One of the more complex challenges that states face in implementing the Affordable Care Act (ACA) is developing the relationship between Medicaid and the emerging health benefit exchanges. In the lead-up to 2014, states will have to determine whether to participate in the federal health benefit exchange, implement their own exchange, or partner with the federal government on some components and then establish their own exchange for others. Regardless of how they proceed, all states will have to make crucial determinations — how to align the exchange with public payers, how to streamline benefits, and how to align eligibility and enrollment to minimize churn.

This brief looks at the opportunities for linkages between public and private coverage, explaining that such linkages should seek to streamline administration across programs and facilitate seamless transitions between programs. Continuity of benefits, providers and health plans is critical to developing a smooth roadmap for exchanges.

This brief is a product of the State Health Reform Assistance Network, a program of the Robert Wood Johnson Foundation that is providing technical support to states to maximize coverage gains as they implement key provisions of the Affordable Care Act. The program is managed by the Woodrow Wilson School of Public and International Affairs at Princeton University.