WASHINGTON – The federal Health IT Policy Committee is backing a plan to build a federal database of business rules that states could use to help determine the eligibility for Medicaid and other federal health insurance programs.

The database would make enrollment data for insurance and healthcare programs accessible to all states. The states could use the data to build electronic health insurance exchanges required by the recent health reform law.

The exchanges would act as an e-commerce gateway to help insurance consumers who are not eligible for Medicaid- or employer-provided insurance find an alternative source of health coverage.

Having all state health program enrollment data in a single database would also keep states from having to rebuild data sets that have already been compiled elsewhere, said Aneesh Chopra, the White House's chief technology officer and chairman of the enrollment work group.

"That will allow for transparency and innovation over time in eligibility rules," he said at a policy committee meeting Aug. 19.

The recommendation is among the first set of proposals that the Health IT Policy Committee approved to help streamline systems states will use in building the insurance exchanges.

The exchanges, which must be available by 2014, will offer healthcare consumers comparative information on state health insurance programs, including Medicaid, hig-risk pools and other public and private health plans.

Determining eligibility

One business rule that applies to Medicaid eligibility is that an insurance seeker's income level must be under a certain threshold of the federal poverty line, Chopra said. Currently, the majority of business rules are not easily known or accessible.

"It's hard to understand how some states determine eligibility," he said.

The committee also recommended that states verify through federal agency systems the personal income, citizenship and legal status of those applying for health programs.

The Internal Revenue Service, the Social Security Administration and the Homeland Security departments are developing Web services that states can use to help determine eligibility for health and human service programs.
Each of the federal agencies requires the use of certain core data elements, such as name, address and income, to help match applications with certain programs.

Using core data elements will eliminate some of the repeated written documentation for each of the programs and also make it easier for states to exchange information.

"We're going to focus on the format of the core data elements so that we can get a higher match rate," said Sam Karp, the co-chairman of the enrollment work group, who is also vice president of programs for the California Healthcare Foundation.

The committee also pushed for the creation of a federal reference verification tool, or sample application, for states to use so they don't have to design and create their own. The software would contain standards for states to verify an individual's eligibility information from federal agencies.