Summary
- IBM Cúram for Health Care Reform allows citizens to avail of a
range of health care options, determine their eligibility for
assistance, shop for plans without assistance, or simply browse
plans made available by plan providers in the Exchange.
- Using a single entry point and HCR application script, citizens
can apply for the range of insurance affordability programs
for which they and their household may be eligible.
- Insurance affordability programs that applicants can be determined
eligible for include Medicaid, CHIP, Insurance Assistance, and
optionally a state basic health program.
- The Exchange is an online market for insurance plans offered by
private insurance carriers that are presented to individuals
for plan selection and enrollment. The Exchange provides a means
for citizens to search for and compare different qualified health
plans.
- Individuals can use the exchange without seeking financial
assistance, although they must be determined eligible to use the
exchange
- Information capture is limited to information needed for an accurate
determination for MAGI-based eligibility - essentially applicant,
household and household income information.
- Eligibility is based on MAGI income, a simplified income
determination in comparison to a traditional Medicaid determination
- no resource test, no complex income rules.
- Electronic verification or e-verification ensures a near real-time
eligibility determination
- HCR integrates with Cúram Income Support to allow individuals
to screen for or apply for other programs that may also be offered
by the agency.
- HCR makes use of the redesigned Cúram Universal Access to provide
a landing page and citizen account functionality for the range
of HCR services a citizen can access.
- Eligibility rules for insurance affordability are based on the
legislative requirements as defined in the Affordable Care Act.
The insurance affordability rule sets are built using the Cúram
Express Rules framework.
- HCR caters for a number of different user roles including
individuals and employees, navigators who assist a citizen in making
an application, and case workers who process and manage client
cases.