Enroll everyone automatically

Months 6–18 for Wave 1, then before each wave · UHA, SSA, IRSDiscuss this step

Every existing law, program, institution, or practice this step changes: what it is today, what happens to it, when, and what that costs or trades off.

What	Today	Change	Trade-off
Annual open enrollment and plan selection endsYear 4 Patients	Yearly choice of plans, re-verification of eligibility.	Ends; enrollment is automatic and permanent while resident.	No paperwork; no plan choice.
UHP number and card (new) newYear 0–1 Data & technology	Different member IDs per insurer; Medicare MBI.	One lifelong identifier (extending the MBI format); digital card.	Simplicity; privacy concerns about a universal identifier.
Health care in jails and prisons (Medicaid inmate exclusion) amendedYear 4 States & localities	Medicaid cannot pay for care of incarcerated people except inpatient stays; recent 1115 waivers allow pre-release services.	UHP covers incarcerated residents in the 90 days before release and immediately at release, so there is no gap.	Reduces overdose deaths and readmissions after release; corrections systems still fund in-custody care.