Health Care Reform

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Enrollment in Health
Coverage in 2014
     From Vision to Reality
         Nov. 11-12, 2010
            Rachel Klein
New Opportunities for
   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
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
       county-based eligibility offices,
       and relevant federal agencies
Joint Application & No Wrong Door

   How will your state handle families with
    members who qualify for different
   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,
   Implementing Health Insurance Exchanges: A Guide to State Activities and Choices,
    Families USA, October 2010,
   Explaining Health Reform: Building Enrollment Systems that Meet Expectations of the
    Affordable Care Act, Kaiser Family Foundation, October 2010,
   Coordinating Coverage and Care In Medicaid and Health Insurance Exchanges,
    Kaiser Family Foundation, October 2010,
   Guidance for Exchange and Medicaid Information Technology (IT) Systems, Version
    1.0, November 3, 2010,
   Proposed rule: Medicaid; Federal Funding for Medicaid Eligibility Determination and
    Enrollment Activities, November 8, 2010,
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