Simplified, Real-Time Verification Issue Brief

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.i,ii These requirements are intended to promote real time eligibility and enrollment in IAPs.

States have significant flexibility in determining their verification policies and procedures for Medicaid and CHIP, including determining the data sources on which to rely and the circumstances under which the information an applicant attests to will be considered reasonably compatible with the information obtained through electronic data sources and enrolled. Where the attestation is reasonably compatible with the data, no additional information may be requested from the applicant.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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