Our good friend Beth Morrow at The Children’s Partnership (TCP) posted a blog last week to highlight a new issue brief on the importance of moving access to public health coverage to smart phones and other mobile devices. I’m all for it but let’s not forget we still have some catching up to do on web-based side of things.

In our survey of Medicaid and CHIP programs, in partnership with the Kaiser Commission on Medicaid and the Uninsured, we reported that just over half of the states (29) have Medicaid applications that can be submitted electronically with an electronic signature. Three more have electronically-submitted Medicaid applications but require applicants to print out the form or a signature page to be signed and mailed or faxed to the appropriate eligibility office.

Given the proliferation of web-based functionality, why aren’t more states using technology to provide applicants with a cost-efficient way to apply? One big reason is the cost of technology, which the Department of Health & Human Services (HHS) is helping to address through a variety of funding opportunities: exchange innovator grants, exchange establishment grants, a proposed rule to provide 90% federal match for Medicaid eligibility systems and even through the latest round of CHIPRA outreach grants.

But cost isn’t the only issue. Another concern we’ve heard is that there is hesitancy on the part of some states due to a lack of clarity about e-signatures. So we dug into this topic a bit and found more questions than answers, which are raised in this new CCF brief on e-signatures.

Going forward, online applications and electronic signatures will no longer be optional for states. The Affordable Care Act (ACA) requires that states establish an internet website allowing individuals to apply for, enroll in and renew coverage using e-signatures. This vision for seamless access to coverage through a single web portal, if implemented properly, will ensure that individuals are screened and enrolled in the appropriate coverage option, be it Medicaid, the Children’s Health Insurance Programs (CHIP) or the Exchange.

Electronic signatures are clearly permissible, however any lingering uncertainty over their use needs to be resolved. Federal guidance on a number of related questions could help accelerate state implementation and move us closer to harnessing the power of technology to promote administrative efficiency and ease of access to public coverage.