ACA Now

Implementation Status

2012

The March 23, 2012, the Medicaid eligibility final rule established standards for Medicaid and CHIP programs regarding the use of a single, streamlined application.

The March 27, 2012, Exchange establishment final rule includes several provisions relevant to this section’s implementation, including details on the single streamlined application.

On December 10, 2012, CMS sent an FAQ to all State governors regarding Exchanges, market reforms and Medicaid expansion, which includes a section on consumer eligibility and enrollment.

2013

On January 14, 2013, HHS issued a proposed rule on a variety of topics relating to Exchanges, Medicaid and CHIP, including appeals, notices, benefits, cost-sharing, eligibility categories, verification of employer-sponsored coverage and application counselors. HHS also posted a fact sheet summarizing the rule.

On January 15, 2013, CMS – via Paperwork Reduction Act data collections – released drafts of the individual, small employer and small business employee applications that are slated for finalization in spring 2013. Also see a related Federal Register information collection.

On February 8, 2013, and February 11, 2013, CMS conducted webinars illustrating the seamless enrollment process and posted videos demonstrating the application process.

On February 21, 2013, CMS released an information bulletin informing States of the verification plans underway for determining MAGI-based eligibility for Medicaid and CHIP. In conjunction with this release, the HHS Office of the Inspector General (OIG) released a report examining the extent to which states intend to streamline eligibility and enrollment under Medicaid, CHIP and their Exchange.

On March 18, 2013, HHS held a National Health Insurance Marketplace Stakeholder Conference Call in which agency officials provided updates on the operational execution of State Partnership and Federally Facilitated Marketplaces, noting the Federal Data Services Hub – a single access point for verifying determinants of subsidy and other program-related eligibility – is “nearly complete.”

On April 30, 2013, HHS released revised – and shortened – versions of the single, streamlined health insurance application for individuals and families seeking financial assistance via Qualified Health Plans in Health Insurance Marketplaces, including any applicable advance premium tax credits, as well as Medicaid and CHIP. HHS also posted an application form for individuals not seeking financial assistance.

On June 18, HHS released guidance for states on the process for developing and seeking approval for alternatives to the model single, streamlined application – released on April 30 –  for QHPs, premium subsidies, cost-sharing reductions and Medicaid and CHIP. CCIIO notes certain adaptations that do not necessitate CMS approval.

On July 5, CMS issued a final rule with wide-ranging eligibility provisions, including several regarding Exchanges’ eligibility and enrollment. Specifically, before January 1, 2015, State-based Exchanges may “accept the applicant’s attestation regarding enrollment in an eligible employer-sponsored plan and eligibility for qualifying coverage in an eligible employer sponsored plan for the benefit year for which coverage is requested without further verification.” For income verification, for the first year of operations, rule note that CMS is “providing Exchanges with temporarily expanded discretion to accept an attestation of projected annual household income without further verification” applicable to individuals who are not part of a statistically-significant sampling strategy that is delineated in the rule. Other provisions address, among others, authorized representatives, enrollment-related transactions, special enrollment periods and terminations. Also see a July 8 Paperwork Reduction Act package related to information collection under the Exchange-related provisions of this rule.

On July 17, CMS submitted for OMB review and requested comment on an information collection activities notice regarding the certified application counselor program under which Exchanges will certify CACs directly or via CAC organizations, which will be designated to certify their staff and volunteers. Comments on the information collection are due on August 14, 2013. Also see the Paperwork Reduction Act package containing CMS’s supporting statement.

On July 2, CMS issued a statutorily required privacy notice noting the establishment of a Computer Matching Program to share data with State-based Administering Entities that administer insurance affordability programs (e.g., Medicaid, CHIP, Basic Health Plan, Marketplace); the data-sharing will facilitate “Eligibility Determinations for Insurance Affordability Programs and certificates of exemption,” the agency said.

On August 19, CMS detailed in Federal Register a Computer Matching Program with the Department of Homeland Security’s U.S. Citizenship and Immigration Services for verifying immigration status and citizenship as part of ACA eligibility determinations. Comments are due in 30 days. CMS also published Computer Matching Program Notices with the VA’s Veterans Health Administration (August 14; see here) and Social Security Administration (August 7; see here).

On August 30, CCIIO published a wide-ranging final rule (also see a factsheet) on Marketplace program integrity and other provisions, noting that it “generally is finalizing previously proposed policies without change.” The rule addressed oversight of Qualified Health Plan (QHP) issuers in Federally Facilitated Marketplaces; individual and SHOP eligibility appeals, including details on a “federally-managed appeals process [that] will be available for appellants in the individual market”; HHS privacy and security-related Marketplace compliance monitoring; an option for a state to operate a State-based SHOP, while having a Federally Facilitated Individual Marketplace; standards regarding issuers’ acceptance of various payment methods from Marketplace consumers; provisions addressing agents and brokers; QHP issuer direct enrollment; and a clarification regarding certain outside-the-Marketplaces plans’ participation in the risk corridors program.

On August 30, HHS released a Paperwork Reduction Act (PRA) Package including details on information collections associated with the August 30 Marketplace Program Integrity final rule, the provisions of which addressed an aspect of the risk corridors program, agents and brokers in Federally Facilitated Marketplaces and various other issues. The PRA package also contains provisions on additional information collections related to Navigators, certified application counselors and habilitative services, among other topics.

On September 26, CCIIO posted the final individual short form application – “Application for Health Coverage & Health Paying Costs (Short Form)” (also see instructions) – along with the individual application without financial assistance  (also see instructions). Additionally, CCIIO posted the family application (also see instructions).

On October 24, CMS released a final rule (see a CCIIO fact sheet) codifying certain program integrity-related components of the ACA pertaining to Exchanges, premium stabilization programs and market standards that were delineated in a June 2013 proposed rule. The final rule also amends and adopts as final provisions delineated in the Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 interim final rule with comment issued in March 2013 related to risk corridors and reconciliation of cost-sharing.