Online application will streamline procedures for state health programs


Starting in 2014, individuals will be able to use an integrated online form to apply for and make payment to different government programs such as Medicaid and insurance coverage offered by state exchanges.

The health reform law, which the Supreme Court recently upheld, streamlined procedures for application, determination of eligibility and enrollment for state Medicaid, Children’s Health Insurance Programs (CHIP) and subsidies for basic health plan programs.

To do that, a single application must incorporate the requirements needed to evaluate eligibility in the programs, match applicant data from other programs, and work with technology on the back end to collect and verify information.

The Centers for Medicare & Medicaid Services (CMS) will develop and provide for each state an integrated online form -- or states can create their own if it includes the standards to enable participation in the programs.

“The goal is to solicit sufficient information so that in most cases no further inquiry will be needed,” CMS said in a notice in the July 6 Federal Register. The notice provided additional details about the application and requested comments about its plans.

CMS is designing the single streamlined application to be a dynamic document that will tailor the amount of data required from an applicant based on the individual’s circumstances and response to particular questions.

According to CMS, the application will be easy to use and structured so an applicant can understand it and complete the form satisfactorily, “taking into account the characteristics of individuals who qualify for the programs,” the notice said.

Individuals will be able to submit an application online, through the mail, over the phone through a call center or in person. The paper version will not be able to be tailored to the extent of the online version.

CMS anticipates that the online application will take from 15 minutes to 30 minutes to complete, with the request for insurance subsidy on the higher end. The agency expects about 7.7 million to apply for the insurance affordability program for exchange plans between 2014 and 2016 and 1.14 million without the subsidies during the same time period.

CMS also provided more details about a similar streamlined form for employees to use to apply for coverage under the small business health option program (SHOP), which will enable small employers to offer employees qualified health plans in the small group market.

Employees who apply electronically will create an online account through which they can manage their enrollment, according to the notice.

CMS will also develop a model application and website that helps employers determine if they are eligible to participate in SHOP.

The Congressional Budget Office has estimated that about 1 million employees, plus their family members, will enroll for health insurance through SHOP in 2014 for a total of about 3 million individuals, according to the notice.

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