Simplified, Real-Time Verification Issue Brief

Prepared for the Centers for Medicare & Medicaid Services' Medicaid and CHIP Learning Collaboratives 

The Affordable Care Act (ACA) requires a coordinated and streamlined eligibility and enrollment process for all Insurance Affordability Programs (IAPs), including Medicaid, the Children's Health Insurance Plan (CHIP), and advance premium tax credits/cost sharing reductions to purchase Qualified Health Plans (QHPs). Beginning in 2014, individuals will be able to apply for IAP coverage using a single, streamlined application which may be submitted online, by telephone, through the mail, or in person to the Medicaid/CHIP agency or new Health Insurance Exchanges (Exchange). Eligibility will be verified primarily through self-attestation and electronic data accessed through the federal data services hub (FDSH) and other state, federal and private data sources. These requirements are intended to promote real time eligibility and enrollment in IAPs. 

The brief provides important "lessons learned" from the states of Oklahoma, Oregon and Louisiana and offers best practices for states as they design their Medicaid and CHIP verification policies and procedures.



pursuant to New York DR 2-101(f)

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