42 U.S. Code § 18083 - Streamlining of procedures for enrollment through an Exchange and State medicaid, CHIP, and health subsidy programs
(a) In general
The Secretary shall establish a system meeting the requirements of this section under which residents of each State may apply for enrollment in, receive a determination of eligibility for participation in, and continue participation in, applicable State health subsidy programs. Such system shall ensure that if an individual applying to an Exchange is found through screening to be eligible for medical assistance under the State medicaid plan under title XIX  [42 U.S.C. 1396 et seq.], or eligible for enrollment under a State children’s health insurance program (CHIP) under title XXI of such Act [42 U.S.C. 1397aa et seq.], the individual is enrolled for assistance under such plan or program.
(b) Requirements relating to forms and notice
(1) Requirements relating to forms
(A) In general
The Secretary shall develop and provide to each State a single, streamlined form that—
(iii) may be filed with an Exchange or with State officials operating one of the other applicable State health subsidy programs; and
(B) State authority to establish form
A State may develop and use its own single, streamlined form as an alternative to the form developed under subparagraph (A) if the alternative form is consistent with standards promulgated by the Secretary under this section.
The Secretary shall provide that an applicant filing a form under paragraph (1) shall receive notice of eligibility for an applicable State health subsidy program without any need to provide additional information or paperwork unless such information or paperwork is specifically required by law when information provided on the form is inconsistent with data used for the electronic verification under paragraph (3) or is otherwise insufficient to determine eligibility.
(c) Requirements relating to eligibility based on data exchanges
(1) Development of secure interfaces
Each State shall develop for all applicable State health subsidy programs a secure, electronic interface allowing an exchange of data (including information contained in the application forms described in subsection (b)) that allows a determination of eligibility for all such programs based on a single application. Such interface shall be compatible with the method established for data verification under section 18081 (c)(4) of this title.
(2) Data matching program
Each applicable State health subsidy program shall participate in a data matching arrangement for determining eligibility for participation in the program under paragraph (3) that—
(B) applies only to individuals who—
(ii) apply for such assistance—
(3) Determination of eligibility
(A) In general
Each applicable State health subsidy program shall, to the maximum extent practicable—
(i) establish, verify, and update eligibility for participation in the program using the data matching arrangement under paragraph (2); and
(4) Secretarial standards
The Secretary shall, after consultation with persons in possession of the data to be matched and representatives of applicable State health subsidy programs, promulgate standards governing the timing, contents, and procedures for data matching described in this subsection. Such standards shall take into account administrative and other costs and the value of data matching to the establishment, verification, and updating of eligibility for applicable State health subsidy programs.
(d) Administrative authority
(2) Authority of exchange to contract out
Nothing in this section shall be construed to—
(A) prohibit contractual arrangements through which a State medicaid agency determines eligibility for all applicable State health subsidy programs, but only if such agency complies with the Secretary’s requirements ensuring reduced administrative costs, eligibility errors, and disruptions in coverage; or
(B) change any requirement under title XIX  that eligibility for participation in a State’s medicaid program must be determined by a public agency.
(e) Applicable State health subsidy program
In this section, the term “applicable State health subsidy program” means—
(1) the program under this title  for the enrollment in qualified health plans offered through an Exchange, including the premium tax credits under section 36B of title 26 and cost-sharing reductions under section 18071 of this title;
(3) a State children’s health insurance program (CHIP) under title XXI of such Act [42 U.S.C. 1397aa et seq.]; and
(4) a State program under section 18051 of this title establishing qualified basic health plans.
 So in original. Probably should be followed by “of the Social Security Act”.
 So in original. Probably should be preceded by “is”.
 See References in Text note below.
Source(Pub. L. 111–148, title I, § 1413,Mar. 23, 2010, 124 Stat. 233.)
References in Text
The Social Security Act, referred to in subsecs. (a), (d)(2)(B), and (e)(2), (3), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Titles XIX and XXI of the Act are classified generally to subchapters XIX (§ 1396 et seq.) and XXI (§ 1397aa et seq.), respectively, of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.