§18083 Streamlining of procedures for enrollment through an Exchange and State medicaid, CHIP, and health subsidy programs

Summary

Set up a system so people in each State can apply for, get a decision about, and stay enrolled in the different state health help programs. If someone applies through an Exchange and a screening shows they qualify for Medicaid or CHIP, they must be signed up for that program. The federal Secretary must give each State one simple, streamlined application form that works for all the covered programs, can be filed online, in person, by mail, or by phone, and is easy for people to fill out. States may use their own form if it meets the Secretary’s rules. People who file the form should get an eligibility notice without having to send more papers unless the information conflicts with checks or the law requires extra documents. States must build a secure electronic system so data from one application can be shared and used to decide eligibility for all their programs. Programs must join a data-sharing setup that lets them check reliable third-party records to confirm and update eligibility, while following privacy and security rules. The Secretary will set standards for how the data checks work and may make model data-sharing agreements. States’ Medicaid agencies may run eligibility for all programs if they meet the Secretary’s requirements, but Medicaid eligibility must still be determined by a public agency. Applicable State health subsidy program means: enrollment in qualified health plans through an Exchange (including premium tax credits and cost-sharing reductions); a State Medicaid program; a State CHIP program; and a State program that creates qualified basic health plans.