Conversely, when states refer individuals denied Medicaid to the FFM, it is difficult for states to determine whether those consumers acquired coverage. Assessment states on the FFM can have difficulty making timely use of data associated with Medicaid referrals coming from the marketplace, which can result in a disjointed application process for consumers. Maine is an assessment state, meaning that the FFM makes an initial assessment of whether applicants are eligible for Medicaid, and then refers these applications to OFI for a final determination. In addition, a resident that applies for and is denied Medicaid coverage should be referred to the marketplace for coverage. gov or their state’s marketplace and be enrolled in Medicaid if they meet their state’s Medicaid income and eligibility requirements. One of the key principles of marketplace design outlined by the ACA is the principle of “no wrong door.”148 A resident should be able to log on to HealthCare. Conduct a joint strategic planning effort across Resolve consumer-facing bottlenecks in Maine-ģ. Use existing state data to target and personalize outreach to facilitate enrollment.Ģ. Our recommendations for Maine officials working on the SBM transition are the following: 1. This section outlines our key findings and recommendations for delivering an SBM that is well-integrated with MaineCare and well-placed to help the State deliver on its goals of increased insurance enrollment. Other conversations with external stakeholders identified multiple adverse impacts that applicants experience under the current system and uncovered best practices that SBMs have operationalized to improve their application and determination processes. Our conversations with state officials uncovered a number of existing technology challenges that stand in the way of seamless FFM and MaineCare integration. Transitioning to an SBM could provide the State the opportunity to better integrate the marketplace with MaineCare.
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