During the Medicaid Enterprise Systems Conference (MESC) 2024, being held from August 12-15 in Louisville, KY, representatives from the Centers for Medicare and Medicaid Services (CMS) discussed a new development in the healthcare exchange enrollment process —Account Transfer 2.0 (AT2.0). This new system will optimize the process of transferring Medicaid accounts between state programs and HealthCare.gov, ensuring a more seamless and efficient experience for beneficiaries.
The Current System’s Challenges
As discussed by Maria Liddane, Health Insurance Specialist at CMS, and her colleagues, the existing account transfer process faces numerous challenges. These include outdated data models, inflexible data formats, incomplete data transfers, and inconsistent verifications. These issues often result in significant delays and gaps in coverage as individuals transition from Medicaid to HealthCare.gov.
AT2.0: A Solution for the Future
AT2.0 addresses these challenges by introducing several key improvements:
1. Modernized Data Formats: AT2.0 will utilize a JSON-based data model, offering greater flexibility and easier updates compared to the rigid XML schema currently in use. This modernization is crucial for aligning state systems with HealthCare.gov’s requirements, simplifying data mapping, and enhancing overall serviceability.
2. Enhanced Data Quality: The new system introduces robust data quality controls, ensuring that all eligibility and verification information is complete and reliable. This improvement is expected to reduce administrative burdens and facilitate smoother coverage transitions.
3. Improved Consumer Experience: For consumers, the transition between Medicaid and HealthCare.gov will become significantly easier. The new process will include better notices and outreach, streamlined application reviews, and customized plan recommendations to support efficient enrollment. The goal is to minimize the risk of beneficiaries becoming uninsured during transitions.
Technical Improvements and Milestones
Alejandra Johnson, Technical Director at CMS’s Division of State Systems, highlighted the technical enhancements planned for AT2.0. These include:
– Updated Data Models: Core sets of well-defined, consistently formatted eligibility and verification data will form the foundation of AT2.0.
– Complete High-Quality Data: Ensuring that data quality controls are in place to maintain the accuracy and completeness of all account transfers.
– Traceability: The new system will enhance the traceability of individuals’ movements between programs, supporting better data analysis and ensuring a seamless experience.
The implementation of AT2.0 will follow a phased approach, with early adopter states beginning integration in 2026 and full nationwide adoption expected by 2027. Six advisory states—Alaska, Hawaii, Iowa, New Hampshire, South Carolina, and Tennessee—are already involved in reviewing the technical drafts and providing feedback to refine the system further.
CMS’s Vision for the Future
Jeff Grant, Deputy Director of Operations at the Center for Consumer Information & Insurance Oversight (CCIIO), introduced the session by emphasizing CMS’s commitment to reducing administrative barriers and enhancing the user experience for all beneficiaries. The goal of AT2.0 is to create a system that not only meets the technical needs of state Medicaid programs and HealthCare.gov but also significantly reduces the risk of coverage gaps for individuals transitioning between the two.
AT2.0 is more than just a technical upgrade; it’s a step towards a more integrated and responsive healthcare system that prioritizes the needs of the consumer. With these advancements, CMS aims to ensure that every American has access to the healthcare they need, without unnecessary delays or interruptions.
How CITIZ3N Can Help
As a leader in supporting state exchanges and exchange-related operations for insurers nationwide, CITIZ3N is committed to helping you navigate these changes with ease. Our solutions are designed to integrate seamlessly with evolving systems similar to AT2.0, ensuring that your operations remain efficient, and your customers receive the best possible service.
Contact us today to learn more about how CITIZ3N can support your health care exchange needs or to schedule a demo of our services.
Author: Josh Schultz, jschultz@citiz3n.com
