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.
As states are working diligently to operationalize the unwinding of the Medicaid continuous coverage requirement, State Health and Value Strategies has been tracking the creative strategies states are implementing to minimize coverage losses. This expert perspective highlights all the hard work states are engaged in and spotlights innovative strategies other states may want to consider adopting. SHVS will continue to track and share state efforts to support coverage through the unwinding period. If your state is implementing a new effort to reach enrollees, or if you have questions about how you can implement an example included in this EP, please be in touch.
The unwinding of the Medicaid continuous coverage requirement represents the largest nationwide coverage transition since the Affordable Care Act, with significant health equity implications. Given the intense focus on coverage transitions during the unwinding, some states are publishing their data to monitor progress. To date, 44 states (including the District of Columbia) have released unwinding data in either an interactive dashboard or static pdf format, or are making public their required CMS Monthly Unwinding Data reports. This expert perspective includes an interactive map with links to state dashboards and reports to CMS. SHVS will continue to update this EP as more states publish their unwinding data.
States are traditionally laboratories for policy innovation and the 2023 legislative session was no exception. The expansion of health coverage was a major priority for states, particularly for low-income populations, children, postpartum individuals and individuals of undocumented status. As the high cost of care continued to be a major barrier for consumers, states bolstered their efforts to enhance healthcare affordability. States also used the 2023 legislative session as an opportunity to study system innovations to expand health coverage and affordability. This expert perspective explores these trends in state healthcare policy reflected in innovative legislation enacted this year.
