Overlapping Eligibility and Enrollment: Human Services and Health Programs Under the Affordable Care Act

Overlapping Eligibility and Enrollment: Human Services and Health Programs Under the Affordable Care Act Prepared by: Stan Dorn, Julia Isaacs, Sarah Minton, Erika Huber, Paul Johnson, Matthew Buettgens, and Laura Wheaton The Urban Institute Under Task Order: HHSP23337026T Integrating Health and Human Services Programs and Reaching Eligible Individuals Under the Affordable Care Act Prepared for: Alana Landey and Carli Wulff Office of the Assistant Secretary for Planning and Evaluation, DHHS 23 December 2013 i Contents Introduction ................................................................................................................................................... 1 Overlaps with health programs that could help human services programs function more effectively ......... 3 Data from health programs could help establish eligibility for human services programs .............. 3 Many eligible nonparticipants in uncapped human services programs will qualify for health coverage ........................................................................................................................................... 4 Overlaps with human services programs that could help health programs function more effectively ......... 8 Participation in human services programs could help establish eligibility for Medicaid ................ 8 Many consumers who will newly qualify for health coverage under the Affordable Care Act already participate in human services programs .............................................................................. 9 Conclusion .................................................................................................................................................. 12 Appendix I. Analytic framework ................................................................................................................ 13 Appendix II. Overview of Programs ........................................................................................................... 18 Appendix III: Microsimulation Methodology ............................................................................................. 36 Appendix IV. Additional Microsimulation Results .................................................................................... 43 Appendix V: Experts Consulted ................................................................................................................. 46 Notes ........................................................................................................................................................... 48 1 Introduction The Patient Protection and Affordable Care Act (Affordable Care Act or ACA) extends health coverage to millions of uninsured Americans, primarily through newly created Health Insurance Marketplaces and expanded Medicaid eligibility. It also sets the stage for major changes to eligibility determination for both health and human services programs. This paper focuses on using data matches and the coordination and integration of enrollment and retention procedures to improve the efficiency and accuracy of eligibility determination and to increase participation by eligible individuals in health programs and uncapped human services programs. Under the ACA, consumers can generally qualify for health coverage based on attestations made under penalty of perjury. However, when federal or state policy requires further verification, it must be based on data matches, if possible, including information in the records of human services programs. Only when data matches fail to verify eligibility can consumers be asked for documentation. Facing a potential surge in health coverage applications in 2013 and 2014, states that use data from human services programs to qualify multiple consumers for health coverage can trim their administrative workload while enrolling a large proportion of the newly eligible. At the same time, many people who have not previously received government assistance will seek health coverage. By connecting to this new stream of applicants for health coverage, programs that guarantee assistance to all eligible consumers, such as the Supplemental Nutrition Assistance Program (SNAP), Earned Income Tax Credit (EITC), and unemployment insurance (UI), could identify and enroll households who qualify but do not yet participate. In addition, information from health programs could simplify the work needed to qualify clients for human services programs that receive capped funding from the federal government and thus generally cannot serve all eligible people. For the latter programs, simplification efforts could reduce burdens for clients and lower the cost of eligibility determination, potentially letting some resources shift from administration to benefits. These programs include Temporary Assistance for Needy Families (TANF), the Child Care and Development Fund (CCDF), the Low Income Home Energy Assistance Program (LIHEAP),