After the Patient Protection and Affordable Care Act (PPACA) became law, a state-based system of health benefit exchanges was established. This system will allow individuals to purchase coverage, with financial support for those between 133-400 percent of the federal poverty level, and expanding Medicaid eligibility to those with income below that level.
A number of provisions in the PPACA require states to design and operate coordinated, technology-supported enrollment processes to assist Americans who lack access to affordable employer-based coverage in obtaining health coverage through Medicaid, the Children's Health Insurance Program (CHIP), or the state exchanges. The law requires states to develop consumer-friendly application processes for these health subsidy programs, coordinate across them to enable seamless transitions, and reduce the burdens of application and renewal by minimizing the up-front information and documentation required to establish eligibility and instead developing procedures that tap available data from other sources.
The charts below summarize and provide highlights of the legislative language from PPACA regarding the main enrollment provisions, particularly those of relevance to low — and moderate-income families. These provisions require enrollment systems that are:
- Consumer-friendly: PPACA requires states to create enrollment systems that ensure that applicants are screened for all available health subsidy programs and enrolled in the appropriate program, with minimal collection of information and documentation from applicants.
- Coordinated: PPACA requires states to coordinate efforts across available health subsidy programs to enable seamless transitions between those programs.
- Simplified: PPACA requires states to operate a streamlined enrollment process and foster administrative simplification, using uniform income rules and forms as well as paperless verification procedures.
- Technology-enabled: PPACA requires states to operate enrollment Web portals and securely exchange and utilize data to support the eligibility determination. In addition, PPACA directs the Secretary of Health and Human Services to establish standards and protocols for electronic enrollment and eligibility systems, to allow for significantly improved streamlining and cross-agency capabilities.
With the passage of health reform, the United States has begun to build a culture of coverage, laying the foundation for this culture shift through new health coverage options, protections, and subsidies, as well as through provisions that promote individual responsibility.
The first stone in this foundation has been laid with the July 1, 2010 launch of a federal informational Internet portal, healthcare.gov, which will ultimately have significant operational capabilities. Further, PPACA tasks states with constructing an enrollment system that assists people in understanding their choices and helps them obtain and keep appropriate health coverage. In order to achieve the optimal enrollment process, with the technology that can support it, states need to begin planning and developing their policies, procedures, and systems right away, to ensure deployment by 2014.
