A Health & Human Services Department panel said it will propose the most minimal standards necessary to streamline processes for determining the eligibility and enrollment for a range of federal and state social and human service programs.
The panel will identify standards for exchanging eligibility and enrollment data electronically among disparate federal and state health and social service programs.
The programs include insurance plans that will be offered through state insurance exchanges to be set up under the new health reform law.
The enrollment standards work group, made up of members of the Health IT Policy and Standards committees as well as outside experts, said it would identify the standards by Sept. 30.
"We need to keep it simple. We will be thinking big, but we want to start small," said Aneesh Chopra, the chairman of the work group and White House chief technology officer.
"We've got to work from where we are, and ideally where there are proven standards in place, and how we can scale them," he said.
The standards will be designed to simplify enrollment in federal and state health and human services programs by multiple means, including electronic matching across state and federal databases, reuse of eligibility information and the capability for individuals to maintain eligibility information online.
People will seek health insurance through different paths, said Penny Thompson, deputy director for the Center for Medicaid, CHIP (Children's Health Insurance Program), Survey and Certification in the Centers for Medicare and Medicaid Services.
"They will come in through an [insurance] exchange door and through a Medicaid door, and in either instance that agency or system must be able to make a determination on behalf of the other and exchange that data for the purposes of enrollment," Thompson said.
The health reform law was written to "make this system work for the person seeking coverage and placing the burden on the system as to where that person belongs," she said.
Under the health reform law, a secure electronic interface must be developed to enable state insurance exchanges, Medicaid and CHIP to share data and determine eligibility for all programs, Thompson said.
HHS must launch an online site on July 1 to provide public information about health insurance exchanges. Over time, the Website must also provide links to state health insurance exchange portals and with state Medicaid sites.
Ruth Kennedy, Louisiana CHIP director and Medicaid deputy director of the Louisiana Department of Health and Hospitals, described the state's electronic eligibility efforts for Medicaid and CHIP.
Louisiana has automatically enrolled children based on eligibility data for other needs-based programs, such as food stamps, despite the programs being housed in separate systems, she said.
"The myriad of issues that must be resolved to automatically enroll individuals by creating an interface and importing data from another system are immense, but they are not insurmountable," Kennedy said.
