Coordinating Enrollment in Health Coverage in 2014

From Vision to Reality

Nov. 11-12, 2010

Rachel Klein

New Opportunities for Coordination Law requires:

Web portal & online applicationSingle, joint applicationNo wrong doorStandardized income rules (MAGI)Simplified eligibility & enrollment processesData-matching “to the maximum extent

practicable”

Joint Application & No Wrong Door What will “no wrong door” mean in your state?

Who will determine eligibility for Medicaid, CHIP, and premium tax credits?

How can your state best achieve collaboration, coordination, and communication among and between: state Medicaid, CHIP, Exchange, and Insurance

agencies/departments,

county-based eligibility offices,

and relevant federal agencies

Joint Application & No Wrong Door (more)

How will your state handle families with members who qualify for different programs?

Will it also apply to non-health programs, like WIC, SNAP, etc.?

Does your state have the IT it needs?

Standardized Income Methodology (MAGI) MAGI is a different animal than Medicaid

agencies are used to Timing of income is an issue

Medicaid requires “point-in-time” & premium tax credits use last year’s tax return (but this year’s income)

States will need an easy way for families to present changes since last tax return

Transitions & Renewals

Important to consider how families maintain & renew their coverage

Need to align Medicaid renewal policy with exchange renewal as much as possible

Use data-matching to make renewal easy

Suggested Reading Enrollment Policy Provisions, Families USA, August 2010,

http://www.familiesusa.org/assets/pdfs/health-reform/Enrollment-Policy-Provisions.pdf Implementing Health Insurance Exchanges: A Guide to State Activities and Choices, Families

USA, October 2010, http://www.familiesusa.org/assets/pdfs/health-reform/Guide-to-Exchanges.pdf

Explaining Health Reform: Building Enrollment Systems that Meet Expectations of the Affordable Care Act, Kaiser Family Foundation, October 2010, http://www.kff.org/healthreform/upload/8108.pdf

Coordinating Coverage and Care In Medicaid and Health Insurance Exchanges, Kaiser Family Foundation, October 2010, http://www.kff.org/healthreform/8118.cfm

Guidance for Exchange and Medicaid Information Technology (IT) Systems, Version 1.0, November 3, 2010, http://www.hhs.gov/ociio/regulations/joint_cms_ociio_guidance.pdf

Proposed rule: Medicaid; Federal Funding for Medicaid Eligibility Determination and Enrollment Activities, November 8, 2010, http://frwebgate1.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=F51PmH/1/2/0&WAISaction=retrieve

More Resources

For more ways to get involved, visit www.standupforhealthcare.org

For more resources, see our website at www.familiesusa.org

Sign up for our Health Action Network atww.familiesusa.org

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