The Federally Facilitated Marketplace (FFM) MAC Learning Collaborative provides a forum for states that are interfacing with the FFM for eligibility and enrollment functions. Consumers in FFM and State Partnership Marketplace (SPM) states have the option to apply for Insurance Affordability Programs (Medicaid, Children’s Health Insurance Program [CHIP] and Premium Tax Credits) through state Medicaid and CHIP agencies or through the FFM. This requires close coordination between states and the FFM to ensure an effective and streamlined eligibility process. Products developed by the Collaborative include:
To assist states with identifying practical strategies to manage application volume and facilitate timely enrollment of Medicaid/CHIP eligible individuals:
- Schematron Update (PDF, 305.57 KB) October 2014
- Meeting summary (PDF, 156.52 KB) October 2014
- Schematron Defect Workaround Update (PDF, 190.71 KB) October 2014
- Release 11, Sprint 31 Account Transfer Service Release Notes (PDF, 277.96 KB) October 2014
- Business Service Definition 10/1/2014 (PDF, 651.69 KB) October 2014
- Strategies for Managing High Volumes of Applications and Account Transfers (PDF, 627.08 KB) December 2013
To assist states with consumer assistance plans for good consumer experiences during open enrollment.
- Marketplace Consumer Assistance: Approaches to Program Sustainability (PDF, 1.24 MB) January 2015
- Insurance Affordability Program Application: Consumer Experience Best Practices (PDF, 6.66 MB) February 2014
As states navigate the Affordable Care Act’s requirement for coordinated eligibility and enrollment systems and real-time verifications, the Simplified, Real-Time Verification Issue brief (PDF, 774.19 KB) outlines lessons from Louisiana, Oklahoma and Oregon for developing streamlined eligibility and enrollment pathways that achieve administrative efficiencies, improve consumers’ experience, and facilitate timely access to coverage and health care.
Applications and Renewals
Information about the streamlined application used in the FFM and relevant interactions with Medicaid and CHIP.
- Coverage Application 2.0 (PDF, 3.14 MB) January 2015
- Meeting summary (PDF, 148.8 KB) October 2014
- Marketplace-Medicaid Renewal Intersections (PDF, 986.28 KB) September 2014
States’ Eligibility & Enrollment Functionality
The following reviews key findings from the “Year 2 Consults” – a process states and CMS undertook together to assess states’ Medicaid/CHIP eligibility and enrollment policy, operations and systems functionality. The information provides a snapshot of states’ functionality at the end of 2014 and beginning of 2015 and does not take into account states’ approved mitigation plans.
- Federally Facilitated Marketplace Year 2 Consult (PDF, 4.05 MB) September 2015