State Based Health Insurance Exchange Individual Eligibility Business Requirements Template

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This template, prepared by Manatt Health Solutions, was developed in order to help drive state decisions and is based on the eligibility business functions that state Exchanges and Medicaid agencies are required to support pursuant to the Patient Protection and Affordable Care Act (ACA), and related federal implementation regulations. The template defines, at a high level, what a state’s eligibility information technology system must do to fulfill Exchange and Medicaid business needs for QHP and insurance affordability program eligibility determinations, including Medicaid, CHIP, the Basic Health Program (should the state implement one), and premium tax credits. 

Access the template here.