On January 27, 2023, the Centers for Medicare & Medicaid Services released a State Health Official (SHO) letter, “Medicaid Continuous Enrollment Condition Changes, Conditions for Receiving the FFCRA Temporary FMAP Increase, Reporting Requirements, and Enforcement Provisions in the Consolidated Appropriations Act, 2023.” The SHO letter is the second in a series of guidance related to section 5131 of the Consolidated Appropriations Act, 2023 (CAA), which established a fixed end date for the Medicaid continuous coverage requirement, a gradual phase-down for the enhanced federal match, and new guardrails for mitigating coverage loss for individuals who continue to be eligible. This expert perspective reviews the additional detail and operational expectations of states during the unwinding of Medicaid continuous coverage as laid out in the SHO letter.
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.