Health Care Reform

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					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 application
     Single, joint application
     No wrong door
     Standardized income rules (MAGI)
     Simplified eligibility & enrollment processes
     Data-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 at
                ww.familiesusa.org
       to receive email alerts and updates

				
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