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 (see text box below). The aim is to make enrollment and renewal in Medicaid and exchanges easy, seamless, readily accessible, and consumer-friendly. Some of the major provisions included in the ACA and subsequent guidance pertaining to eligibility and enrollment include that individuals have a "first class customer experience" comparable to that of major commercial websites such as Amazon; that individuals have multiple ways to apply for coverage (online, by mail or phone and in person); that a single streamlined application can be available to apply for Medicaid, CHIP or exchange coverage; to the extent possible that systems match with other data systems to verify eligibility; and that the most advanced technologies are used in developing these systems. To a large 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timeframe and, moreover, that many states currently have Medicaid eligibility and enrollment systems that are terribly outdated, with some still relying heavily on paper forms and processes that are not electronically connected to other state or federal programs. To help states modernize their eligibility and enrollment systems and bring them into compliance with the ACA, the federal government is making significant funding available to states. A major source is the health insurance exchange planning and establishment grants that, among other things, provide states resources to research and plan for their exchange eligibility and enrollment systems as well as to establish them. In addition, in 2011 the federal government awarded "Early Innovator" grants to seven states to design and implement IT systems to support their health insurance exchanges. Another major source of federal funding aimed to help states improve their Medicaid and CHIP IT systems is through the Medicaid Information Technology Architecture (MITA) initiative. Under MITA states can obtain up to a 90 percent matching rate to overhaul or enhance their IT systems. Given the link between the exchange, Medicaid, and the CHIP programs envisioned under reform, having an up-to-date IT system for these programs is also critical. In this brief we draw on the experiences of five states--Colorado, Kansas, Minnesota, New York and Oregon--that received federal grant funding from the Health Resources and Services Administration (HRSA) through the State Health Access Program (SHAP). Launched in 2009, before enactment of the ACA, SHAP grants were designed to help states expand health coverage to uninsured individuals using approaches that included community-based outreach and improvements to Medicaid/CHIP eligibility and enrollment processes. We describe the best practices that these states shared with regard to their 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.
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