Reform Alert - News from the Blues' Office of National Health Reform

CMS releases revised Marketplace paper applications

Update: June 21, 2013 — Revised paper applications for employers and employees

May 28, 2013

The Centers for Medicare and Medicaid Services (CMS) is providing states with a single, streamlined application form for Marketplace, Medicaid and CHIP coverage. States may elect to develop and use their own application, subject to approval by CMS.

On January 28, 2013, CMS published its first draft online and paper applications for Marketplace, Medicaid and CHIP coverage.

On April 30, 2013, CMS released revised paper applications for Marketplace, Medicaid and CHIP coverage. The paper application was shortened from 21 pages to three pages for individuals applying for self-only coverage or without special circumstances, and to seven pages for individuals applying for family coverage or having special circumstances. To date, revisions to the online application have not been made. A description of the new paper applications is below.

Application process
As provided in previous rulemaking, individuals will be able to submit an application online, through the mail, over the phone or in person. The application will be accepted by the Marketplace and state Medicaid and CHIP agencies.

The Marketplace will begin taking applications for coverage when open enrollment begins on October 1, 2013. Medicaid and CHIP agencies will begin accepting applications on the same date.

Online application
As previously indicated, the online system will be designed to catch inadvertent errors in real time and immediately verify information in most cases. It will also allow individuals to save information through a unique user account and obtain access to immediate help resources.

Revised paper applications
The revised paper applications include three different forms, depending on the applicant's status:

  • Application for Health Coverage & Help Paying Costs (Short Form—3 pages): This form is for single adults who do not have dependents; cannot be claimed as a dependent on someone else's tax return, are not offered coverage from their employer; and do not have other special circumstances (e.g., Native American, certain foster children).
  • Application for Health Coverage & Help Paying Costs (Long Form—7 pages): This form is for families, individuals who have access to employer-sponsored coverage, former foster children under age 26, individuals who can deduct items from the income calculation, and Native Americans.
  • Application for Health Coverage (3 pages): This form is for individuals and families who do not need help paying costs. It includes a reminder to use a different application if the individual wants help with the cost of coverage, highlighting that individuals with as much as $94,000/year for a family of four could qualify for help.

The Marketplace anticipates following up within one to two weeks of application submission, but does not promise to make a decision on eligibility within that timeframe. Individuals will get information about the next steps to complete health coverage.

Where can I find more information?
Links to the new paper applications are available here:

  • Application for Health Coverage & Help Paying Costs (Short Form)
  • Application for Health Coverage & Help Paying Costs (Long Form)
  • Application for Health Coverage (Marketplace Only)


The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an educational tool only and does not replace a more rigorous review of the law’s applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. As required by US Treasury Regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code.