Minimum Essential Coverage

•Individuals must maintain “Minimum Essential Coverage” or face a tax penalty

•An individual eligible for “Minimum Essential Coverage” is not eligible for tax credits

•Most, but not all, Medicaid programs provide “Minimum Essential Coverage”

Pregnant Women •For pregnant women, new coverage

opportunities intersect with existing Medicaid coverage during pregnancy

•All states cover pregnant women under Medicaid▫Some go beyond 133% FPL▫Up to 300% FPL in some states

•Some states cover all services in the State Plan; others cover only services related to pregnancy

Pregnant Women: The Bottom Line (1)

•Medicaid for pregnancy related services is not Minimum Essential Coverage

•No penalty if enrolled in Medicaid for pregnancy related services in 2014

•Not eligible for benchmark plans through Medicaid expansion if pregnant at enrollment

Pregnant Women: The Bottom Line (2)

• If pregnant at enrollment, eligible for Medicaid for pregnancy related services

•Should be able to enroll in both Medicaid for pregnancy related services and a QHP with an advance payment premium tax credit, but…

•Marketplaces were built before the final rule and structures are unknown…

Additional Medicaid Programs NotMinimum Essential Coverage

•Additional Medicaid programs that do not provide Minimum Essential Coverage

▫Family Planning Services §1396a(a)(10)(A)(ii)(XXI)

▫Tuberculosis-Related Services §1396a(a)(10)(A)(ii)(XII)

▫Emergency Medical Conditions Only §1396b(v)