ACA legislation consists of several interconnected provisions, such as eligibility, entitlement and access to an exchange to ensure citizens are offered continuous and affordable coverage. IBM Cúram for Health Care Reform satisfies these by providing a single point of entry through which citizens can shop for the full range of "Insurance Affordability" programs - a collective term which includes Medicaid, CHIP, state basic health program and insurance assistance in the form of premium tax credits and cost-sharing reductions. Applicants can apply for assistance and if determined eligible, can enroll in the appropriate program.
To ensure a simplified, streamlined application process, information gathering is shorter than has traditionally been the case; only information that is necessary for a determination is collected, which is represented by capturing details about the primary applicant, the household and the household income. Further consumer-friendly provisions are satisfied by providing assistance to consumers in a variety of ways, either through navigators who provide fair and impartial help, or through outreach assistance services.
The HCR application determines eligibility across all of the available insurance affordability programs using the same simplified eligibility rules for premium tax credits, Medicaid and CHIP. Consistent income rules are used for all programs where Modified Adjusted Gross Income (MAGI) is used to determine eligibility. Individuals do not have the option to apply for a single program alone; they are considered for all available health programs and enrolled in the appropriate program. The coordinated approach ensures individuals do not have to apply to multiple programs, nor are they sent from one program to another if they initially apply to a program for which they are not ultimately eligible - ensuring there is "no wrong door" into coverage.
Another key provision of the ACA is to increase efficiency to help reduce agency worker workload; the ACA introduces a Federal Data Services Hub (Federal Hub for short) which can be used wherever possible to ensure client-attested information is compared to, or verified against information about the client that is maintained on other state and federal systems. This near real-time verification of client information when successful negates the need for case workers to follow up with the client for supporting documentation, allowing individuals to receive an eligibility determination and enroll in a plan in a single visit. The timely determination benefits both the client and the worker or agency.