The Affordable Care Act (ACA) expands health coverage under Medicaid, creates subsidies for private coverage through a Health Benefit Exchange, and mandates that individuals have health insurance coverage. To accomplish these goals, the ACA presents states with a roadmap for a modern, streamlined, and seamless system that integrates Medicaid, the Children's Health Insurance Program, and exchange eligibility screening and enrollment.

CHCF commissioned the National Academy for State Health Policy (NASHP) to identify opportunities for states in implementing these ACA enrollment provisions. At this CHCF-sponsored Sacramento health policy briefing, NASHP presented the ACA's vision for a modernized eligibility and enrollment process in a post-health reform environment, and discussed potential challenges as states shape enrollment systems with recent federal guidance. A panel discussed ACA and enrollment provisions in a California context.

The speakers were:

• Kim Belshé, California Health and Human Services Agency
• Alice Weiss, National Academy for State Health Policy
• Toby Douglas, California Department of Health Care Services
• Elizabeth Landsberg, Western Center on Law & Poverty
• Will Lightbourne, Social Services Agency of Santa Clara County and California Welfare Directors Association (CWDA)

Highlights from the presentation were:

• Alice Weiss provided a comprehensive overview of the vision in the ACA for an “enrollment superhighway.” Her presentation identified gaps and challenges for states, and she described experiences and opportunities of states to help prepare for ACA implementation in 2014.
• Toby Douglas briefly described the options the state can pursue for enrolling and reenrolling the 5.5 to 6.5 million people under the new modified adjusted gross income (MAGI) rules. The options Douglas identified are to build a new rules engine that connects to county systems and eventually phases them out, or to build a new rules engine from the ground up. He indicated that there are five systems in the mix — six, including the exchange. Douglas made it clear that the federal government requires consumer-friendly and one-time system investments.
• Will Lightbourne pointed out that the system must be certified by the federal government by October 2013. He advanced four approaches on behalf of CWDA: Build on what works, add MAGI rules to existing Statewide Automated Welfare System (SAWS), link systems using service-oriented architecture, and use this opportunity to update the Medi-Cal Eligibility Data System (MEDS).
• Elizabeth Landsberg urged a "no wrong door" approach with consistency of rules and methodology, confidentiality, real-time determinations, consumer assistance, language appropriate assistance, and options for enrollment in a full array of programs.

The presentation slides are available as a Document Download. A video recording of the event is available on the California Channel site listed under External Links.