In light of recent postal delays and housing displacements caused by the COVID-19 pandemic and related economic crisis, and a wave of natural disasters across the country, state Medicaid and Children’s Health Insurance Program (CHIP) agencies face new challenges communicating with their enrollees about their health coverage. Acting now to mitigate these challenges is essential as states are preparing for the end of the public health emergency (PHE) and “catching up” on coverage renewals for a large portion of their enrollees. This expert perspective reviews strategies that state Medicaid and CHIP agencies may consider to help mitigate coverage losses.
ACA Implications for State Network Adequacy Standards
Georgetown University Health Policy Institute – Sally McCarty and Max Farris
This brief, prepared by the Georgetown University Health Policy Institute, explores some of the discrepancies that can arise with varying network adequacy standards and provides examples of how some states have resolved such issues. Network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all health care services included under the terms of the contract.
States have taken different approaches in regulating the adequacy of health plan networks based on their state-specific market. States have a variety of options available to maintain robust health insurance markets by balancing access needs with the goals of controlling costs and attracting a healthy number of insurers. Appendix A serves as a comparison table of different network adequacy standards and requirements. Appendix B provides a narrative description of network adequacy standards in California, Colorado, Delaware, Hawaii, Maryland, Minnesota, Montana, Texas, Vermont, Washington, and the Federally-facilitated Marketplace.