Milestone: Establish processes to promote consistency in eligibility, enrollment and retention decisions across application methods
The ACA requires consistent determination decisions regardless of the application method or entry point into the integrated eligibility and enrollment system.
*Full name: Establish structures or processes to promote consistency in eligibility, enrollment and retention decisions across application sites and methods.
*Relevance to the ACA:
The ACA requires states to develop a simplified, streamlined application and renewal process for consumers. Regardless of where an application or renewal comes into the system, a consumer will receive an eligibility or renewal determination for the appropriate health subsidy program. This cross-functionality between multiple programs necessitates that states coordinate their eligibility and enrollment processes across all programs to allow for consistent, accurate decisions. Provisions relevant to consistent eligibility, enrollment and retention decisions:
§1413 – Required streamlining procedures for enrollment, including a single application form and data matching arrangements among state agencies.
§2201 – Required establishment of 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.
-- Exchanges are required to screen for and enroll eligible applicants in Medicaid or CHIP.
-- Medicaid programs can establish agreements with an Exchange to make tax subsidy determinations.less