Opportunities under the Affordable Care Act for Human Services Programs to Modernize Eligibility Systems and Expedite Eligibility Determination

Opportunities under the Affordable Care Act for Human Services Programs to Modernize Eligibility Systems and Expedite Eligibility Determination Prepared by: Stan Dorn and Rebecca Peters The Urban Institute Under Task Order: HHSP23337405T Integrating Health and Human Services Programs and Reaching Eligible Individuals Under the Affordable Care Act Prepared for: Alana Landey Office of the Assistant Secretary for Planning and Evaluation, DHHS 21 July 2014 Project 08800-026-00 i Contents Executive Summary ...................................................................................................................................... ii Introduction ................................................................................................................................................... 1 Generous federal funding to modernize eligibility systems .......................................................................... 1 Opportunities presented by the ACA ..................................................................................................... 1 Background of enhanced federal funding and the cost-allocation exception................................... 2 Some basic ground rules of the cost-allocation exception ............................................................... 3 Options for taking advantage of this opportunity ................................................................................... 5 Jointly buying or building service capacities that will serve both programs ................................... 5 Developing an efficient interface between health and human services programs ........................... 5 Reducing the amount of work required from state Medicaid officials ............................................ 7 Using data from health programs to expedite eligibility determination and verification for human services programs ....................................................................................................................................................... 7 Opportunities presented by the ACA ..................................................................................................... 7 Options for taking advantage of this opportunity ................................................................................... 9 Gaining legal access to health programs’ eligibility records ........................................................... 9 Addressing differences between program rules for health and human services programs ............ 12 Conclusion .................................................................................................................................................. 14 About the authors and acknowledgments ................................................................................................... 14 Appendix A: Excerpts from final text of 45 CFR §155.260 and ACA §1411 ............................................ 15 Appendix B. Members of the Technical Working Group ........................................................................... 20 Notes ........................................................................................................................................................... 20 ii Executive Summary The Patient Protection and Affordable Care Act (Affordable Care Act or ACA) creates opportunities for human services programs to modernize their eligibility systems and to use data from health programs to streamline eligibility determination for human services. Modernizing eligibility systems For information technology (IT) improvements that are in place by no later than December 31, 2015, and that are required for Medicaid eligibility purposes, the federal Medicaid program will pay 90 percent of investment costs. Even if human services programs also benefit, a time-limited exception to normal cost-allocation rules eliminates the need for them to share in those investment expenditures, so long as the investment involves either—  the development or procurement of a business service that serves both Medicaid and human services programs; or  the construction of an interface between Medicaid and a human services program that helps the Medicaid program (1) verify eligibility or (2) “fast track” Medicaid enrollment of uninsured individuals, based on information in their human services case files. This step can also include development of functionality needed for the interface to obtain necessary information from human services records, functionality that can help the human services program in other ways as well. This opportunity is available in all states. Whether or not a state expands Medicaid eligibility, the ACA requires it to use data matches with reliable sources, whenever possible, to determine eligibility. That shift to data-driven eligibility has required, in turn, a significant investment of federal IT funds needed to modernize Medicaid’s previously outdated eligibi