Creating California’s “No Wrong Door” for Health Coverage: Recommendations from Consumer Advocates

The Affordable Care Act (ACA) will fundamentally change the way millions of Californians will access health coverage. Instead of having to apply for a particular health coverage program, the ACA requires a seamless ―no wrong door‖ approach to coverage, meaning that regardless of where a person applies for health coverage she or he is evaluated for all programs and enrolled into the most beneficial program based on income and other criteria.
A number of important decisions need to be made regarding how to structure this system in California so that it is up and running by January 1, 2014. Recognizing this, the Western Center on Law & Poverty started in the fall of 2010 working with advocacy partners, in some twenty organizations, to analyze the opportunities and challenges in the ACA and make recommendations as California moves to implement the Eligibility, Enrollment and Retention portions of the ACA. While we recognize that there are additional issues related to this topic, this paper presents our analysis, recommendations, and assessment of remaining questions regarding the architecture of the new system, including electronic applications and information technology issues.
This paper addresses the structural issues involved in building the needed Eligibility, Enrollment and Retention (EER) System. This includes the application and renewal processes, verification systems, real-time enrollment, transitions between programs, and appeals.

Download the Paper Here


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