Designing the Infrastructure for Medicaid and CHIP Eligibility
The Centers for Medicare and Medicaid Services would like to develop an electronic infrastructure that States can integrate to implement the Modified Adjusted Gross Income (MAGI) method for determining eligibility for Medicaid and the Children’s Health Insurance Program (CHIP) eligibility that is required under the Affordable Care Act (ACA).
Under the Affordable Care Act (ACA), an estimated 30 million additional Americans will gain access to affordable insurance coverage by 2014. The ACA sets the income eligibility threshold for Medicaid to 133% of the Federal Poverty Level (FPL) in all States and territories. Currently two-thirds of the non-elderly uninsured are low-income, therefore this standardization of the FPL eliminates the gaps in eligibility for individuals under age 65. By January 2014, States must convert existing methods for determining eligibility for affordable insurance programs to the Modified Adjusted Gross Income (MAGI) approach, which determines income, household composition and family size to comply with ACA.
The development of a “MAGI in a box” solution could be shared with the States, will reduce the risk of States missing the January 2014 deadline, and maximize resources by minimizing duplication of effort among the States. The desired outcome is the development of a MAGI eligibility determination solution that could be given to States (TBD if it would be an open source product.) Given that CMS is already creating this functionality for the Federally-facilitated Exchange, this project would be prime for a rapid development strategy, leveraging what is already available internally and delivering it to our State partners in time for integration into their systems. External Entrepreneurs Zac Jiwa and Chris Lunt are working to develop this infrastructure.
Skill Sets for the External Entrepreneur (Previously External Innovation Fellow(s)):
- IT innovator who thinks about software-as-a-service or a cloud-based technology solutions to common business needs and
- Understands IT development life cycles
- Can develop a strategic approach for creating IT products for use by the States
- Can develop tools and guidance to enable states to integrate the solution into their existing systems and eligibility work flows.
Internal Entrepreneurs (Host Innovation Fellows):
- Julie Boughn, MS, MBA (nominating official) - Deputy Director, Center for Medicaid and CHIP, CMS
- Jessica Kahn, MPH - Senior Technical Advisor in the Center for Medicaid and CHIP Services, CMS
- Henry Chao – Deputy Chief Information Officer, CMS
- Elaine Olin – Director, Data and Systems Group, Center for Medicaid and CHIP Services, CMS
External Entrepreneurs (External Innovation Fellows):