Eligibility & Enrollment Modernization

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Helping states create a simplified path to health care coverage

Eligibility and Enrollment Modernization

Offering a Straightforward Eligibility and Enrollment Model

Health care reform opens the door to health care coverage for tens of millions of Americans, with Medicaid and CHIP serving as the foundation for expansion. States need an application and eligibility determination process for their subsidized programs that coordinates and assesses an individual’s or family’s eligibility, is easy for consumers to understand, and satisfies program requirements.

Standardizing the Application & Renewal Process

A standardized, modernized and simplified application and renewal process for eligibility increases consumers’ abilities to accurately complete the application. We help states improve choice rates and health outcomes by offering consumers a simple, straightforward application process. Our Eligibility and Enrollment Modernization solution:

  • Offers a straightforward application that seamlessly works across multiple health insurance programs
  • Reduces the documentation required to determine program eligibility
  • Decreases consumer churn through operational best practices
  • Provides multi-channel access via mail, fax, Web and phone
  • Gives consumers self-service tools with 24/7 access
  • Promotes application completion through plain language educational materials, applications, forms, instructions and Websites
  • Addresses diverse language and literacy levels with multilingual materials and customer service representatives

Maximizing Operational Efficiency

A simplified eligibility and enrollment model promotes operational efficiencies, allowing states to achieve simplicity and cost efficiency without compromising program integrity. We can help states create a model that features:

  • Full business-process automation and electronic workflow to standardize basic steps
  • Automated income and citizenship verification through public and third-party databases
  • Unified application that collects required data for all subsidized insurance programs

Customized Solutions to Meet All State Requirements

As the leading enrollment contractor for government health insurance programs, MAXIMUS offers flexible, proven eligibility systems and solutions that are easily customized to a state’s rules and program design. Together we can help you create an accurate and efficient enrollment process to meet the needs of all subsidized consumers.