Update on Health Care Reform Implementation

In 2010, the Affordable Care Act introduced healthcare legislation to protect consumers, improve quality of care, lower overall costs of healthcare, and increase access to affordable care. Families raising children with special health care needs and/or disabilities were among the first to feel the impact of this legislation. Many families have benefited from the requirement that health plans cannot limit or deny benefits or deny coverage for a child younger than age 19 simply because the child has a “pre-existing condition”—that is, a health problem that developed before the child applied to join the plan; and the ability add or keep your children on your health insurance policy until they turn 26 years old.

As we move closer to full implementation of the law in 2014 many of our members are interested in learning more about how it will impact them. We are excited by your interest and encourage you to stay engaged. One piece of the legislation that will touch many Hoosiers is the increased eligibility for Medicaid. As a provision of that law, millions of currently uninsured Americans will gain access to Medicaid coverage in 2014, when eligibility for coverage increases to 133% of the federal poverty level (FPL) (approximately $29,000 for a family of four), regardless of age.

As one of the many cost-saving and quality improvement measures of the ACA, states are required to streamline their eligibility processes and systems in order to ensure maximum participation in offered healthcare programs. To do this, states will be required to employ “express lane” technologies, such that public and health subsidy programs create shared database linkages. In other words, when a family applies for services, such as Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for the Needy (TANF), and others, their eligibility information would link to other similar programs. Moreover, these databases would also be linked to those operated by the Social Security Administration, Internal Revenue Service, and Department of Homeland Security.

Sharing of information among these agencies will not only streamline the process of determining eligibility and applying for services but will also help state and federal agencies identify individuals who may qualify for services. In order for their information to be shared, families must provide consent to share their information with other assistance programs (typically an element of present application processes).

According to the The Henry J. Kaiser Family Foundation’s “Focus on Health Reform,” by 2014, express lane strategies will automatically transition approximately 700,000 children whose family incomes fall between 100% and 133% FPL from Children’s Health Insurance Programs (CHIP) to Medicaid. Moreover, these strategies will serve to identify a large portion of the approximately 7 million uninsured children who currently qualify for either CHIP or Medicaid, and will therefore, lead to higher enrollment rates and lower rates of uninsured.

To further simply the process, uniform eligibility requirements that satisfy federal standards will be used for all programs. This measure is intended to further ease information sharing and avoid recalculation of “modified adjusted gross income.” It is also expected to improve the efficiency of the renewal process.

In addition to streamlined identification and enrollment for children, express lane technologies are expected to also simplify the eligibility process for some of the 32 million uninsured adults who are not currently enrolled in Medicaid or Medicare programs. Many of those individuals are parents of children who are currently receiving services under an assistance program. All adults will need to pursue enrollment in the state- and federally-funded programs.

While these data sharing strategies are expected to automatically identify many of currently uninsured Americans, it is important to note that some families may remain unidentified. Examples include families whose income falls below tax filing requirements and those whose circumstances have changed since the most recent data collection and/or application for services.

It is hoped that these technologies will not only increase identification and delivery of services to children and adults but also reduce long term costs associated with processing paperwork, especially in regards to applications for multiple services and renewal of services. Moreover, linkages between state and federal databases will facilitate transition of services across state lines.

To ensure compliance and ease the burden on the states, the federal government will match up to 90% of state expenses for development of exchange and data sharing systems and 75% of maintenance costs. In May 2011, the US Department of Health and Human Services Awarded Indiana a $6.8 million grant in order to support upgrades and development of the information technology necessary for compliance with the ACA.