Coordinating Enrollment in Health Coverage in 2014 From Vision to Reality Nov. 11-12, 2010 Rachel Klein.

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Presentation transcript:

Coordinating Enrollment in Health Coverage in 2014 From Vision to Reality Nov , 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 years tax return (but this years 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, reform/Guide-to-Exchanges.pdfhttp:// reform/Guide-to-Exchanges.pdf 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, bin/PDFgate.cgi?WAISdocID=F51PmH/1/2/0&WAISaction=retrievehttp://frwebgate1.access.gpo.gov/cgi- bin/PDFgate.cgi?WAISdocID=F51PmH/1/2/0&WAISaction=retrieve

More Resources For more ways to get involved, visit For more resources, see our website at Sign up for our Health Action Network at ww.familiesusa.org to receive alerts and updates