Health Reform WK-EDGE Data matching will confirm eligibility for affordability programs
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Friday, November 9, 2018

Data matching will confirm eligibility for affordability programs

By Patricia K. Ruiz, J.D.

CMS has partnered with the Department of Defense (DOD) in a new matching program that will provide the departments with data verifying individuals’ eligibility for coverage under a DOD health benefits plan, such as TRICARE, when requested by CMS and state-based administering entities for the purpose of determining eligibility for insurance affordability programs under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). CMS seeks comments on this notice through November 30, 2018 (Notice, 83 FR 54755, October 31, 2018).

Eligibility for minimum essential coverage. DOD health benefit plans provide minimum essential coverage, and eligibility for such plans precludes eligibility for financial assistance in paying for private coverage. CMS and the administering entities will use the DOD data to authenticate an enrollee’s identity, determine eligibility for financial assistance (including advance tax credit and cost-sharing reductions under sections 1401 and 1402 of the ACA), and determine the amount of financial assistance. The matching program will apply to active duty service members and their family members, as well as retirees and their family members, whose TRICARE eligibility records at the DOD match data provided to the DOD by CMS about individual consumers applying for or enrolled in private health insurance coverage under a QHP through a federally facilitated or state-based health insurance exchange.

Data exchange. For each applicant or enrollee seeking an eligibility determination, CMS will submit a request file to the DOD that may contain data elements such as social security number, first name, middle name, surname, date of birth, gender, requested QHP coverage effective date, and requested QHP coverage end date. The DOD will provide for each applicant or enrollee data indicating whether or not the individual is eligible for minimum essential coverage via TRICARE during the coverage period.

FederalRegisterIssuances: Notices NewsFeed CostSharingNews EnrollmentNews EssentialBenefitNews HealthInsuranceExchangeNews PremiumTaxNews TricareNews

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