Financial Sustainability of Medicaid and Exchange Integrated Eligibility Systems: State Cost Allocation Methodologies
Center for Health Care Strategies – Veronica Guerra, Carolyn Ingram, and Shannon McMahon
This brief and companion chart, prepared by Center for Health Care Strategies, reviews cost allocation methodologies states use to determine how exchange development expenses are charged to different agencies. Through a review of Implementation Advance Planning Documents/Implementation Advance Planning Document Updates (IAPD/IAPDU) from California, Massachusetts, Minnesota, Nevada, Oregon and Rhode Island, the brief analyzes various cost allocation methodologies that can be used by other states in developing suitable methodologies for ACA compliant eligibility system integration efforts. The brief also provides examples of strategies used for validating and tracking costs included in the cost allocation plans. The methodologies included in this analysis have been reviewed and individually approved by the Centers for Medicare & Medicaid Services (CMS) after the state’s IAPD submission, and are consistent with the cost allocation principle requiring that methodologies produce an equitable result that is repeatable and based on valid recorded data. The models analyzed offer insights to aid states in developing appropriate methodologies that efficiently allocate costs, maximize federal contributions and ensure the long-term financial sustainability of the Exchange, Medicaid and other human service programs.
Medicaid enrollment has increased by over 10 million (or 15 percent) from February 2020 through February 2021 across all states since the outbreak of the COVID-19 pandemic. States have a clear imperative to center health equity as they plan for the end of the public health emergency (PHE) given that Black, Latino/a, and other people of color are most at risk of coverage loss. This expert perspective highlights strategies states can implement to ensure that the end of the PHE does not exacerbate already widespread racial and ethnic disparities in our health care system.
COVID-19 vaccines are now widely accessible in the United States and free to everyone over the age of 12. Given the spread of the Delta variant, there is an urgent need to increase vaccination rates, particularly among Medicaid enrollees. States across the country continue to report Medicaid enrollees are getting vaccinated at lower rates than the general population. This expert perspective explores how state Medicaid managed care programs and health plans can work collaboratively to increase COVID-19 vaccination rates for the more than 55 million Medicaid enrollees in comprehensive managed care plans.
Many states are looking to fill gaps in race and ethnicity data for Medicaid and related agencies. Working with the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota, with support from the State Health and Value Strategies (SHVS) program, New York tested multiple strategies aimed at encouraging applicants to answer the optional race and ethnicity questions. This expert perspective highlights an effort by New York’s official state-based marketplace, NY State of Health, to improve the completeness of race and ethnicity data that applicants share when applying for Medicaid; Child Health Plus, the state’s Children’s Health Insurance Program (CHIP); the Essential Plan, New York’s Basic Health Program (BHP); or Qualified Health Plan (QHP) coverage through its Marketplace.