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Transitioning to SBM in Determination States - There are many considerations when a state decides to transition off the Federally Facilitated Marketplace (FFM) and establish a state-based marketplace (SBM). One such decision is whether the SBM will assess or determine eligibility. In this paper, we explore the policy and technical design impacts, program integrity opportunities, as well as opportunities for public health advancement when a state decides to operate as a “determination state” for the purposes of MAGI Medicaid eligibility.
Designing an Eligibility Determination System - States planning their transition from the FFM to a state-based marketplace (SBM) need to thoughtfully design their eligibility determination system to meet a state’s unique policy needs and diverse consumer characteristics. The system needs to be flexible enough to easily keep pace with the state’s evolving vision and changing goals while ensuring program integrity without disrupting existing processes. The most desirable scenario is one in which all stakeholders — the exchange, the Medicaid department, and the technology vendor—collaborate and partner.
SaaS vs. Custom – Technology Choices for State Healthcare IT Implementation: A state’s choice of a technology platform in building a state-based marketplace (SBM) impacts policy considerations, budgets, timelines, and overall success of an exchange. This white paper takes a look at the impact each type of build can have on an SBM’s overall performance.
Easy Enrollment – A Facilitated Enrollment Strategy for the Uninsured: Since 2017, the non-elderly uninsured population rate has steadily risen, and this population faces tremendous financial and health risks. States, starting with Maryland, have adopted initiatives to reduce the number of uninsured. Maryland’s Easy Enrollment Health Insurance Program leverages the relationship between tax filing and eligibility for insurance and is the country’s first attempt to use income-tax filing as an on-ramp to health coverage for the uninsured. We describe best practices that states can adopt to implement a similar program to encourage eligible uninsured people to get health insurance coverage.
Enhanced Direct Enrollment (EDE): Enhanced Direct Enrollment (EDE) is a new standard created by the Centers for Medicare and Medicaid Services (CMS) that will simplify enrollment in health plans sold through the Federally Facilitated Marketplace (FFM) for the 2019 Open Enrollment Period, allowing brokers and consumers to start and finish their health insurance enrollments on a single website. GetInsured was a pioneering participant in the early CMS discussions on how to best build an EDE pathway and is one of the only companies to complete all three phases.