore excluded from MAGI?
Supplemental Security Income (SSI), Temporary Assistance to Needy Families (TANF), Veterans’ disability, Workers’ Co... (more)

Who should be contacted with questions?
If there are questions or problems related to the system/website, please contact the MACPro Help Des... (more)

How do the home and community-based settings requirements impact assisted living facilities?
The requirements for home and community-based settings set forth in the final rule apply to all settings where individua... (more)

What is MAGI and how is it different than the way states calculate eligibility today? 
It’s a new, simpler way to determine eligibility for Medicaid and CHIP. The Affordab... (more)

What does it mean for an individual to withdraw their Medicaid application in order to receive a determinat...
In a State where the Marketplace makes Medicaid and CHIP eligibility assessments, but not eligibility determination... (more)

What if an account contains an out of state address?
Applicants can apply for whatever state they choose. Sometimes someone will want to file an application for a state they... (more)

When an individual is eligible for Medicaid and receives a level of care assessment in order to qualify for...
No.  The 75% match for eligibility is limited by statute to activities directly related to the eligibility determin... (more)

What does the Five-Year Period for Certain Demonstration Projects and Waivers provision of the final rule a...
 In accordance with section 2601 of the Affordable Care Act, states have the option to request, subject to the appr... (more)

What if there is an account for someone who is already enrolled in Medicaid?
The flat file contains only accounts that have been determined/assessed as eligible for Medicaid or referred for a full ... (more)

What are the seven conditions and standards that are required for purposes of receiving the enhanced funding?
In accordance with the regulations issued in April 2011, Eligibility & Enrollment projects funded with enhanced fund... (more)

How can states use premium assistance to help families that are split among the Exchange, Medicaid, and the...
In 2014, some low-income children will be covered by Medicaid or CHIP while their parents obtain coverage on the Ex... (more)

Is there a potential conflict with the Medicaid requirement to process an application within 45 days and th...
The requirements are different, but they are not in conflict.  The 45-day limit for Medicaid is the outer boundary ... (more)

Can a residential agreement between the individual and the entity that owns or controls the property have t...
Yes, however the state must ensure that a lease, residency agreement or other form of written agreement will be in place... (more)

What is a standard health plan for purposes of BHP?  What benefits are included?
A standard health plan is a health benefits plan in which an individual is enrolled through the BHP.   States ... (more)

Does a Medicaid application have to be to approved and processed in order for a PE eligibility determinatio...
The purpose of hospital PE and PE more broadly is to provide a streamlined option for people who appear to be eligibl... (more)

What is the purpose of the final home and community-based services rule (CMS 2249-F and CMS 2296-F)?
The final rule supports enhancement of the quality of home and community-based services (HCBS), adds protections for ind... (more)

What methods can states use to execute conversion to modified adjusted gross income (MAGI) as required by t...
Effective January 1, 2014, MAGI eligibility rules will be used to determine eligibility for nonelderly,... (more)

If an application contains a household which is a mixed case with MAGI and non-MAGI individuals, how should...
Because the Federally Facilitated Marketplace (FFM) is providing eligibility determinations/assessments for Medicaid und... (more)