States have been working to improve public health coverage program application, enrollment and retention systems for individuals and families for decades. Beginning in the 1990’s and inspired by the flexibility offered under the Children’s Health Insurance Program (CHIP), states have piloted and implemented policies aimed at increasing enrollment of eligible populations, reducing enrollment and renewal barriers and streamlining work processes for state staff.

In 2009, the Children’s Health Insurance Program Reauthorization Act (CHIPRA) created new enrollment simplification tools like Express Lane Eligibility and offered states new financial incentives in the form of performance bonuses for states that adopted 5 of 8 simplification strategies and experienced an increase in children’s enrollment in Medicaid and CHIP.

The enactment of the Patient Protection and Affordable Care Act (ACA) marks a transformation of eligibility and enrollment systems for all public coverage programs, including Medicaid, CHIP, Basic Health Programs and premium tax credits and cost-sharing subsidies available for qualified health plans purchased through a health insurance marketplace, moving states toward a new era of simpler, more accessible systems and processes.

NASHP has worked with states to support their efforts to improve enrollment and retention systems over the past two decades and the work in this area spans the spectrum of eligible populations, from children, to aged, blind and disabled populations, pregnant women, newborns, and newly eligible adults. For more information on NASHP’s work with states to cover children check out NASHP’s Children’s Health Insurance webpage.

From 2008 through January 2014, NASHP served as the national program office for the Robert Wood Johnson Foundation’s (RWJF) Maximizing Enrollment initiative, a project that supported state learning on simplification of enrollment and retention of children and helped states prepare for implementation of new eligibility and enrollment system requirements under the ACA. Alabama, Illinois, Louisiana, Massachusetts, New York, Utah, Virginia, and Wisconsin participated in Maximizing Enrollment to improve their systems, policies and procedures with the aim to become more efficient and effective in enrolling and retaining eligible individuals in health coverage.

NASHP is also supporting state implementation of new health insurance marketplaces for all states through the State Health Exchange Leadership Network (known as Exchangers), which is supported by RWJF and states. And NASHP provides an interactive forum for state policymakers and other interested stakeholders to discuss and share promising strategies for enrollment and retention of eligible populations through StateRefor(u)m, an RWJF-funded online network.

Available resources and products from this work include reports, charts, analyses, archived webinars, blogs, and materials from state convenings from NASHP’s work in this area. On this page, readers can access these materials to explore state enrollment systems, processes, and policies.

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