Issue Briefs | Feb 12, 2013

A Strategic Approach for Insurance Exchanges to Select and Manage Qualified Health Plans

Wakely Consulting Group – Jon Kingsdale, Susan Tuite, Patrick Holland, and James Woolman

Wakely Consulting Group has prepared this policy brief to aid state Exchanges in their contracting strategies with qualified health plans (QHPs). Section I of this brief describes many of the types of decisions that Exchanges should consider in preparing to launch a clean, effective QHP solicitation process. Section II describes the standards that Exchanges will use to certify QHPs. It summarizes the major federal requirements that all QHPs must meet and sets forth examples of additional requirements that some states are considering. Section III sets forth options for “negotiating” key elements of the issuers’ proposals. Unlike many start-up tasks, certifying, re-certifying, de-certifying and managing the relationship over time with health plans is an ongoing and evolving set of tasks. Therefore, Exchanges should take a strategic approach to these functions, each state can craft plan selection and ongoing partnerships to support the achievement of its goals for health care reform.

Wakely also hosted a webinar covering the topics of this brief.


Expert Perspectives

November 22, 2024

Information Sharing Considerations for Implementing the Consolidated Appropriations Act’s Requirements for Justice-Involved Children and Youth

This expert perspective reviews the information sharing considerations for states in implementing the Consolidated Appropriations Act’s (CAA) requirements to provide targeted case management and screening and diagnostic services for children and youth who are incarcerated and enrolled in Medicaid or CHIP. The expert perspective highlights key areas of CAA implementation that require information sharing, which states will need to consider as they work towards coming into full compliance.

November 15, 2024

CMS Releases Guidance on Optional Long-Term Use of Unwinding-Related Section 1902(e)(14) Waivers

On November 14, 2024, CMS released its second installment in its series of Medicaid and CHIP guidance intended to support state efforts to verify eligibility and conduct renewals in compliance with federal Medicaid and CHIP requirements. A new expert perspective summarizes the latest CMCS Informational Bulletin and accompanying slide deck which address the continued use of unwinding-related section 1902(e)(14) waivers beyond the previously established expiration date of June 30, 2025.