Health Insurance Exchange/Integrated Eligibility System Development

As the centerpiece of the Patient Protection and Affordable Care Act of 2010 (ACA), State-Based Health Insurance Exchanges offer the promise of creating a one-stop insurance marketplace where individuals and small businesses can shop and enroll in partially subsidized or non-subsidized insurance based on a side-by-side comparison.

By 2014, all states are required to establish Exchanges–which can be operated as a government agency or a non-profit organization–with the federal government stepping in if a state does not set one up. 

The ACA also mandates that Exchanges establish a single, streamlined eligibility and enrollment process that will serve as the central point of access to all subsidized health coverage programs, including Medicaid and subsidized private care. The Exchange is also the point of entry for individuals seeking to purchase private coverage without a subsidy.

In order to meet the ACA's timelines and vision for a "single, streamlined eligibility and enrollment process," Massachusetts first evaluated their current MA-21 system used to determine eligibility for state-run public health programs in the context of the ACA and Early Innovator grant (issued by CCIIO).  From this evaluation, it was determined that the 15 year-old system is nearing end-of-life. 

Accordingly, the state believes it is imprudent to leverage this system to meet the goals of the ACA in the long run because the system operates on old mainframe technology and does not lend itself to the IT approaches the ACA supports and NESCIES seeks.  

To coordinate the Commonwealth's effort to replace the current MA-21 eligibility system and Health Connector (Massachusetts' current health insurance exchange) with a new Health Insurance Exchange/Integrated Eligibility System (HIX/IES), Massachusetts has developed a "single project approach" to coordinate development, procurement, and implementation of HIX and IES technology design and implementation. 

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NESCIES

New England States Collaborative for Insurance Exchange Systems
333 South Street
Shrewsbury, MA 01886

tel: 508-856-6653