Health reform needs a streamlined enrollment process where there is no wrong door to health insurance. No matter where individuals enter the system, they should be able to fill out one application—creating efficiency and reducing costs. This application should serve multiple programs. It should collect all necessary information to enroll the family into private coverage operated by the exchange, the public plan option, or any public program or subsidy for which they are eligible. In addition, if based on this information it appears that the family could be eligible for other public programs, then the exchange could follow-up to determine eligibility for those programs, such as Medicaid or the Children’s Health Insurance Program.
It will be important to ensure that new eligibility determinations for subsidies seamlessly fit with existing Medicaid and Children’s Health Insurance Program processes. In the likely case that there is a hardship waiver that will exempt individuals from the individual responsibility to have health insurance if that coverage is unaffordable, that should also be determined when an individual first encounters the system.
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