ACA Implementation Toolkit for Departments of Insurance
Georgetown University Health Policy Institute – Mila Kofman, Katie Dunton and Sally McCarty
In order to assist states in accomplishing tasks related to insurance market reforms and certification and management of qualified health plans, the Georgetown University Health Policy Institute has developed a toolkit for insurance departments. Many Affordable Care Act (ACA) implementation issues fall squarely within existing state insurance regulatory functions. This toolkit is designed to help insurance regulators effectively implement ACA provisions, regulations, and other guidance by planning and allocating resources for and conducting many of the plan management functions associated with successful exchange implementation.
This toolkit includes several self-audits, templates, and checklists to help departments of insurance work in concert with other state agencies in ascertaining the appropriate locus of exchange related functions. Further, the toolkit can help state agencies operationalize those responsibilities. The toolkit will be updated periodically with additional resources and uploaded to www.StateNetwork.org. The list of specific resources and descriptions follow:
Form Review Checklist, Model Notices and Examples The form review checklist is a document for insurance regulators to use in reviewing forms associated with products (insurance contracts, policies, certificates of coverage, etc.) filed by issuers for approval prior to offering the products to consumers. The document in the toolkit serves as an example of the Form Review Checklist. To fill out the form, download the editable file here.
ACA Insurance Self-audit The self-audit is a chronological, step-by-step checklist that gives states a guide as they analyze their insurance laws, rules and regulations, etc. for compliance with the ACA.
Exchange Functions Checklist The exchange functions checklist is a tool to help departments of insurance work with their health insurance exchanges to identify and document functions they may currently perform and to determine which entities should perform these functions going forward.
Work Plan Template The work plan template is a matrix designed to allow state officials to identify tasks that have been completed, what is on-going, and what needs to begin for plan management functions.
Qualified Health Plan (QHP) Certification ‘Cheat Sheet’ This summary of QHP provisions from federal guidance is designed as a quick reference for states providing a high level outline of requirements including certification of and minimum standards for QHPs.
Essential Health Benefits (EHB) Planning Template This template provides the key decisions and considerations states need to address in choosing an EHB benchmark plan and the related work to operationalize that decision once it is made.
In the absence of federal legislation, states are actively seeking tools to reform their health care systems. While 1115 waivers rightly get a lot of attention, because of their ability to reshape state Medicaid programs, the Affordable Care Act’s Section 1332 waivers continue to be a promising avenue for states to stabilize their health insurance marketplace. SHVS is tracking state activity and has many resources, including a template, for states interested in pursuing a Section 1332 waiver.
In recent months, states have increasingly introduced proposals for individuals above Medicaid eligibility levels to “buy-in” to Medicaid or leverage the Medicaid program to strengthen coverage across the individual market and Medicaid. State Health and Value Strategies is tracking current state activity and has mapped out which states are pursuing a program and those that are establishing task forces to understand the impact of a Medicaid buy-in program.
On March 27, for the second time, a federal judge vacated the Centers for Medicare & Medicaid Services (CMS) approval of Kentucky’s Medicaid 1115 demonstration waiver to test, among other things, a work requirement as a condition of Medicaid eligibility. In a related case of Arkansas’s Medicaid work requirements demonstration, the judge likewise vacated the federal approval, remanding it to CMS for further consideration. Notably, because Arkansas, unlike Kentucky, had already implemented the work requirements, the decision requires the state to cease its work requirement and related Medicaid disenrollments. This expert perspective reviews the court’s decision and its implications for both Kentucky and Arkansas and other states with similar approved or pending waiver requests, as well as for states contemplating imposing work or other “community engagement” requirements on Medicaid beneficiaries.
