Health insurance exchanges aiming for real-time eligibility determinations using Treasury, IRS data

Health insurance exchanges should be able to make real-time determinations of eligibility for various types of coverage using data from the Treasury Department and the IRS, officials from the U.S. Department of Health and Human Services (HHS) said at a recent regional forum on implementing the Patient Protection and Affordable Care Act (PPACA) in Washington, D.C.

The PPACA generally requires states to establish American Health Benefit Exchanges by January 1, 2014. If a state decides not to establish an exchange for its residents, HHS will operate a federally facilitated exchange (FFE). Qualified taxpayers will be able to purchase health insurance coverage through the exchanges. Some taxpayers may be eligible for the Code Sec. 36B premium assistance tax credit to help them obtain coverage. The Treasury and the IRS have issued guidance on the Code Sec. 36B tax credit (I.R.B. 2012-24).

HHS officials said that, through the exchanges, individuals will be able to learn if they are eligible for programs to make insurance more affordable, such as eligibility for the premium assistance tax credit, or health programs such as Medicaid and the Children’s Health Insurance Program (CHIP). HHS is aiming for real-time determinations of eligibility for coverage, the officials said.

Federal agencies are planning a "data services hub" to facilitate the exchange of information, the officials said. An inter-agency task force is currently meeting to develop the parameters of the hub. "There is an incredible amount of complex work going on," one official said.