The U.S. Department of Health and Human Services (HHS) released proposed rules designed to create a single, streamlined application process for several government health insurance programs. The application process is being developed in preparation for the Health Exchange Programs that begin on January 1, 2014, under the Affordable Care Act.

The proposed rules summarize changes to existing enrollment, eligibility, notice, and appeal provisions of the Medicaid, Children’s Health Insurance Program (CHIP), and similar insurance programs. They also seek to correct various inconsistencies in eligibility and enrollment provisions among the programs.

Published in the Federal Register on January 22, 2013, the regulations are intended to ease the burden on consumers who are eligible for these “insurance affordability programs” and coordinate the appeal process.

The proposed regulations outline the development of:

  • A process for the automatic transfer of financial information from a federal data services hub to an applicable exchange when an individual is determined to be ineligible for Medicaid or other program available for low-income individuals and their families
  • Standardized notices relating to eligibility and enrollment denials
  • A uniform certification procedure for application counselors (to assist individuals in enrolling for the appropriate coverage program)
  • Minimum requirements for the designation of authorized representatives
  • A consolidated appeal process for the adjudication of appeals of individual eligibility for the various programs, as well as employer-sponsored coverage and Small Business Health Insurance Options Program (SHOP) eligibility determinations

In a related development, the Centers for Medicare and Medicaid Services released for comment a draft form of the individual and SHOP application forms on January 28.

As the federal health care reform effort gained steam, Ballard Spahr attorneys established the Health Care Reform Initiative to monitor and analyze legislative developments. With federal health care reform now a reality, our attorneys are assisting health care entities and employers in understanding the relevant changes and planning for the future. They also have launched the Health Care Reform Dashboard, an online resource center for news and analysis on developments under the Affordable Care Act.

If you have questions about the proposed rule or other aspects of the insurance affordability programs, contact Jean C. Hemphill at 215.864.8539 or

Copyright © 2013 by Ballard Spahr LLP.
(No claim to original U.S. government material.)

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, including electronic, mechanical, photocopying, recording, or otherwise, without prior written permission of the author and publisher.

This alert is a periodic publication of Ballard Spahr LLP and is intended to notify recipients of new developments in the law. It should not be construed as legal advice or legal opinion on any specific facts or circumstances. The contents are intended for general informational purposes only, and you are urged to consult your own attorney concerning your situation and specific legal questions you have.

Related Practices

Employee Benefits and Executive Compensation
Health Care
Health Care Reform 

HCR Dashboard 

Visit the Health Care Reform Dashboard, our online resource center > 

Subscribe to the Dashboard via e-mail.>