The ACA’s requirements for simplification and integration of Medicaid, CHIP and Exchange subsidy eligibility determinations necessitate an examination of roles that each program and administering and implementing agencies will play in newly designed systems.

*Milestone details:

*Full name: Decide state agency, county, Exchange and other parties’ responsibilities for eligibility determinations.

*Relevance to the ACA:

With ACA changes in Medicaid and CHIP eligibility determination, new Exchange tax subsidy determinations, and the requirement that these processes be integrated, states will need to determine the most effective, complementary roles for relevant agencies and entities in these processes. With a state level Exchange, and with more technology enabled eligibility determinations, greater centralization of many eligibility and enrollment functions will be possible and may be preferable in achieving streamlined eligibility determinations required under the ACA. Provisions relevant to responsibility for eligibility determinations include:

§1411 – Eligibility determination procedures for the Exchange and federal tax credits.

§1413 – Requirement that individuals found eligible for Medicaid or CHIP through an Exchange are enrolled accordingly.

§2201 – Requirements about screening and enrollment into Medicaid, CHIP and Exchanges.