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maxenroll Bachrach 033011.pdf - National Academy for State Health ...

maxenroll Bachrach 033011.pdf - National Academy for State Health ...

esult in changes in

esult in changes in eligibility year-to-year, this remedy would also provide coverage continuity byallowing them to stay in the same plan, albeit with a different level of subsidy. 20Enrolling Consumers in CoverageSummaryA key function of the Exchange is creating a marketplace in whichconsumers may shop and select and enroll in health insurance. TheACA mandates that Exchanges be accountable for eligibilitydeterminations but not explicitly for Medicaid/CHIP health planenrollment actions.IssuesStates must address how to meet streamlining and customerexperience goals through both eligibility determinations andenrollment functions. Despite the fact that the ACA doesnʼt giveaccountability for Medicaid or CHIP health plan enrollment to theExchange, states must design business processes and technicalsystem supports that work effectively across the Exchange andMedicaid for both eligibility and enrollment functions.Decision Points for States o How will the state implement health plan enrollment forconsumers who are determined Medicaid/CHIP-eligiblethrough the Exchange?ooShould states integrate Medicaid/CHIP health plan enrollmentinto the Exchange enrollment function? What are the technicaloptions for making this happen?Can both fee-for-service and managed care Medicaidenrollment be effectuated in the Exchange?Providing Consumer Outreach and EducationIn order to access health subsidies and coverage enrollment, consumers will require significantinformation about their coverage options and how to access the Exchange. By 2014, stateExchanges must establish grant programs to award funding to “Navigators,” entities that will provideconsumers with fair and impartial information about their health insurance options, and offerassistance to facilitate enrollment in health insurance coverage. 21 The Navigator program is intendedto support robust consumer outreach and education regarding the:ooooValue of health insurance;Availability of subsidies to offset premium costs;Mandate to purchase insurance; andTypes of subsidies and coverage available.20 Rosenbaum S. and Sommers B., "Issues in Health Reform: How Changes in Eligibility May Move MillionsBack and Forth Between Medicaid and Insurance Exchanges," Health Affairs, Issue No. 2. Vol. 30 228-236.21 ACA, Sec. 1311(i). Medicaid’s Role in Exchanges -12

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