A Health and Human Services Department panel backed a plan to build a federal database of business rules that states could use to help determine the eligibility of consumers for Medicaid and other federal health insurance programs.
The collection of program eligibility rules in a single location would enable states to compare their enrollment processes with other states' and find instances where systems could be re-used or merged.
"That will allow for transparency and innovation over time in eligibility rules," said Aneesh Chopra, the White House's chief technology officer and chairman of the enrollment work group at a policy committee meeting Aug. 19.
The consolidation of health program enrollment systems will become increasingly important as states move to build electronic health insurance exchanges required by the recent health reform law.
The exchanges would act as an e-commerce gateways to help insurance consumers who are not eligible for Medicaid or employer-provided insurance find an alternative source of health coverage.
The recommendation is among the first set of proposals that the Health IT Policy Committee approved to help streamline systems states will use in building the insurance exchanges.
The exchanges, which must be available by 2014, will offer health care consumers comparative information on state health insurance programs, including Medicaid, high risk pools and other public and private health plans.
One business rule that applies to Medicaid eligibility is that an insurance seeker's income level must be under a certain threshold of the federal poverty line, Chopra said. Currently, the majority of business rules are not easily known or accessible.
"It's hard to understand how some states determine eligibility," he said.
The committee also recommended that states verify through federal agency systems the personal income, citizenship and legal status of those applying for health programs.
The Internal Revenue Service, the Social Security Administration and the Homeland Security departments are developing Web services that states can use to help to help determine eligibility for health and human service programs.
Each of the federal agencies requires the use of certain core data elements, such as name, address and income, to help match applications with certain programs.
Using core data elements will eliminate some of the repeated written documentation for each of the programs and also make it easier for states to exchange information.
"We're going to focus on the format of the core data elements so that we can get a higher match rate," said Sam Karp, the co-chairman of the enrollment work group, who is also vice president of programs for the California Healthcare Foundation.
The committee also pushed for the creation of a federal reference verification tool, or sample application, for states to use so they don't have to design and create their own. The software would contain standards for states to verify an individual's eligibility information from federal agencies.
