- TO:
- ALL COUNTY OFFICES
- FROM:
- ALYSON CAMPBELL, DIRECTOR
- SUBJECT:
- "THE BETTER DOOR"
DISCUSSION:
This memorandum introduces the "The Better Door" functionality for the Missouri Eligibility Determination and Enrollment System (MEDES).
This memorandum discusses:
THE "BETTER DOOR"
The Affordable Care Act (ACA) introduces a single streamlined application, a simplified eligibility determination based on modified adjusted gross income (MAGI) for MO HealthNet, CHIP, and coverage through the Exchange, and requires seamless, "no wrong door" enrollment systems. MEDES must be able to refer individuals to the federally facilitated marketplace (FFM) portal, and the FFM must be able to refer individuals to Missouri's citizen portal at mydss.mo.gov.
The "Better Door" refers to efficiently directing online customers to the best health care options available to meet their needs. To accomplish this, beginning November 7, 2013, potential applicants must complete the MAGI pre-screening calculator as part of the application process.
When individuals select "Apply for Health Benefits" on mydss.mo.gov, they are directed to the pre-screening calculator. The pre-screening calculator asks for information about household size, number of dependents, pregnancy, and gross annual income. When the pre-screening calculator is completed, it informs individuals of their healthcare options.
Individuals who are potentially eligible for MO HealthNet benefits will be able to create accounts and complete online applications. If potentially eligible for advanced premium tax credits or cost sharing reductions, a link is provided to direct the individuals to the FFM at www.healthcare.gov.
NOTE: On Nov. 6, 2012, Missouri voters approved Proposition E, which prohibits any state agency from implementing a health insurance exchange/marketplace absent a legislative act, an initiative petition, or referendum. Based on current state law, the Missouri Department of Social Services is not participating with the federal government in the administration of the health insurance exchange/marketplace used by Missouri residents.
Individuals who apply for health care coverage through the FFM may be eligible for lower cost monthly premiums because they qualify for Advanced Premium Tax Credits, or they may pay less for health care because of eligibility for Cost Sharing Reductions.
ADVANCED PREMIUM TAX CREDITS FROM THE FFM
The Advanced Premium Tax Credit (APTC) is a new tax credit designed to help individuals afford health insurance coverage purchased through the FFM. Advance payments of the tax credit can be used to lower monthly premium costs.
Additional information is available on the www.healthcare.gov website.
COST SHARING REDUCTIONS FROM THE FFM
Cost Sharing Reductions (CSR) are discounts that lower the amount individuals pay out-of-pocket for deductibles, coinsurance, and copayments. Individuals receiving health insurance through the FFM may qualify for CSR if the household's income is below a certain level.
Individuals who are members of a federally recognized tribe may qualify for additional cost-sharing benefits. Information is available on the www.healthcare.gov website.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
AC/pc