Following income information capture, the system captures the remaining information in order to complete an application. This is either program-specific questions that are presented only where applicable, or questions asked of all applicants as the information is required to help screen for non-MAGI Medicaid.
To present program-specific questions at the start of this section, it is necessary to run rules for each applicant in the household to determine whether they are eligible for Medicaid/CHIP (assuming any outstanding verifications are resolved) or potentially eligible for insurance assistance. If any of the applicants are eligible for Medicaid/CHIP, then a page is displayed which asks questions of those applicants which are specific to those programs. This page displays a single question about the applicant's medical bills for the last 3 months, but this can be altered as states may want to add other questions.
If there are any applicants who are potentially eligible for insurance assistance, then other pages which ask questions specific to that program are asked of those applicants, for example, incarceration and access to employer-sponsored coverage. The answers to these follow-up questions will be used by the rules which are run at the end of the script to determine actual eligibility for Insurance Assistance.
For Medicaid-eligible individuals, avoiding the Insurance Assistance questions is very beneficial. An individual potentially eligible for Insurance Assistance will be asked for details about their access to employer-sponsored insurance. If they have employer-sponsored insurance, they are further asked about the cost of that insurance and the contribution made by the employer. This information is necessary for the affordability test which checks whether the cost of the insurance offered to the employee, after taking into account the available contribution; represents greater than 9.5% of the individual's household income. If it does, then the coverage is not considered affordable and therefore that employee may be eligible for premium tax credits and cost-sharing reductions that they would otherwise be ineligible for. If they are already enrolled in employer-sponsored coverage then it is by implication considered affordable. All of this information is of no relevance to those eligible for Medicaid, and therefore is not displayed unless relevant for the applicant or a member of his tax household.
Applicants who are not eligible for any financial assistance but are applying to purchase QHPs in the exchange are presented with questions to determine tobacco usage and incarceration. Tobacco usage is a contributing factor to plan premiums for QHPs made available in the exchange, and incarceration is a condition of eligibility for enrollment in a QHP.
After program-specific questions have been captured, a page is displayed at the end of the script which asks questions about each applicant in the household regardless of what program they might be eligible for, the answers to which are used to screen for non-MAGI Medicaid on the application results page. These questions identify whether anyone is blind, disabled, or in need of assistance with their daily needs. The ACA mandates that these MAGI-excepted individuals must follow the traditional Medicaid application process - a link to that traditional Medicaid application process is available from the HCR eligibility results page.