Shared Services Enrollment Systems
Achieving integrated eligibility systems necessitates that states determine what approaches and steps they will take to make seamless enrollment connections among state health subsidy programs.
*Milestone details:
*Full name: Establish a plan for integrated enrollment systems among Medicaid, CHIP, and federal tax credits.
*Relevance to the ACA:
The ACA requires the development of an integrated enrollment system among Medicaid, CHIP, and federal tax credits. This system must be consumer-friendly, simple and seamless, and technologically advanced, utilizing a single application with multiple application methods for enrollment into all health subsidy programs. Provisions relevant to integrated enrollment systems include:
§1401 – Requirements for determining tax subsidies for individuals purchasing insurance through Exchanges, including use of modified adjusted gross income (MAGI).
§1413 – Required streamlining procedures for enrollment, including a single application form and data matching arrangements among state agencies.
§2002 – Eligibility determination for Medicaid using MAGI.
§2101 – Eligibility determination for CHIP using MAGI.
§2201 – Requires an enrollment website that allows comparisons of benefits, premiums, and cost-sharing across Medicaid, CHIP and Exchange plans, and enrollment in the appropriate program through one application.
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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.
The RFP is available at http://www.statereforum.org/sites/default/files/dcas_si_vendor_rfp_5-29-...
District of Columbia
Just wanted to let the community know about a new piece (and related 2-pager) Enroll America published this week. It's a checklist for enrollment-related work that stakeholders should ensure is happening this year.
California
The State of Nebraska has issued RFP 12-002Z1 HIX Design Services, for the Purpose of Selecting a qualified contractor to provide continued planning and design of the potential Exchange.
RFP 12-002Z1 HIX Design Services
Nevada
Nevada released an RFP for our Exchange Eligibility Engine on 12/20/11.
Nevada
INDEPENDENT VERIFICATION AND VALIDATION SERVICES (IV&V) OF THE HEALTH CARE REFORM ELIGIBILITY ENGINE PROJECT
Connecticut
DSS Modernization of Client Services Delivery (MCSD) will include an online-web-based application, an integrated document management system and integrated voice response system that builds upon the Eligibility Management system. It will provide faster access to critical services including application to Medicaid.
The CT MCSD technology project is currently in the design phase, with a tentative 21-month schedules starting at 9/2/2008 and continuing through 9/1/2012.
Rhode Island
The second half of the attached presentation depicts Rhode Island's vision for integrated eligibility determination.
Rhode Island
This report describes Rhode Island's planned modernization of shared eligibility services to support both Medicaid and the Exchange.
North Dakota
During a special legislative session Nov. 7-11, House Bill 1475 was introduced to upgrade the Medicaid eligibility system and passed the House and Senate easily. The Medicaid system was priced at $42 million and 18 full time positions for IT and Medicaid staffing. The Insurance Department was also given four full time positions to offset health care reform work.
See a summary of measure actions here:
Indiana
These MAGI Eligibility Flow charts detail our interpretation of the proposed eligibility processes described in the Notice of Proposed Rule Making (NPRM) 45 CFR 155 and 157 Exchange functions and the Individual Market: Eligibility Determinations; Exchange Standards for Employers and NPRM 42 CFR 431, 433, 435, and 457 Medicaid Program: Eligibility Changes Under the Affordable Care Act of 2010. The charts include:
• An overview of the coverage options that will exist in 2014;
• An overview of the MAGI calculation process for tax subsidy and Medicaid coverage;
• An overview of the MAGI categories of coverage (note: this chart reflects Indiana specific eligibility information);
• The routes to non-MAGI Medicaid determination;
• Determining citizenship;
• Determining incarceration;
• Determining state residency;
• Household size calculation and exceptions;
• Income calculation.
Massachusetts
Massachusetts, in conjunction with the other New England States, was awarded an Early Innovator's Grant. Through this grant, MA will continue to build upon what is already an integrated enrollment system for medicaid, CHIP, and Commonwealth Care (benefits provided under MA's current version of the "Exchange").
District of Columbia
This issue brief explores the potential goals of an Exchange in WA, including: reducing the number of uninsured and increasing access to care; ensuring greater accountability and transparency; increasing the portability and continuity of coverage; simplifying health insurance purchasing; increasing competition in the health insurance marketplace; and driving quality improvement and cost containment. Access the brief here: http://www.statereforum.org/sites/default/files/waexchange_goalvalue_iss...
District of Columbia
The Washington State Health Care Authority put together a comprehensive Implementation Plan sharing steps taken and those projects currently in the works for implementing the expansion of Medicaid in 2014.
Washington
FYI - over the coming days and weeks, the documents that I just posted will be updated to reflect new decisions in how Medicaid Expansion will be implemented. Nothing earth shattering, but minor adjustments to the application flow and power point which will add clarity and process. Thanks.
http://www.hca.wa.gov/me/documents/ME2014_Fact_Sheet.pdf
Washington
Here is an overview presentation about what the 2014 Medicaid expansion means for Washington State.
Washington
Attached is a detailed flowchart of the Medicaid application process in Washington State.
District of Columbia
The purpose of this transition plan contained herein is to provide the incoming Executive Administration with key recommendations and information to assist in the successful implementation of national health care reform in New Mexico.
Access the plan here:
http://www.statereforum.org/sites/default/files/ohcr_transition_plan_122...
District of Columbia
This presentation to the New Mexico Legislative Finance Committee describes the goals and functions of the Exchange in New Mexico, outlines decisions the state needs to make, and highlights statutory considerations for establishing the state's Exchange.
Access the presentation here:
http://www.statereforum.org/sites/default/files/nm_exchanges.pdf
District of Columbia
House Bill 33 was introduced in the NM legislature in 2011. It would establish the structure, governance, and duties of the Exchange.
Access the legislation here:
http://www.statereforum.org/sites/default/files/hb0033.pdf
District of Columbia
This is WI's application for support under the State Exchange Planning and Implementation Funding Opportunity. Access the application here: http://www.statereforum.org/sites/default/files/wi_innovator_grant_app.pdf
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