---
kind: "section"
citation: "42 U.S.C. § 1396w–3"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1396w–3"
heading: "Enrollment simplification and coordination with State health insurance exchanges"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1396w-3"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XIX — Grants to States for Medical Assistance Programs"
---

# §1396w–3. Enrollment simplification and coordination with State health insurance exchanges

- (a) **Condition for participation in Medicaid—** As a condition of the [State](/usc/42/619.md?p=5) plan under this subchapter and receipt of any Federal financial assistance under [section 1396b(a) of this title](/usc/42/1396b.md?p=a) for calendar quarters beginning after January 1, 2014, a [State](/usc/42/619.md?p=5) shall ensure that the requirements of [subsection (b)](#b) is[^1] met.
- (b) **Enrollment simplification and coordination with State health insurance exchanges and CHIP—**
  - (1) **In general—** A [State](/usc/42/619.md?p=5) shall establish procedures for—
    - (A) enabling individuals, through an Internet website that meets the requirements of [paragraph (4)](#b-4), to apply for [medical assistance](/usc/42/1396d.md?p=a) under the [State](/usc/42/619.md?p=5) plan or under a waiver of the plan, to be enrolled in the [State](/usc/42/619.md?p=5) plan or waiver, to renew their enrollment in the plan or waiver, and to consent to enrollment or reenrollment in the [State](/usc/42/619.md?p=5) plan through electronic signature;
    - (B) enrolling, without any further determination by the [State](/usc/42/619.md?p=5) and through such website, individuals who are identified by an Exchange established by the [State](/usc/42/619.md?p=5) under [section 18031 of this title](/usc/42/18031.md) as being eligible for—
      - (i) [medical assistance](/usc/42/1396d.md?p=a) under the [State](/usc/42/619.md?p=5) plan or under a waiver of the plan; or
      - (ii) [child health assistance](/usc/42/1397jj.md?p=a) under the [State child health plan](/usc/42/1397jj.md?p=c-7) under subchapter XXI;
    - (C) ensuring that individuals who apply for but are determined to be ineligible for [medical assistance](/usc/42/1396d.md?p=a) under the [State](/usc/42/619.md?p=5) plan or a waiver or ineligible for [child health assistance](/usc/42/1397jj.md?p=a) under the [State child health plan](/usc/42/1397jj.md?p=c-7) under subchapter XXI, are screened for eligibility for enrollment in qualified [health plans](/usc/42/1320d.md?p=5) offered through such an Exchange and, if applicable, premium assistance for the purchase of a qualified [health plan](/usc/42/1320d.md?p=5) under section 36B of the Internal Revenue Code of 1986 (and, if applicable, advance payment of such assistance under [section 18082 of this title](/usc/42/18082.md)), and, if eligible, enrolled in such a plan without having to submit an additional or separate application, and that such individuals receive information regarding reduced cost-sharing for eligible individuals under [section 18071 of this title](/usc/42/18071.md), and any other assistance or subsidies available for coverage obtained through the Exchange;
    - (D) ensuring that the [State agency](/usc/42/629a.md?p=a-3) responsible for administering the [State](/usc/42/619.md?p=5) plan under this subchapter (in this section referred to as the “[State](/usc/42/619.md?p=5) Medicaid [agency](/usc/42/1397n–12.md?p=1)”), the [State agency](/usc/42/629a.md?p=a-3) responsible for administering the [State child health plan](/usc/42/1397jj.md?p=c-7) under subchapter XXI (in this section referred to as the “[State](/usc/42/619.md?p=5) CHIP [agency](/usc/42/1397n–12.md?p=1)”) and an Exchange established by the [State](/usc/42/619.md?p=5) under [section 18031 of this title](/usc/42/18031.md) utilize a secure electronic interface sufficient to allow for a determination of an individual’s eligibility for such [medical assistance](/usc/42/1396d.md?p=a), [child health assistance](/usc/42/1397jj.md?p=a), or premium assistance, and enrollment in the [State](/usc/42/619.md?p=5) plan under this subchapter, subchapter XXI, or a qualified [health plan](/usc/42/1320d.md?p=5), as appropriate;
    - (E) coordinating, for individuals who are enrolled in the [State](/usc/42/619.md?p=5) plan or under a waiver of the plan and who are also enrolled in a qualified [health plan](/usc/42/1320d.md?p=5) offered through such an Exchange, and for individuals who are enrolled in the [State child health plan](/usc/42/1397jj.md?p=c-7) under subchapter XXI and who are also enrolled in a qualified [health plan](/usc/42/1320d.md?p=5), the provision of [medical assistance](/usc/42/1396d.md?p=a) or [child health assistance](/usc/42/1397jj.md?p=a) to such individuals with the coverage provided under the qualified [health plan](/usc/42/1320d.md?p=5) in which they are enrolled, [including](/usc/42/1301.md?p=b) services described in [section 1396d(a)(4)(B) of this title](/usc/42/1396d.md) (relating to [early and periodic screening, diagnostic, and treatment services](/usc/42/1396d.md?p=r) defined in [section 1396d(r) of this title](/usc/42/1396d.md?p=r)) and provided in accordance with the requirements of [section 1396a(a)(43) of this title](/usc/42/1396a.md?p=a-43); and
