The New Wave of Eligibility Systems

INPUT Analyst Kate Tussey reports on eligibility systems.

In case you missed the boat, the Affordable Care Act (ACA) includes several key technology pieces that states must implement by 2014. One with noticeable emphasis is designing streamlined, consumer-friendly eligibility and enrollment systems for health insurance exchanges, Medicaid, and the Children’s Health Insurance Program (CHIP). To help states, the Centers for Medicare and Medicaid (CMS) proposed new federal funding that would be available to all states to streamline and upgrade their Medicaid eligibility systems. After meeting qualifying conditions, eligibility systems will be eligible for an enhanced federal matching rate of 90 percent for design and development of new systems, and a 75 percent federal matching rate for maintenance and operations. The current match rate for eligibility systems is 50 percent. The enhanced funding will be available until December 31, 2015, and the 75 percent matching rate will be available beyond that date, assuming qualification conditions are continually met.

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