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    Milestone: Enable electronic data exchange among programs to obtain information needed for eligibility determinations

    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.


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    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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    Laura Grossmann
    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... read more

    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...

    replyMar 17th, '11
    Katharine Witgert
    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.... read more

    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

    replyMar 11th, '11