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2 Assumptions • It is assumed that the State plan amendment will be approved by the CMS to begin on January 1, 2025. • Pregnant women and infant members currently receiving postpartum coverage with an income level of 215.0% of the FPL or higher will remain continuously eligible for Medicaid after January 1, 2025. The earliest date a pregnant woman will be disenrolled is December 2025, while the latest date will be September 2026. Infant disenrollment will begin in January 2025 for infants that enrolled in Medicaid or saw renewed eligibility in January 2024, while disenrollment will not occur until December 2025 for infants that enrolled in Medicaid or saw renewed eligibility in December 2024. • Postpartum coverage will remain without interruption for Medicaid members with an income level of 215.0% of the FPL or lower. • According to the HHS, one-time information technology (IT) costs totaling $1.2 million are necessary due to enrollment changes in Medicaid and the IHAWP and will be expended in FY 2025. The State will pay for approximately 25.0% of these costs, or $297,000, out of the Family Investment Program General Fund appropriation. • IT costs include hiring contractors for a total cost of $107,000 for 438 total hours at $125 per hour to update the data warehouse, 29 total hours at $125 per hour for project management, 97 total hours at $125 per hour for a business analyst, and 288 total hours at $125 per hour for enterprise architecture. • IT costs also include $1.1 million to update the HHS’s Eligibility Integrated Application Solution (ELIAS) system to determine Medicaid eligibility for pregnant women. • An actuarial services contract may be necessary to determine the impact of enrollment changes on managed care organization (MCO) capitation rates and maternal and infant health care payments to the MCOs. The costs of this contract are anticipated to be absorbed within the existing Health Program Operations General Fund appropriation. • There are currently 10,800 Medicaid members with postpartum coverage. The HHS reports that approximately 15.8%, or 1,700 members per month on average, will be ineligible for Medicaid coverage in future years under the provisions of the Bill, including approximately 1,300 women with income between 215.0% and 375.0% of the FPL and 400 infants in families with income between 302.0% and 375.0% of the FPL. • A monthly average of approximately 1,100 infants in families with income between 215.0% and 302.0% of the FPL may have coverage shifted from Medicaid to Hawki if they are not covered by other insurance. • A monthly average of approximately 2,300 pregnant women are anticipated to maintain Medicaid coverage beyond the current two months postpartum instead of transferring to the IHAWP, which has income eligibility up to 133.0% of the FPL. Beginning in FY 2025, the State is estimated to pay for 36.75% of expenses under Medicaid for pregnant women and 11.61% of expenses for the IHAWP, creating increased net State costs of $86 per month for these members. • An estimated 2,700 women with an income level of 215.0% of the FPL or lower who otherwise would have lost Medicaid coverage after 60 days may be eligible for Medicaid coverage. • Combined with program savings due to an estimated monthly average of 1,300 pregnant women who in future years will not be eligible for Medicaid coverage, the estimated fiscal impact related to pregnant women under Medicaid is an increase in total costs of $1.8 million in FY 2025 ($1.2 million increase in State costs), an increase in total costs of $7.1 million in FY 2026 ($5.4 million increase in State costs), and a decrease in total costs of $685,000 in FY 2027 ($2.7 million increase in State costs). Costs are anticipated to be funded from the Medical Assistance (Medicaid) General Fund appropriation. • An additional monthly cost of $3.89 per infant and $6.60 per adult was added to account for dental costs paid outside of MCO capitation rates.