Health Benefit Exchanges: Complexities and Challenges Associated With Modernizing State Enterprise Eligibility Systems

The Patient Protection and Affordable Care Act (ACA)1, signed into law in March 2010, requires states to make available by October 2013 a health benefit exchange (HBE).

An HBE will allow individuals or small businesses to compare and purchase private health insurance or be enrolled in an expanded Medicaid program should a state opt to expand the program. As a result of these requirements, and other funding incentives, the federal government has established several programs to provide funds to states for HBE implementation and eligibility modernization activities.

However, although these opportunities provide great opportunities for states to rethink their Health and Human Services (HHS) enterprise, the time constraints associated with HBE implementation and the time-limited nature of the available federal funding make the prospect of state HHS initiatives challenging.

This white paper, developed under the sponsorship of the KPMG Government Institute, highlights the existing opportunity as well as the complexities and challenges associated with modernizing state enterprise eligibility systems in conjunction with HBE implementations.

In addition, this paper introduces an approach as well as tools that KPMG has developed specifically to provide states the opportunity to accelerate such initiatives so they may benefit from the federal funding available.