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.
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.