“Reasonable” Flexibility: Exploring Models to Help States Resolve Inconsistencies in Income for Medicaid, CHIP and Tax Credit Eligibility
With the recent affirmation by the Supreme Court that the Affordable Care Act (ACA) passes constitutional muster, states will want to accelerate their planning efforts to implement eligibility system provisions under the law for Medicaid, CHIP and Exchanges. This webinar will offer detailed analysis of one of these provisions, the standards under which states can find “reasonable compatibility” of income information provided by applicants for Medicaid, CHIP and the exchanges that is not precisely equivalent. Income data is typically neither static nor centralized, and states must be prepared to resolve discrepancies when income data is submitted by applicants or retrieved from state, federal, or other independent sources. In the case of a discrepancy, CMS eligibility rules provide guidelines to help states proceed with an eligibility determination, including some flexibility for states to find data is “reasonably compatible.”
The Affordable Care Act presents dramatic opportunities and challenges for states in transforming eligibility and enrollment systems for existing public coverage as well as new subsidies that will be available through Exchanges. Over nearly two years eight states participating in the Robert Wood Johnson Foundation's Maximizing Enrollment national program have focused attention and resources on their health coverage enrollment and retention systems. Building on an assessment of system strengths and weaknesses, these states have begun to implement new improvement strategies to streamline their systems. Lessons learned from their efforts to simplify processes, be more data-driven, develop technology to support client-centered systems, and promote a culture of coverage are relevant for other states which are working toward improved systems to successfully implement health reform.