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Report (OEI-07-10-00530)

02-20-2013
Most States Anticipate Implementing Streamlined Eligibility and
Enrollment by 2014

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Summary

WHY WE DID THIS STUDY

The Patient Protection and Affordable Care Act (ACA) requires the Secretary of Health and Human Services and States to streamline procedures for determining eligibility and enrolling applicants in State health subsidy programs (i.e., Medicaid, the Children's Health Insurance Program (CHIP), and State exchanges) by January 1, 2014. Specifically, section 1413 of the ACA requires changes to (1) eligibility and enrollment systems, (2) application forms, and (3) eligibility data sharing among State health subsidy programs. Given the complexity of the required changes, an assessment of States' readiness to implement the streamlined systems by the target date can provide useful information to CMS and to States.

HOW WE DID THIS STUDY

In March and April 2012, we conducted a survey regarding States' readiness to implement streamlined eligibility and enrollment systems. We asked all 50 States and the District of Columbia (States) questions about (1) streamlined eligibility and enrollment systems, (2) streamlined application forms, and (3) eligibility data sharing. We also asked States about guidance they had received on how to achieve streamlined eligibility and enrollment requirements, and about how helpful it was.

WHAT WE FOUND

Of the 45 States that responded to the survey, 35 reported that they anticipate implementing streamlined eligibility and enrollment systems, streamlined application forms, and data sharing and matching by January 1, 2014. However, States reported challenges, such as implementing the requirements by the target date and upgrading outdated eligibility and enrollment systems. They described various funding issues related to implementing needed changes. States also reported needing information and guidance, particularly on the Secretary's application form, the planned Federal data services hub, and the calculation of Modified Adjusted Gross Income.

WHAT WE CONCLUDE

Although States generally anticipate implementing streamlined eligibility and enrollment by the target date, they reported needing information and guidance on a number of topics. CMS should continue to provide guidance to States as they prepare to implement the streamlined eligibility and enrollment systems. In its comments, CMS described its ongoing work with States to implement open enrollment for Medicaid, CHIP, and State exchanges since our survey responses were collected.

Copies can also be obtained by contacting the Office of Public Affairs at Public.Affairs@oig.hhs.gov.

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