Eligibility and Enrollment: Guidance for State Planning

Eligibility and Enrollment: Guidance for State Planning

Overview and Analysis of Exchange, Medicaid and IRS Regulations

A new report released September 7, 2011 by the Robert Wood Johnson Foundation’s State Health Reform Assistance Network analyzes three federal draft regulations that, taken together, offer new insight into how consumers and employees of small businesses will obtain health insurance across the continuum of coverage options proposed in the Patient Protection and Affordable Care Act (ACA).

Two of the regulations, issued by the U.S. Department of Health and Human Services (HHS), focus on Medicaid and Children’s Health Insurance Program (CHIP) eligibility and enrollment procedures, as well as eligibility for exchanges, insurance affordability programs and Qualified Health Plans. The third proposed rule, issued by the Internal Revenue Service, provides guidance on determining eligibility for and calculating the amount of premium tax credits offered through the exchange. The regulations provide a new level of detail that will inform state planning efforts; guide the design and implementation of business processes, IT and administrative systems; and, ultimately, impact consumer experience with state exchanges and Medicaid.

To read the full report click here.