Issue Briefs , Reports | Jan 8, 2016

A Look at Marketplace Models: How Can They Help States Achieve Their Goals?

Wakely Consulting Group and KPMG

The recently released Proposed Payment Notice for 2017 formalizes a fourth model of marketplace – State-Based Marketplace/Federal Platform. Along with State Based Marketplaces, State Partnership Marketplaces and the Federally Facilitated Marketplace, states have a range of choices for what their Marketplace looks like. A key question for states will be how these different models help to achieve coverage goals. This issue brief written by State Network Technical Assistance Experts at Wakely Consulting Group and KMPG digs into the different models and how they stack up against a set of common goals for states.


Expert Perspectives

October 25, 2021

State Policy and IT System Strategies to Prepare for PHE Unwinding: Updating Medicaid Enrollee Address Information and Responding to Returned Mail

At the end of the public health emergency (PHE), people currently enrolled in Medicaid and the Children’s Health Insurance Program are at risk of losing their coverage unless state Medicaid/CHIP agencies take steps to update enrollee mailing addresses and other contact information. This expert perspective examines the information technology system, policy, and operational strategies states can consider to update key enrollee contact information to ensure eligible enrollees are able to keep or transition to new affordable health coverage at the end of the PHE.

October 22, 2021

The No Surprises Act Interim Final Rule on Dispute Resolution, Uninsured Protections, and External Review: Implications for States

On October 7, the U.S. Departments of Health and Human Services (HHS), Treasury, and Labor (DOL) and the Office of Personnel Management (OPM) published a third rule implementing the No Surprises Act (NSA), the comprehensive federal law banning balance bills in emergency and certain non-emergency settings beginning January 1, 2022. This third rule, an interim final rule, provides details on the independent dispute resolution process (IDR), good faith estimates for enrollees on the cost of services, the dispute resolution process for uninsured patients, and external review. This expert perspective summarizes the provisions of the IFR and notes particular implications for state regulators.