§1396w–3 Enrollment Simplification and Coordination with State Health Insurance Exchanges

Summary

To get federal Medicaid funds for calendar quarters after January 1, 2014, a State must set up rules and tools so people can apply for, enroll in, and renew Medicaid or a Medicaid waiver online. The State must run a website that lets people sign electronically. The State must let its health insurance Exchange automatically enroll people the Exchange finds eligible for Medicaid, a waiver, or CHIP. If someone is ruled ineligible for Medicaid or CHIP, the State must check them for enrollment in an Exchange qualified health plan and for premium help under section 36B (and advance payments under section 18082) and enroll them without asking for another application. The State must share information securely between the Medicaid agency, the CHIP agency, and the Exchange, coordinate coverage for people who have both Medicaid/CHIP and an Exchange plan (including required child screenings), and do outreach to enroll vulnerable and underserved groups. The State Medicaid and CHIP agencies may make an agreement with the Exchange to determine who gets premium help if the Treasury Secretary sets rules to lower errors and costs. States must use the streamlined system under section 18083. The required website must be live and linked to the Exchange and CHIP agency by January 1, 2014, and must let people compare Medicaid or waiver benefits, premiums, and cost-sharing with Exchange plan options (including child and family coverage). These rules do not change the State’s duty to assess people for home and community-based services under existing Medicaid rules.