The Affordable Care Act (ACA) requires that most Americans have health insurance by January 1, 2014. Through an expansion in Medicaid and a system of state-based and federal health insurance exchanges, an estimated 32 million newly eligible individuals will gain coverage under the law. To help achieve this coverage goal, the ACA also includes several provisions that call for major changes in state eligibility and enrollment processes currently used in public health insurance programs. The aim is to make enrollment and renewal in Medicaid and exchanges easy, seamless, readily accessible, and consumer friendly. To a great extent, much of the responsibility for creating these eligibility and enrollment systems resides with the states. This is a tall order, particularly given the short timeframe and, moreover, that many states currently have Medicaid eligibility and enrollment systems that are terribly outdated, with some still relying heavily on paper forms and processes that are not electronically connected to other state or federal programs. In this brief we draw on the experiences of five states--Colorado, Kansas, Minnesota, New York, and Oregon--that received federal grant funding to expand health coverage using approaches that included community-based outreach and improvements to Medicaid/CHIP eligibility and enrollment processes. We describe the promising approaches that these states shared with regards to activities related to outreach, streamlining application and enrollment processes, and modernizing eligibility determination systems; and consider the implications of these practices for implementing the ACA. Given that Kansas, New York, and Oregon were recipients of three of the seven Early Innovator grants initially awarded by the federal government in February 2011 to states for IT systems development, our study states include recognized leaders in terms of readiness and ability to develop eligibility and enrollment processes systems that will comply with provisions set out in the ACA.
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