State Enrollment Experience: Implementing Health Coverage Eligibility and Enrollment Systems Under the ACA

While the ACA afforded states the choice to host a health insurance exchange or expand Medicaid, it required all states to make major changes to Medicaid eligibility policy, including adding mandatory coverage of new groups, implementing streamlined eligibility and renewal processes, incorporating new eligibility and verification requirements, and coordinating enrollment systems with exchanges. As a result, states had to create or significantly modify existing systems, collaborate and coordinate with other state and federal agencies, and develop new processes to support enrollment. This brief examines states’ early experiences implementing the ACA’s eligibility and enrollment requirements; highlights promising practices and lessons learned; provides some context on the state experience; and concludes with possible areas of focus for future enrollment and implementation efforts.