Information Technology Systems & Data

In anticipation of the passage of the Affordable Care Act, CMS developed and codified a policy and financing structure designed to provide States with tools needed to achieve the immediate and substantial investment in information technology systems that is needed in order to ensure that Medicaid systems will be in place in time for the January 1, 2014 launch date of the new Affordable Insurance Exchanges as well as the expansion of Medicaid eligibility.

Areas of interest under this provision:

Eligibility and Enrollment Systems

Providing federal funding to assist states with streamlining and upgrading Medicaid eligibility systems is critical to assuring a simple and seamless enrollment experience for consumers who qualify for Medicaid or CHIP or who are shopping for health insurance in the Affordable Insurance Exchanges.

• Medicaid Eligibility and Enrollment (EE) Implementation Advanced Planning Document (IAPD)
• Final Rule 42 CFR Part 433 "Medicaid Program: Federal Funding for Medicaid Eligibility Determination and Enrollment Activities" - 4/19/11
• CMCS Informational Bulletin - 4/14/11
• Enhanced Funding Requirements: Seven Conditions and Standards 1.0 - 4/2011
• Guidance for Exchange and Medicaid Information Technology (IT) Systems 2.0 - 5/2011
• Tri-Agency Letters
  • 7/20/15-Cost Allocation of Information Technology Systems
  • 1/23/12-Cost Allocation of Information Technology Systems 
  • 8/10/11-Cost Allocation of Information Technology Systems
• CMCS Informational Bulletin - 8/31/11
• Supplemental Guidance on Cost Allocation for IT Systems - 10/2012

New Reports Released by HHS/ASPE

ASPE’s Office of Human Services Policy and Office of Health Policy have released three new reports under their co-funded research project, “Integrating Health and Human Services Programs and Reaching Eligible Individuals Under the Affordable Care Act.”  The study supports Affordable Care Act implementation by exploring opportunities for cross-program integration, outreach, and enrollment activities. The first of the new reports, listed below, provides valuable information for states interested in taking advantage of time-limited cost-sharing for IT systems. 

• Opportunities under the Affordable Care Act for Human Services Programs to Modernize Eligibility Systems and Expedite Eligibility Determination - This paper summarizes opportunities for states to utilize time-limited federal cost-sharing to modernize human services program eligibility systems and to use data from health programs to streamline eligibility determination for human services.
• Examples of Promising Practices for Integrating and Coordinating Eligibility, Enrollment and Retention: Human Services and Health Programs under the Affordable Care Act - This paper presents findings from case studies of selected state-level integration and coordination approaches under the Affordable Care Act and identifies areas of notable success or potential which may be of interest to other states.
• Using Behavioral Economics to Inform the Integration of Human Services and Health Programs under the Affordable Care Act - This paper examines opportunities to apply findings from behavioral economics and decision-making theory to two specific health/human services program interaction contexts: using targeted enrollment strategies to get SNAP recipients into Medicaid, and encouraging individuals seeking health insurance through state marketplaces to apply for SNAP.

Finder.HealthCare.gov: Establishing a Website (portal) through which individuals and small businesses can obtain information about the insurance coverage options that may be available to them in their state. This new resource is now available at Finder.HealthCare.gov.

• Section 1103 under Title I Quality, Affordable Health Care For All Americans
• CMCS Informational Bulletin - 4/21/10

CMS is continuing to work to provide ongoing guidance to give States the support they need to enroll millions of newly eligible individuals through multiple channels; operate seamlessly with newly authorized Affordable Insurance Exchanges; and produce notices and communications to applicants and beneficiaries concerning the process, outcomes, and their rights to dispute or appeal.

For questions and more information, please reference the Frequently Asked Questions page.