Enrollment and Eligibility In Health Care Reform

After health care reform passes it’s final hurdle and is passed into law, the next major problem facing reformers will be implementing the bill so that before the next several elections it appears to be a success.  Success means the number of uninsured will be reduced and the benefits promised will get to the individuals in need.  Unfortunately, the current versions of the bill do not make this process simple.

The Urban Institute released a report yesterday that highlights the key changes that can be made to the House and Senate bills that will make enrollment, eligibility determination, and retainment in Medicaid and to receive subsidies in the exchange easier.  Some of their recommendations include:

The streamlining provisions contained in Section 1413 of the Senate bill,

which require a single application form and eligibility system for all subsidies

under reform (Medicaid, CHIP, and subsidies in the exchange) and which

take other steps to base eligibility on government data whenever possible,

thereby reducing the need for consumers to complete forms before receiving

or retaining coverage;

The corrections to that section contained in Senate Amendment 3167,

which apply to Medicaid the same streamlined procedures for eligibility and

enrollment that are planned for the exchange; and

A compromise between annual eligibility periods in the Senate bill and

“real time” eligibility updates in the House bill that establishes annual

subsidy eligibility, as a general rule, while making exceptions for essential

mid-year adjustments.

While these provisions may appear to be minor in comparison to the top-line provisions such as abortion, taxes, and the national exchange currently plaguing Congressional leaders, making the enrollment process simple is the key to the bill’s success.  The Medicaid expansion equates to 41% of the newly insured.  States will need assistance in ensuring that as many of the newly eligible for Medicaid sign up for the state based program.  Whether the exchange is national or state based, the administration and determination of eligibility for subsidies must be easy for the consumer.

Without a streamlined and efficient process for individuals to participate in the new and expanded programs created by the bill, the work of reformers is wasted.



Filed under Health Policy

2 responses to “Enrollment and Eligibility In Health Care Reform

  1. Have been searching for some decent information on this for awhile now thats for the great article.

  2. Thanks for talking about this subject. I had been looking for good information about it.

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