Guidance On State Alternative Applications For Health Coverage

Today, the Centers for Medicare & Medicaid Services (CMS) is releasing guidance on state alternative applications for health coverage.

Beginning on October 1, 2013, the new Health Insurance Marketplace, also known as the Affordable Insurance Exchange (Exchanges), and State Medicaid and Children’s Health Insurance Program (CHIP) agencies will use a single, streamlined application to determine eligibility for enrollment in Qualified Health Plans (QHPs) through the Marketplace, and for insurance affordability programs including advance payments of the premium tax credit (APTCs), cost-sharing reductions (CSRs), Medicaid, and CHIP.

On April 30, 2013, CMS released the model single, streamlined application for coverage through the Marketplace and insurance affordability programs. The model single, streamlined application is available for review at This application, in both its paper and online versions, will be the sole application used by the Federally-facilitated Marketplace to facilitate eligibility determinations and enrollment in health coverage. Medicaid agencies, CHIP agencies, and State-based Marketplaces may choose to use the model single, streamlined application, or may develop an alternative single, streamlined application that is approved by CMS.

CMS is committed to providing technical assistance to states to facilitate the adoption of the model application and in their development of alternative applications. For example, in addition to today’s guidance, we have posted materials that will be of interest to states considering an integrated human services application. Developed through our Medicaid and CHIP Expanding Coverage Learning Collaborative, these materials present an analysis of existing integrated human services applications and identify questions that would need to be added to support MAGI eligibility determinations. Language and placement recommendations are included.

For additional information, please refer to the guidance, which is available online at

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