1. Harmonizing Eligibility, Enrollment and
Coverage: Can States Hit the Right Notes?
What ACA Means for States
Alice Weiss
Program Director, NASHP
NASHP 23rd Annual
State Health Policy Conference
New Orleans, LA
October 5, 2010

2. March 23 – ACA Becomes Law

3. Eligibility Transformation
Major Medicaid Eligibility Expansion
Streamlined Medicaid Eligibility Test
MAGI (with Medicaid “point in time’ and “countable
sources of income rules”)
Subsidized Coverage Through Exchanges
More Stringent Regulation of Private Coverage
MOE for Current Medicaid and CHIP Eligibility

4. Streamlined Enrollment
Single Application Form for All Programs
Minimum Documentation Standard
Application Online, By Phone, In Person, By Mail
“No Wrong Door”
“Screen and Enroll” Promotes Seamless
Coverage, Transitions
Presumptive Eligibility Option

5. New Coverage Imperative
Individual Mandate
Children Must Be Enrolled When Parents Enroll
Exchange Coverage Options
Consumer Assistance
>> Paradigm Shift Towards Universal Coverage

6. Unprecedented Challenges…
Financial and Political
Complexities of New Rules
Systems Upgrades
Local Administration
Culture Change
Rapid Pace of Change

7. … and Opportunities
Paradigm Shift Rewards for States, Consumers
System Reform Goals Within Reach
Quality/Provider Payment
Vertical/Horizontal Integration of Eligibility Systems
Changes to Local/State Relationship
Health Disparities
Moving the Needle on Uninsured

8. Questions?
Alice Weiss
Program Director, NASHP
Deputy Director, Maximizing Enrollment for Kids
1233 20th Street NW, Suite 303
Washington, DC 20036
202-903-0101
aweiss@nashp.org