This report from the National Academy for State Health Policy explores the role that state will have in developing enrollment processes that bridge the enrollment gap between Medicaid and the future exchanges. The Affordable Care Act requires integrated enrollment processes for these systems, and the pressure falls upons the states to develop these processes.

From the report:

The Affordable Care Act (ACA) is generating a sea change for state health coverage programs. By initiating a historic coverage expansion under Medicaid, creating new tax subsidies to support private coverage for low- and moderate-income individuals, and mandating individuals to have health insurance coverage, ACA promises to make health coverage more affordable and accessible than ever. States are playing a lead role in ACA’s implementation and creating eligibility and enrollment systems that can screen, enroll, renew and transfer coverage among programs is a central component of their work. To support state efforts, ACA provides a transformative vision for eligibility and enrollment in public and publicly subsidized health coverage: an enrollment superhighway that is streamlined, modern, seamless, integrated, easy for consumers to use, and connects Medicaid, CHIP and Exchange coverage. Given the prominence of health coverage as a goal for health system reform, whether states can implement this vision for a simpler, streamlined enrollment system and ultimately enroll the estimated 32 million newly eligible individuals will be a critical test of ACA’s success.

Full Report: Paving an Enrollment: Bridging State Gaps Between 2014 and Today (PDF | 430 KB) 

National Academy of State Health Policy. (2011). Paving an enrollment superhighway: bridging state gaps between 2014 and today. Weiss, A. M. and Grossman, L.