    - (F) conducting outreach to and enrolling vulnerable and underserved populations eligible for [medical assistance](/usc/42/1396d.md?p=a) under this subchapter or for [child health assistance](/usc/42/1397jj.md?p=a) under subchapter XXI, [including](/usc/42/1301.md?p=b) children, unaccompanied homeless [youth](/usc/42/629a.md?p=a-11), children and [youth](/usc/42/629a.md?p=a-11) with special health care needs, pregnant women, racial and ethnic minorities, rural populations, victims of [abuse](/usc/42/1397j.md?p=1) or trauma, individuals with mental health or substance-related disorders, and individuals with HIV/AIDS.
  - (2) **Agreements with State health insurance exchanges—** The [State](/usc/42/619.md?p=5) Medicaid [agency](/usc/42/1397n–12.md?p=1) and the [State](/usc/42/619.md?p=5) CHIP [agency](/usc/42/1397n–12.md?p=1) may enter into an agreement with an Exchange established by the [State](/usc/42/619.md?p=5) under [section 18031 of this title](/usc/42/18031.md) under which the [State](/usc/42/619.md?p=5) Medicaid [agency](/usc/42/1397n–12.md?p=1) or [State](/usc/42/619.md?p=5) CHIP [agency](/usc/42/1397n–12.md?p=1) may determine whether a [State](/usc/42/619.md?p=5) resident is eligible for premium assistance for the purchase of a qualified [health plan](/usc/42/1320d.md?p=5) under section 36B of the Internal Revenue Code of 1986 (and, if applicable, advance payment of such assistance under [section 18082 of this title](/usc/42/18082.md)), so long as the agreement meets such conditions and requirements as the [Secretary](/usc/42/1301.md?p=a-6) of the Treasury may prescribe to reduce administrative costs and the likelihood of eligibility errors and disruptions in coverage.
  - (3) **Streamlined enrollment system—** The [State](/usc/42/619.md?p=5) Medicaid [agency](/usc/42/1397n–12.md?p=1) and [State](/usc/42/619.md?p=5) CHIP [agency](/usc/42/1397n–12.md?p=1) shall participate in and comply with the requirements for the system established under [section 18083 of this title](/usc/42/18083.md) (relating to streamlined procedures for enrollment through an Exchange, Medicaid, and CHIP).
  - (4) **Enrollment website requirements—** The procedures established by [State](/usc/42/619.md?p=5) under [paragraph (1)](#b-1) shall include establishing and having in operation, not later than January 1, 2014, an Internet website that is linked to any website of an Exchange established by the [State](/usc/42/619.md?p=5) under [section 18031 of this title](/usc/42/18031.md) and to the [State](/usc/42/619.md?p=5) CHIP [agency](/usc/42/1397n–12.md?p=1) (if different from the [State](/usc/42/619.md?p=5) Medicaid [agency](/usc/42/1397n–12.md?p=1)) and allows an individual who is eligible for [medical assistance](/usc/42/1396d.md?p=a) under the [State](/usc/42/619.md?p=5) plan or under a waiver of the plan and who is eligible to receive premium credit assistance for the purchase of a qualified [health plan](/usc/42/1320d.md?p=5) under section 36B of the Internal Revenue Code of 1986 to compare the benefits, premiums, and cost-sharing applicable to the individual under the [State](/usc/42/619.md?p=5) plan or waiver with the benefits, premiums, and cost-sharing available to the individual under a qualified [health plan](/usc/42/1320d.md?p=5) offered through such an Exchange, [including](/usc/42/1301.md?p=b), in the case of a [child](/usc/42/1382c.md?p=c), the coverage that would be provided for the [child](/usc/42/1382c.md?p=c) through the [State](/usc/42/619.md?p=5) plan or waiver with the coverage that would be provided to the [child](/usc/42/1382c.md?p=c) through enrollment in family coverage under that plan and as supplemental coverage by the [State](/usc/42/619.md?p=5) under the [State](/usc/42/619.md?p=5) plan or waiver.
  - (5) **Continued need for assessment for home and community-based services—** Nothing in [paragraph (1)](#b-1) shall limit or modify the requirement that the [State](/usc/42/619.md?p=5) assess an individual for purposes of providing home and community-based services under the [State](/usc/42/619.md?p=5) plan or under any waiver of such plan for individuals described in subsection (a)(10)(A)(ii)(VI).[^2]

## Footnotes

[^1]: So in original. Probably should be “are”.
[^2]: Probably means subsection (a)(10)(A)(ii)(VI) of section 1396a of this title.

## Source credit

(Aug. 14, 1935, ch. 531, title XIX, § 1943, as added Pub. L. 111–148, title II, § 2201, Mar. 23, 2010, 124 Stat. 289.)

## Notes

### Editorial Notes

### References in Text

The Internal Revenue Code of 1986, referred to in subsec. (b)(1)(C), (2), (4), is classified generally to Title 26, Internal Revenue Code.