Federal guidance announced to help states establish consumers' eligibility for insurance through health information exchanges.
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In the shadow of Tuesday's election results that saw Republicans gain control of the House of Representatives and declare that their victory is, in part, a mandate to repeal healthcare legislation, the Department of Health and Human Services (HHS) announced Wednesday new measures to develop health insurance exchanges (HIEs) as it continues to lay the groundwork for the expansion of healthcare coverage to 32 million Americans.
HHS said it will take two steps to strengthen the IT infrastructure that will help states simplify the enrollment experience for consumers who qualify for Medicaid or who are shopping for health insurance in the HIEs under the Affordable Care Act.
First, HHS proposed new federal funding that will be available to all states to upgrade their Medicaid eligibility systems in preparation for the changes that will result from the Affordable Care Act in 2014. Second, HHS announced guidance to help states design and implement IT needed to establish exchanges. These systems will help enroll people who qualify for Medicaid or the Children's Health Insurance Program (CHIP), tax credits, or cost-sharing reductions available through the Affordable Care Act.
"The resources and guidance announced today are an important next step in developing seamless systems of coverage and ensuring effective and efficient implementation of health insurance exchanges and a modernized Medicaid program," Cindy Mann, Centers for Medicare and Medicaid Services (CMS) deputy administrator and director for the Center for Medicaid, CHIP, and Survey and Certification, said in a statement. "Building a smooth customer experience requires a foundation of integrated eligibility systems for health insurance assistance at both the state and federal levels and the resources and guidance announced today supports this foundation."
These technology investments will support a coordinated, consumer-oriented system for individuals, families, and businesses to sign up for the health insurance plan that they choose. They complement the competitive funding announcement, released on October 29, to create models for IT infrastructure that all states can use, HHS officials said.
"Individuals will seek healthcare coverage without necessarily knowing whether they are looking for an exchange plan, a Medicaid, or a CHIP plan," said Joel Ario, director of the office of health insurance exchanges. "Effective and efficient data exchange between state and federal health programs is critical to achieving this one stop shopping experience and today's guidance establishes the framework and approach that will make this seamless coordination possible."
As states prepare for 2014, they have requested early guidance and funding assistance for their technology projects, particularly with respect to eligibility and enrollment systems.