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ACA Year Three: The Final Countdown

Innovations in Health Reform Update March 2013 (pdf)

With the Supreme Court decision upholding the Affordable Care Act (ACA) solidly behind us, states are racing to get State-Based, Federally-Facilitated, or State Partnership Exchanges and related enrollment systems ready by October 1, 2013. Following are some good resources to help states tackle issues they face today:


  1. Finalizing the single streamlined application, paper as well as online.

States will be able to use the model federal streamlined application or develop their own (if it meets the standards set by the Secretary of Health and Human Services). A balance must be achieved between simplification and collecting enough information to make an accurate eligibility determination. Application assistance (in-person, online, and on the phone) is going to be very important.

Do you know? Fewer than half of current Medicaid and CHIP applications include a toll-free hotline number for families to call for assistance completing the application.

Resource: The Single Streamlined Application Under the Affordable Care Act: Key Elements of the Proposed Application and Current Medicaid and CHIP Applications

  1. Ensuring privacy while sharing data across programs to do outreach and eligibility verification.

State and local human services agencies administer funds from various federal programs to help those in need --many of whom are served by multiple programs. Data sharing across programs can improve administrative efficiencies and client service, though clarification is needed about how privacy rules apply.

Do you know? Data sharing systems in Utah reduced eligibility verification time from 17 minutes to 3 minutes.

Resource: Human Services: Sustained and Coordinated Efforts Could Facilitate Data Sharing While Protecting Privacy

  1. Finalizing eligibility verification plans.

States are required to develop effective verification policies that align with the ACA’s goal for a seamless and streamlined system of eligibility determinations. The deadline for states to submit their MAGI-based eligibility verification plan to CMS is March 20, 2013.

Do you know? A state must request approval and justify the use of an alternative when it does not plan to use listed state and federal data sources (along with the federal hub) to verify income.

Resource: A PDF version of the template, the template instructions, and examples of reasonable compatibility scenarios can be found at

  1. Ensuring a seamless enrollment experience.

States are required to provide a seamless consumer experience, even if the enrollment process is bi-furcated between the Exchange and Medicaid or between the Federally-Facilitated Exchange and a State Medicaid/CHIP agency. States are still waiting for further guidance on what is required to ensure a smooth hand off between entities.

Do you know? States using a bi-furcated process must ensure that it does not increase burdens on applicants or cause delay.

Resource: Coordination of Eligibility and Enrollment Between Medicaid/CHIP and the Exchange: An Overview of the Rules Applicable to the “Assessment” Model

While every state is under pressure to meet the October 1, 2013 deadline to begin enrollment in newly available coverage, some have resources and technical assistance to offer others.

Do you know? provides a State Toolbox: Exchange Innovators in Information Technology. This resource contains various tools and artifacts from the Exchange Innovators MAC Collaboratives.