Eligibility System Specifications
The ACA requires a new income based (MAGI) test for CHIP and Medicaid, although categorically eligible groups remain and federal match varies by old and new eligibility categories. While simplifying, states need to have systems to capture these differences.
*Milestone details:
*Full name: Develop systems specifications necessary to determine eligibility for new and continuing Medicaid eligibility categories and CHIP conversion to MAGI.
*Relevance to the ACA:
The ACA simplifies eligibility rules for those eligible based on their income, requiring use of a common income standard, modified adjusted gross income (MAGI). States need to set eligibility system specifications to accommodate these new eligibility rules while maintaining systems for those Medicaid eligibility categories (such as for the disabled) that are not eliminated under the ACA. Provisions relevant to system specifications for eligibility rules in the ACA include:
§2001 – Medicaid expansion to cover individuals with incomes at or below 133% of the federal poverty line.
-- Differential Federal funding for newly eligible individuals – FMAP for newly eligible individuals for most states begins at 100% in 2014, decreasing to 90% in 2020 and for the years following.
§2002 – Eligibility determination for Medicaid using MAGI.
§2101 – Eligibility determination for CHIP using MAGI.
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District of Columbia
CMS released a Frequently Asked Questions (FAQ) document addressing state questions regarding the availability of 90/10 matching funds for eligibility and enrollment systems.
New Jersey
Upcoming All-State MAC Collaboratives Webinar: "Information Technology in Support of Health Insurance Exchanges and Modernized Medicaid Eligibility Systems: Early Innovator Status Update," August 9, 11:30 AM - 1:00 PM ET. This webinar will feature presentations by the Early Innovator States designated by the Center for Consumer Information and Insurance Oversight (CCIIO) Cooperative Agreements to Support Innovative Exchange Information Technology (IT) Systems. The Exchange IT system components developed by the Early Innovator States will be made available to any state or eligible territory for incorporation into their exchanges and/or modernized Medicaid eligibility systems. The objective for this session is to provide information on potential “re-use” of Early Innovator state technology components that could facilitate or accelerate exchange development or Medicaid eligibility system modernization in other states.
Click the link for more information and to register.
District of Columbia
DC's Department of Human Services and Department of Health Care Finance issued an RFP for a vendor to design and implement the District of Columbia Access System (DCAS). DCAS will provide the District’s Exchange, a new integrated eligibility system for Medicaid, private health insurance and other programs, with new case management capabilities that span programs and agencies.
Louisiana
Louisiana's Implementation Advance Planning Document for Medicaid Eligibility Data Systems IT Architecture Upgrade (IAPD) was approved by CMS on 10/03/11. In order to correct a few typographical errors and to add an IV&V component, an updated IAPD has been prepared and is currently being reviewed prior to submission to CMS.
District of Columbia
Hi Megan:
Great question. We have checked in with quite a few states, but have not been able to publicly share an APD so far. While 18 states (MA, RI, NJ, MD, GA, AL, LA, KY, IL, KS, OK, NM, AZ, WY, MT, OR, NV, HI) have approved Advanced Planning Documents, they are still in the process of procuring their IT systems and are not ready to post anything publicly at this point (See a full report from the Kaiser Commission on Medicaid and the Uninsured here: http://www.kff.org/medicaid/upload/8272.pdf). If you are still looking for examples, we would be happy to connect you with people in the states with approved APDs who may be willing to share directly with you. Let me know if we can help with that.
Colorado
Colorado's Medicaid agency is working on an Implementation Advance Planning Document to CMS for Medicaid eligibility system development/modification to meet the requirements of the Affordable Care Act and is looking for examples. Do you have an approved, submitted, or draft IAPD? Please share it here.
Connecticut
CT does not support providing any other eligibility rules or criteria other than MAGI based criteria.
California
New Resources To Help States Design Consumer-Friendly Enrollment Systems
The Children’s Partnership launched a detailed, interactive graphic that walks the viewer, step-by-step, through an individual’s first-class health insurance enrollment experience under health reform. This graphic accompanies the publication, Easy, Efficient, and Real-Time (EER): A Framework for a First-Class Health Insurance Enrollment Experience in California. (attached) While developed for California, the graphic identifies the features of an ideal consumer experience that are relevant in any state.
Western Center on Law & Poverty released Creating California's "No Wrong Door" for Health Coverage: Recommendations from Consumer Advocates. The paper was written in collaboration with The Children’s Partnership and other consumer advocacy organizations to provide the consumer perspective on the structural issues involved in creating and implementing the ideal eligibility and enrollment system in California under the Affordable Care Act.
District of Columbia
Presumptive eligibility in Medicaid was first established as a state option to accelerate access to ambulatory prenatal care. The Affordable Care Act (ACA) added a new population to presumptive eligibility, giving states the flexibility to extend it to include parents and other adults eligible for Medicaid, in addition to pregnant women and children. This is an important step that can help states move to more coordinated family-based coverage.
Notably, the ACA will give hospitals that provide Medicaid services the prerogative to make presumptive eligibility decisions regardless of whether the state otherwise has adopted the option. This authority goes into effect in 2014 along with the new national income eligibility floor for Medicaid of 133 percent of the federal poverty level. Given this new reality, states may want to consider implementing the policy now to get their processes in place in advance of 2014. As states design their eligibility systems for health reform, they can look to leader states such as Iowa and Wisconsin to see how technology can facilitate presumptive eligibility.
This brief provides useful background information on presumptive eligibility and reviews the implementation considerations as states move forward on this policy.
District of Columbia
This paper outlines the major ways insurance Exchanges will influence the private insurance markets in Colorado, both inside and outside the Exchange. Access the paper here: http://www.statereforum.org/sites/default/files/hixprivatemkt.pdf
California
This report discusses a number of goals related to eligibility and enrollment.
Access the report:
http://www.statereforum.org/sites/default/files/md_finalreportentryworkg...
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 report, produced by the New York Department of Health, describes the state’s plan to transition the current locally-based administration of its Medicaid program, to a state-based administration system. The report broadly outlines how the state plans to accomplish this transition by the April 1, 2016 target date set by state legislation enacted in June. Access the report here: http://www.statereforum.org/sites/default/files/ny_adminreport2010.pdf