Spotlight Exclusives

Chance of a Lifetime: Helping States Make the Most of the Affordable Care Act

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The Patient Protection and Affordable Care Act (ACA) will go a long way toward improving health care for millions of Americans, including those who struggle daily to afford life۪s most basic necessities. Perhaps less well known are the many other ways that the ACA has the potential to aid low-income families. <?xml:namespace prefix = o ns = “urn:schemas-microsoft-com:office:office” />


Under the new law, many people mostly parents and adults without children will be newly eligible for Medicaid coverage. Many of these individuals may already be enrolled in the Supplemental Nutrition Assistance Program (SNAP) or other benefit programs. In other cases, many individuals will apply for health coverage under the new law who have never had contact with state human services. They may find they are eligible for other benefits, such as SNAP, child care subsidies, or energy assistance. 


As states begin to implement the ACA, they will face challenges, including how to manage this influx of new beneficiaries and how to align the administration of health and human service programs with health reform. States will need to think critically about how best to reorganize their processes, workforces, and bureaucratic structures to most effectively provide support to low-income families.


This is a critical time for states to connect eligible people with the benefits and services they may be missing. Because most states co-administer Medicaid and SNAP, it also provides a unique opportunity for states to think anew about how they will design their health and human services application and enrollment systems.

That۪s why it۪s essential that as states modify and upgrade their systems to prepare for ACA implementation, they plan carefully to ensure that these families۪ experiences with obtaining benefits are not only protected, but improved. Getting this wrong could be a significant missed opportunity to help many Americans climb the economic ladder.

In particular, states will need to pay attention to the following issues as they prepare for the rollout of the ACA:

·         How to avoid being overwhelmed by new Medicaid applicants. If all states expand their Medicaid programs in 2014, it is likely that six million adult SNAP recipients will become newly eligible for Medicaid. States already know which of their residents are receiving SNAP and could use this information to create a streamlined process for enrolling new Medicaid patients. States can use the information they already have to develop the most efficient enrollment systems possible.


·         How to use technology to better integrate health and human service systems.Electronicintegration up front will save time, effort, and money. The federal government is providing significant funds for Medicaid system development on a time-limited basis, making this the best time to electronically integrate systems. If states create interoperable systems as soon as the ACA takes effect, families will be more aware of what benefits are available to them, and will experience less burden in enrolling in them.


·         How broadly they want to integrate their health and human service systems. The application, enrollment, and renewal processes for Medicaid and other social benefits are filled with redundancies. States must decide if there is a way to use tools, services, and staff from across all programs to provide individuals and families with a simpler, more unified benefit system.

These are daunting issues, and one of the most important things states can do is invest time now in figuring out how to make the most of this unique moment. To help states respond to some of these concerns, we have developed a toolkit for state agencies as they sort through the many choices they will face connecting people in need with key benefits and services.

The toolkit۪s seven modules provide states with a step-by-step process for implementing and evaluating their new health and human service systems. In addition to guiding a review of their current eligibility and re-enrollment processes, the toolkit will help states think critically about the best structures for delivering services once the ACA goes into effect. It provides context on the importance of each topic the ACA raises, and details several factors that can affect a family۪s ability to access multiple benefits.

We hope this toolkit is helpful to states, but more can be done. All states must make this upfront planning and careful deliberation a priority, or risk missing a once-in-a-generation opportunity to improve the efficacy of the safety net for low-income families.

Restructuring their health and human service systems will not be easy, but if states are willing to put in the effort, their families will reap the rewards. With the right resources and guidance, states can create a system that will help more low-income Americans rise out of poverty than ever before.

To print a PDF version of this document, click here

January Angeles and Shelby Gonzales are senior policy analysts at the Center on Budget and Policy Priorities

The views expressed in this commentary are those of the author or authors alone, and not those of Spotlight. Spotlight is a non-partisan initiative, and Spotlight۪s commentary section includes diverse perspectives on poverty. If you have a question about a commentary, please don۪t hesitate to contact us at

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