Electronic Eligibility Verification
Electronic exchange of data needed for eligibility determinations simplifies the process for both the applicant and the system, eliminating or reducing substantially the documentation burden.
*Milestone details:
*Full name: Enable electronic data exchange among programs to obtain information needed for eligibility determinations.
*Relevance to the ACA:
The ACA requires states to develop electronic interfaces for exchange of data and third-party data matching to the greatest extent possible to determine eligibility for Medicaid, CHIP, the basic health program and tax subsidies. Provisions relevant to electronic data exchange include:
§1411 – An Exchange must submit information to the Secretary to verify information provided by an applicant, including information on citizenship or immigration status and income.
§1413 – Requires states to develop secure, electronic interfaces for exchange of data for all state health subsidy programs, and requires Medicaid, CHIP, and Exchanges to participate in data sharing. The Secretary may establish agreements for the sharing of data; these agreements must protect privacy and data integrity.
§1414 – Parameters around the disclosure of taxpayer information and social security numbers to the Secretary, the Exchange or a state agency when necessary to determine eligibility for premium tax credits in the Exchange and other state health subsidy programs.
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Michigan
I've been assuming that as of January 2014, if individual apply for Medicaid through the Exchange and are otherwise Medicaid eligible, the Exchange will do the data match with SSA to determine citizenship. This would be the only way "real time" enrollment could occur for Exchange products, so the Exchanges need to have this functionality. Does this make sense?
District of Columbia
Hi Eileen, yes it is our understanding that both state and federal exchanges will need to verify electronic data through the federal data hub, which will include the SSA citizenship match. This applies whether the exchange is conducting assessments or determinations.
District of Columbia
In the January issue of Health Affairs, NASHP staff member Alice Weiss highlights Oklahoma's experience with revamping its eligibility and enrollment system and potential lessons for other states as they implement ACA eligibility system provisions.
District of Columbia
State Refor(u)m user Joe Flores recently posted a question about eligibility verification and NASHP's Alice Weiss provided a response with details on Oklahoma's real-time online enrollment system and process for eligibility verification. To join the discussion visit http://www.statereforum.org/discussions/essential-health-benefits.
District of Columbia
Please join HMS as we discuss how states should approach and prepare for this critical paradigm shift from paper to electronic eligibility verifications. In this webinar we will:
• Review the latest electronic verification requirements for Exchanges recently released in the Exchange Final Rule
• Highlight states that have already incorporated electronic verifications into their eligibility determination process
• Discuss challenges, considerations, and best practices for electronic verifications for Exchanges
Register Here: https://www2.gotomeeting.com/register/363010506
District of Columbia
Steve Novick, Eligibility Policy Specialist at the Oregon Health Insurance Exchange, made this presentation on income verification and self-attestation at a small group consultation on Certifying Income for Real-Time Enrollment in January 2012. The meeting was sponsored by the State Health Reform Assistance Network which is funded by the Robert Wood Johnson Foundation.
California
This presentation from NASHP's 2010 Annual Conference discusses the eligibility and enrollment processes for WI's BadgerCare Plus program.
District of Columbia
This issue brief on Presumptive Eligibility explains what it is, discusses how it's working in Iowa and Connecticut, and suggests things advocates may want to do to prepare for 2014.
California
This presentation discusses Oklahoma’s SoonerCare program (Medicaid) efforts around online enrollment for health programs. Access the presentation here: http://www.statereforum.org/sites/default/files/ok_coordinatingelig.pdf
California
This report outlines Maryland’s efforts to increase CHIP and Medicaid enrollment through a tax-based outreach initiative, strategies used to identify eligible children, and lessons learned through interagency data sharing. Access the report here: http://statereforum.org/sites/default/files/overcominginteragencydata-sh...
District of Columbia
These comments are California's response to the HHS request for comments on insurance exchanges. They include comments on Exchange issues, risk adjustment, eligibility and enrollment and more. Access the comments here:
http://www.statereforum.org/sites/default/files/california-1.pdf
District of Columbia
Deborah Bachrach presented on New York’s approach to coordinating enrollment between Medicaid and the health insurance exchange. She also identified key eligibility and coverage issues for the state.
Access the presentation here:
http://www.statereforum.org/sites/default/files/ny_bachrach_elig.pdf
California
This issue brief draws on lessons from New York’s experience in covering childless adults, which other states may find helpful as they extend eligibility to this population as outlined in the Affordable Care Act. Access the brief here: http://www.statereforum.org/sites/default/files/ny_enrollingchildlessadu...