42 U.S.C. § 1396w–3 | Enrollment simplification and coordination with State health insurance exchanges

(a)

Condition for participation in Medicaid

section 1396b(a) of this titleJanuary 1, 20141

1 So in original. Probably should be “are”.

As a condition of the State plan under this subchapter and receipt of any Federal financial assistance under for calendar quarters beginning after , a State shall ensure that the requirements of subsection (b) is  met.

(b)

Enrollment simplification and coordination with State health insurance exchanges and CHIP

(1)

In general

A State shall establish procedures for—

(A)

enabling individuals, through an Internet website that meets the requirements of paragraph (4), to apply for medical assistance under the State plan or under a waiver of the plan, to be enrolled in the State plan or waiver, to renew their enrollment in the plan or waiver, and to consent to enrollment or reenrollment in the State plan through electronic signature;

(B)

section 18031 of this title enrolling, without any further determination by the State and through such website, individuals who are identified by an Exchange established by the State under as being eligible for—

(i)

medical assistance under the State plan or under a waiver of the plan; or

(ii)

child health assistance under the State child health plan under subchapter XXI;

(C)

section 18082 of this title section 18071 of this title ensuring that individuals who apply for but are determined to be ineligible for medical assistance under the State plan or a waiver or ineligible for child health assistance under the State child health plan under subchapter XXI, are screened for eligibility for enrollment in qualified health plans offered through such an Exchange and, if applicable, premium assistance for the purchase of a qualified health plan under section 36B of the Internal Revenue Code of 1986 (and, if applicable, advance payment of such assistance under ), and, if eligible, enrolled in such a plan without having to submit an additional or separate application, and that such individuals receive information regarding reduced cost-sharing for eligible individuals under , and any other assistance or subsidies available for coverage obtained through the Exchange;

(D)

section 18031 of this title ensuring that the State agency responsible for administering the State plan under this subchapter (in this section referred to as the “State Medicaid agency”), the State agency responsible for administering the State child health plan under subchapter XXI (in this section referred to as the “State CHIP agency”) and an Exchange established by the State under utilize a secure electronic interface sufficient to allow for a determination of an individual’s eligibility for such medical assistance, child health assistance, or premium assistance, and enrollment in the State plan under this subchapter, subchapter XXI, or a qualified health plan, as appropriate;

(E)

section 1396d(a)(4)(B) of this title section 1396d(r) of this title section 1396a(a)(43) of this title coordinating, for individuals who are enrolled in the State plan or under a waiver of the plan and who are also enrolled in a qualified health plan offered through such an Exchange, and for individuals who are enrolled in the State child health plan under subchapter XXI and who are also enrolled in a qualified health plan, the provision of medical assistance or child health assistance to such individuals with the coverage provided under the qualified health plan in which they are enrolled, including services described in (relating to early and periodic screening, diagnostic, and treatment services defined in ) and provided in accordance with the requirements of ; and

(F)

conducting outreach to and enrolling vulnerable and underserved populations eligible for medical assistance under this subchapter or for child health assistance under subchapter XXI, including children, unaccompanied homeless youth, children and youth with special health care needs, pregnant women, racial and ethnic minorities, rural populations, victims of abuse or trauma, individuals with mental health or substance-related disorders, and individuals with HIV/AIDS.

(2)

Agreements with State health insurance exchanges

section 18031 of this title section 18082 of this titleThe State Medicaid agency and the State CHIP agency may enter into an agreement with an Exchange established by the State under under which the State Medicaid agency or State CHIP agency may determine whether a State resident is eligible for premium assistance for the purchase of a qualified health plan under section 36B of the Internal Revenue Code of 1986 (and, if applicable, advance payment of such assistance under ), so long as the agreement meets such conditions and requirements as the Secretary of the Treasury may prescribe to reduce administrative costs and the likelihood of eligibility errors and disruptions in coverage.

(3)

Streamlined enrollment system

section 18083 of this titleThe State Medicaid agency and State CHIP agency shall participate in and comply with the requirements for the system established under (relating to streamlined procedures for enrollment through an Exchange, Medicaid, and CHIP).

(4)

Enrollment website requirements

January 1, 2014section 18031 of this titleThe procedures established by State under paragraph (1) shall include establishing and having in operation, not later than , an Internet website that is linked to any website of an Exchange established by the State under and to the State CHIP agency (if different from the State Medicaid agency) and allows an individual who is eligible for medical assistance under the State plan or under a waiver of the plan and who is eligible to receive premium credit assistance for the purchase of a qualified health plan under section 36B of the Internal Revenue Code of 1986 to compare the benefits, premiums, and cost-sharing applicable to the individual under the State plan or waiver with the benefits, premiums, and cost-sharing available to the individual under a qualified health plan offered through such an Exchange, including, in the case of a child, the coverage that would be provided for the child through the State plan or waiver with the coverage that would be provided to the child through enrollment in family coverage under that plan and as supplemental coverage by the State under the State plan or waiver.

(5)

Continued need for assessment for home and community-based services

2section 1396a of this title Probably means subsection (a)(10)(A)(ii)(VI) of .

Nothing in paragraph (1) shall limit or modify the requirement that the State assess an individual for purposes of providing home and community-based services under the State plan or under any waiver of such plan for individuals described in subsection (a)(10)(A)(ii)(VI).

Aug. 14, 1935, ch. 531 Pub. L. 111–148, title II, § 2201Mar. 23, 2010124 Stat. 289(, title XIX, § 1943, as added , , .)

Editorial Notes

References in Text

The Internal Revenue Code of 1986, referred to in subsec. (b)(1)(C), (2), (4), is classified generally to Title 26, Internal Revenue Code.