Expansion Medicaid Transitions: A Guide for Advocates

The Affordable Care Art of 2010 gave states the option to expand Medicaid to low-income adults aged 19-64 with incomes up to 138% of the federal poverty level (FPL). Because the expansion Medicaid population is not permitted to have both Medicare and Medicaid, expansion Medicaid eligibility ends when an individual turns 65 or becomes Medicare-eligible.

This guide for advocates–developed by the Medicare Rights Center with support from NCOA–aims to assist state advocates nationally who seek to learn about state transition processes, troubleshoot problems their clients are facing, and/or seek improvements to current processes. The guide includes useful terminology, an overview of the main steps in transition processes, a review of the most common transition pathways, with state-specific examples, and a set of troubleshooting steps to consider when encountering problems.