An HHS advisory panel recommended states look to federal agencies for examples of how to set up enrollment and eligibility systems for the electronic insurance "exchanges" states are required to build under the recent health reform law.
In an Aug. 12 meeting, members of the HIT Policy Committee's enrollment workgroup said the Internal Revenue Service, the Social Security Administration and the Homeland Security Department provide verification of personal income, citizenship and legal residence through electronic interfaces and Web services for some federal programs.
Instead of reinventing the wheel, states should use these tools to develop their insurance exchanges, which are intended to offer a convenient and economical way for people who do not qualify for Medicaid or employer-based insurance to purchase health insurance.
Policymakers also recommended that the technology be made available to state health and human services, such as Medicaid, the Children's Health Insurance Program and the Supplemental Nutrition Assistance Program.
Where practicable, state health and human services programs should also use federal or national data sources to verify key pieces of an applicant's eligibility information, said Steven Fletcher, Utah's chief information officer and a member of the panel. He cited the national database of Departments of Motor Vehicles as a potential data source.
"We tried to identify those [services] in existence that we use for verification, put some standards around them, and a straw man example to look at how to use and modernize them among many different programs," he said.
The panel also proposed that HHS' Office of Child Support Enforcement develop the technical infrastructure to enable inquiries into the national Directory of New Hires so states can access and verify an individual's job status, wages and unemployment information, he said.
Besides considering individual verification services, the panel advocated that an automated verification Web service or engine be built around a number of base services that could be updated and expanded over time, such as standards translators states with legacy information systems could use to tap federal data sources.
The health reform law will make millions more Americans eligible for health insurance, and states will take the lead to direct individuals to Medicaid services, high risk pools and other public and private health plans.
To make that transformation more efficient, the health reform law passed earlier this year required that various government agencies simplify the process needed to electronically exchange information for deciding eligibility and enrollment in those programs.
"What we know is that there is tremendous variation of how eligibility and enrollment are done in the states and that there is a lack of standardization. They have a great openness to uniformity," said Sam Karp, co-chairman of the enrollment work group and vice president of programs for the California Healthcare Foundation.
The work group must finalize its recommendations by Sept. 30 to meet the requirements of the Affordable Care Act.
