States tracking along with ACA requirements

The Affordable Care Act (ACA) requires the federal government and states to offer residents streamlined application and enrollment systems -- online and through traditional methods -- for Medicaid, CHIP and state insurance exchanges.

Most states are on track to meet requirements for upgrading their Medicaid management systems and sharing data with federal agencies, but a few have been struggling and won’t meet January 2014 deadlines, according to the Department of Health & Human Services (HHS)’ Office of the Inspector General (OIG).

Of the 45 states that responded to the OIG’s survey in April 2012, 35 anticipated having ACA-ready systems — including streamlined application forms and meeting data-sharing requirements — by January 2014, while several cited challenges with the deadline, legacy IT systems and funding shortfalls.

Thirty-five states told the OIG they would likely meet all the requirements by January 2014, while nine said they probably won’t. Thirty-eight states anticipate meeting requirements for eligibility and enrollment, while five do not.

Forty states are on track to meet application form requirements, while two are not, and 37 states anticipate meeting data-sharing and matching requirements and having secure electronic interfaces for January 2014, while five (Florida, Idaho, Nebraska, New Hampshire and Oklahoma) do not.

Thirty-one states told OIG they had agreements with at least one of the federal agencies required for data verification. All 31 had agreements with the Social Security Administration, while only 20 and 13 had agreements with the Internal Revenue Service and Department of Homeland Security, respectively.

Eleven states told OIG their main challenge was outdated eligibility and enrollment systems, describing their existing systems as decades old and lacking the functionality for streamlined processes.

One state, unnamed, told OIG: “Without a prior online system, we are having to create something from scratch. Creating both the policy and technical capacity in such a short timeframe, with inadequate federal guidance, is the biggest hurdle.”

Nebraska told the OIG it would take up to four years to implement a system meeting all of the requirements, and New Hampshire said it was having difficulty obtaining funding to make the necessary system changes.

In the past year, HHS has stepped up guidance on the next enrollment requirements, in addition to providing financial support.

In late January, HHS published guidance on the federal application form states can use in lieu of their own, including a list of questions and the business logic contained in the online application.