A report by the Urban Institute notes that both the House (HR 3962) and Senate (HR 3590) health care reform bills create multiple subsidy systems that may present barriers to coverage.  The report recommends creating a single application for Children’s Health Insurance Program (CHIP), Medicaid, and exchange subsidies under the Senate bill, applying the same streamlining measures to exchange subsidies and Medicaid, and establishing annual subsidy eligibility with exceptions for certain mid-year corrections.

From the report:

The eligibility rules and procedures contained in the Patient Protection and Affordable Care Act, passed by the Senate (Senate bill), and the Affordable Health Care for America Act, passed by the House (House bill), include many promising elements. However, neither bill extends to Medicaid the streamlined enrollment procedures that will help consumers receive subsidies in the exchange. With Medicaid accounting for 41 percent of the coverage expansion forecast by the Congressional Budget Office (CBO), a failure of Medicaid to achieve its goals could undermine the overall effectiveness of reform. And with multiple subsidy systems operating under either version of the legislation, consumers could easily fall between the cracks and fail to receive coverage.

Full report:   Eligibility, Enrollment, and Retention Policies in the House and Senate Health Reform Proposals (PDF | 125.09 KB)

Urban Institute. (2010). Reconciling House and Senate health reform proposals: eligibility, enrollment, and retention policies that will maximize health coverage among the low-income uninsured.  Dorn, S.