42 USC 18083 - Streamlining of procedures for enrollment through an Exchange and State medicaid, CHIP, and health subsidy programs

U.S Code last checked for updates: Nov 22, 2024

§ 18083.

Streamlining of procedures for enrollment through an Exchange and State medicaid, CHIP, and health subsidy programs

(a)

In general

(b)

Requirements relating to forms and notice

(1)

Requirements relating to forms

(A)

In general

The Secretary shall develop and provide to each State a single, streamlined form that—

(i)

may be used to apply for all applicable State health subsidy programs within the State;

(ii)

may be filed online, in person, by mail, or by telephone;

(iii)

may be filed with an Exchange or with State officials operating one of the other applicable State health subsidy programs; and

(iv)

is structured to maximize an applicant’s ability to complete the form satisfactorily, taking into account the characteristics of individuals who qualify for applicable State health subsidy programs.

(B)

State authority to establish form

(C)

Supplemental eligibility forms

(2)

Notice

(c)

Requirements relating to eligibility based on data exchanges

(1)

Development of secure interfaces

(2)

Data matching program

Each applicable State health subsidy program shall participate in a data matching arrangement for determining eligibility for participation in the program under paragraph (3) that—

(A)

provides access to data described in paragraph (3);

(B)

applies only to individuals who—

(i)

receive assistance from an applicable State health subsidy program; or

(ii)

apply for such assistance—

(I)

by filing a form described in subsection (b); or

(II)

by requesting a determination of eligibility and authorizing disclosure of the information described in paragraph (3) to applicable State health coverage subsidy programs for purposes of determining and establishing eligibility; and

(C)

consistent 2

 So in original. Probably should be preceded by “is”.

with standards promulgated by the Secretary, including the privacy and data security safeguards described in section 1942 of the Social Security Act [42 U.S.C. 1396w–2] or that are otherwise applicable to such programs.

(3)

Determination of eligibility

(A)

In general

Each applicable State health subsidy program shall, to the maximum extent practicable—

(i)

establish, verify, and update eligibility for participation in the program using the data matching arrangement under paragraph (2); and

(ii)

determine such eligibility on the basis of reliable, third party data, including information described in sections 1137, 453(i), and 1942(a) of the Social Security Act [42 U.S.C. 1320b–7, 653(i), 1396w–2(a)], obtained through such arrangement.

(B)

Exception

(4)

Secretarial standards

(d)

Administrative authority

(1)

Agreements

(2)

Authority of exchange to contract out

Nothing in this section shall be construed to—

(A)

prohibit contractual arrangements through which a State medicaid agency determines eligibility for all applicable State health subsidy programs, but only if such agency complies with the Secretary’s requirements ensuring reduced administrative costs, eligibility errors, and disruptions in coverage; or

(B)

change any requirement under title XIX ¹ that eligibility for participation in a State’s medicaid program must be determined by a public agency.

(e)

Applicable State health subsidy program

In this section, the term “applicable State health subsidy program” means—

(1)

the program under this title 3

 See References in Text note below.

for the enrollment in qualified health plans offered through an Exchange, including the premium tax credits under section 36B of title 26 and cost-sharing reductions under section 18071 of this title;

(2)

a State medicaid program under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.];

(3)

a State children’s health insurance program (CHIP) under title XXI of such Act [42 U.S.C. 1397aa et seq.]; and

(4)

a State program under section 18051 of this title establishing qualified basic health plans.

(Pub. L. 111–148, title I, § 1413, Mar. 23, 2010, 124 Stat. 233.)

cite as: 42 USC 18083