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.
Establishing Performance Standards for Hospital-based Presumptive Eligibility
Manatt Health Solutions – Jocelyn Guyer
The Affordable Care Act (ACA) allows hospitals to use preliminary information to enroll people who appear eligible for Medicaid into coverage on a temporary basis. The goal of this “presumptive eligibility” (PE) option for hospitals is to quickly and efficiently enroll eligible people into Medicaid while insuring immediate health care costs are covered. While presumptive eligibility is not a new concept in Medicaid, the ACA for the first time gives hospitals – rather than states – the authority to decide whether to participate in PE. This issue brief, prepared by Manatt Health Solutions (Manatt), describes the flexibility available to states to establish training and performance standards for hospitals conducting PE determinations, and discusses approaches states may want to consider as they develop standards. It is based on Manatt’s review of federal law and regulations, as well as interviews with several state officials and other experts from states that currently operate hospital-based presumptive eligibility programs