into public coverage and publicly subsidized programs. This initiative has provided a great deal of information that can assist states as they design and implement their state health insurance exchanges.

To disseminate their findings and foster communication, NASHP hosts an interactive venue on health reform topics for states and other policy makers called State Refor(u)m (www.staterefor(u)m.org). It is a website where states can post materials, share information, and engage in conversations about health reform. NASHP also provides technical assistance to the State Health Reform Assistance Network, a RWJF project that supports a number of organizations as they work intensively with 10 states to implement health reform.

ACA Enrollment Reforms

The Affordable Care Act (ACA) created a vision for an “enrollment superhighway.” Instead of a system that places the burden to navigate the array of public programs on the consumer, there is a single, unified application that can be used to apply to any program. This seamless, “one-stop” system would provide consumers with assistance and understandable information to guide them through the enrollment process. Individuals would present their enrollment information and then be guided through the eligibility process as states draw down their electronic information and match their information to various program eligibility requirements. This integrated approach to enrollment differs markedly from current systems, where there are different processes for enrollment. The new system is going to be integrated, not only within a state between Medicaid, the Children’s Health Insurance Program, private coverage options, and subsidized coverage, but also with federal programs, such as those offered through the Social Security Administration.

ACA Eligibility Reforms

The ACA replaces the existing multiple categories of Medicaid eligibility with a single eligibility category for individuals under 138 percent of the federal poverty level (FPL). There is also a much simpler process for determining eligibility. Instead of having a standard that depends on whether or not an individual fits into a certain category within his or her income, the ACA eligibility standard depends primarily on modified adjusted gross income. The other eligibility categories are set aside unless an individual meets certain criteria, such as being disabled or elderly. For individuals with incomes between 138 and 400 percent of the FPL, the ACA provides subsidies for health insurance coverage. The enrollment process is technology-enabled. In contrast to the usual paper-based



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