Yet Another Green Light for Simplification

By Guest Blogger

The following blog was written by Christine Sebastian, formerly a Health Policy Analyst at Families USA.

In order to make sure people get seamlessly enrolled into health coverage beginning with the first open enrollment period in 2013, states will need to develop a consumer-friendly information technology (IT) infrastructure through which people can apply for coverage, learn which health coverage programs they may qualify for, update their personal information, renew coverage, choose a plan and providers, and even learn about other non-health coverage programs for which they may be eligible. “Consumer-friendly” means that this entire process should be in plain language, be quick and easy to complete, and that it should be easy to get help at any time. However, designing an IT system that is easy to use and highly effective and efficient is no easy task, particularly given the current fiscal challenges states face. States also need to think not only about designing new systems for their health insurance exchanges, but also how these systems interface with the systems already in place for Medicaid and the Children’s Health Insurance Program (CHIP). In many states, the Medicaid eligibility and enrollment systems are decades old and will need to be modernized to handle the demands of expanded eligibility come 2013.

With this in mind, in April of this year, CMS issued a final rule that will provide additional financial help to states to develop, improve, and maintain their IT systems to get people enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). States that meet a set of federal standards for streamlining, simplifying, and modernizing the enrollment process can qualify for significant federal matching rates for developing and maintaining new systems. States will get nine federal dollars for every state dollar spent developing the systems (between now and December 31, 2015) and three federal dollars for every state dollar spent to maintain them. This financial boost will help states tremendously with the costs of revamping their IT systems, but why stop at health care? After all, many of the people eligible for Medicaid and CHIP coverage are also eligible for other forms of assistance like the Supplemental Nutrition Assistance Program (SNAP; formerly food stamps) and child care assistance.

The good news is that in August, the Administration for Children and Families (ACF), the Centers for Medicare and Medicaid Services (CMS), and the Food and Nutrition Service (FNS) released an exciting Tri-Agency letter which specifies that states that are developing new Medicaid IT systems can integrate other human services programs into these systems as well. States can build health coverage eligibility systems that also connect people with programs like SNAP, the Child Care and Development Fund (CCDF), and Temporary Assistance for Needy Families (TANF). States would only be responsible for any additional costs associated with integrating the systems that they wouldn’t already incur if the system were developed strictly for Medicaid and CHIP.

Overall, this letter signifies yet another green light to states looking to seize the opportunity to simplify enrollment in health coverage programs and streamline this process with other forms of public assistance. We know that coordination among Medicaid and CHIP agencies, state exchanges, and the federal government is paramount to successful health coverage enrollment, and ensuring compatibility and communication among other human services programs will make the process easier still for those who seek out health coverage, but may qualify for additional assistance. With the federal government offering to foot between 75 and 90 percent of the cost, this is a win-win for states and for people seeking coverage. 


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