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.
As states continue the unwinding of the Medicaid continuous coverage requirement and redetermining their enrollees, states across the country have reported scams asking consumers for financial or personal information are prevalent. This expert perspective provides recommendations on what state communications and digital teams can do to mitigate online scams and protect official sources of information.
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 have initiated plans to publish a data dashboard to monitor progress. To date, the District of Columbia and 15 states have published unwinding data in a visual dashboard format (this does not include states with pre-existing enrollment dashboards that don’t specifically identify unwinding cohorts). This expert perspective now includes an interactive map with the links to all the dashboards and states publishing CMS unwinding reports. SHVS will continue to update the EP and map as more states publish their unwinding data.