More Details Released on Health Insurance Exchange

Last Friday, the administration released three sets of proposed rules that cover eligibility and enrollment for Medicaid plans offered in the exchange and premium tax credits under the Affordable Care Act (ACA) that can be used to help people purchase insurance. The rules envision a simplified and largely automated system that allows people to apply through multiple points of entry for all programs, including Medicaid, exchange plans, and related tax credits and subsidies. The “no wrong door entry” is intended to help ensure that people are enrolled in the appropriate insurance and assistance programs regardless of where they begin their application.

Another way the ACA and the regulations achieve simplification is by creating a standardized income eligibility threshold and universal Modified Gross Adjusted Income (MAGI) calculation to be applied across most populations applying for Medicaid, exchange plans, premium tax credits and other insurance affordability programs. The rules also set forth parameters for electronic data exchanges between state and federal agencies, most specifically the IRS, that will allow state Medicaid offices and exchanges to verify information supplied by applicants without requiring the applicant to provide additional information. Only when there is a discrepancy in the data or where no data match is available will a person be required to submit further documentation to confirm the information supplied on the initial application.

Medicare Rights Center is working with states, the federal government and fellow stakeholders to ensure that people with Medicare who are eligible for Medicaid programs are also able to benefit from streamlined enrollment systems. Enrollment and system reforms would help prevent bureaucratic disentitlement for the Medicare population eligible for Medicaid programs and smooth transitions to Medicare by helping to eliminate data matching errors, onerous documentation and other requirements that often block access to benefits.

Read the proposed rule on exchange functions and enrollment.

Read the proposed rule on Medicaid eligibility changes.

Read the proposed rule on health insurance premium tax credits.