By Claudia Page, Social Interest Solutions

The Affordable Care Act (ACA) is truly a game-changer in how consumers will connect to coverage. For many consumers, especially low-income individuals in need of public benefits, seeking coverage today is a complicated maze of paper forms and referrals, disconnected eligibility systems and silos, multiple trips to social services offices and confusing communication about eligibility and enrollment. Consumers knock on multiple doors and still, many miss out on coverage options and assistance for which they may be eligible.

But in January 2014 with the full implementation of ACA, consumers will open one door and it will lead them to Medicaid, CHIP, health insurance subsidies, private coverage and other social services such as SNAP and TANF.  By January 2014, policies, procedures and enrollment IT systems will need to support this new vision.  To this end, while new eligibility rules and other operational policies are still being ironed out, the Secretary of Health and Human Services recently adopted a series of Enrollment IT Standards for use by states and federal agencies implementing ACA.  The standards were mandated by Section 1561 of the health reform legislation, developed by a workgroup of stakeholders co-chaired by U.S. Chief Technology Officer Aneesh Chopra and California Healthcare Foundation Vice President Sam Karp, and are now posted on the web site of the National Coordinator for Health Information Technology. They are worth a read, as are the accompanying appendices.  At a high level, the standards support the following vision:

• All people have the opportunity to make informed choices about their health coverage and other benefits.
• Consumers apply online, renew coverage online, and learn about final determination online.
• Systems talk to each other and share and store information so consumers don’t have to provide the same information over and over again.
• Information provided for one program is used to support consumers through their permission and direction in applying for other programs for which they may be eligible.
• Consumers will be able to see data provided by federal verification systems and provide appropriate updates or information to validate their current situation.
• Consumers will be able to download and re-use the information they provide for program eligibility for other purposes, similar to the Veteran’s Administration “Blue Button” approach.
• The process is transparent and enables consumer participation, thereby reducing burden on everyone — including states and counties.

While it may seem overwhelming to imagine getting state enrollment systems from where they are now to where they need to be in 2014, the good news is current technology has the ability to handle connectivity and communication among different systems regardless of how they are built and how they function. Because most states do not have the resources or time to rip and replace legacy systems to accommodate the changes required by ACA, learning about and implementing newer solutions for integration will be critical. That said, the clock is ticking and is important for states to begin assessing their systems against the standards that have been posted and learning about integration solutions now.

Editor’s Note: Social Interest Solutions helped to draft Section 1561 of the Affordable Care Act and is currently consulting to the Office of the National Coordinator, Department of Health and Human Services, regarding development and implementation of online enrollment standards. Social Interest Solutions operates the One-e-App online enrollment system in Arizona, California, Maryland and Indiana. 

The views expressed by Guest Bloggers do not necessarily reflect the views of the Center for Children and Families.