Issue Briefs | Sep 21, 2015

Financing Shared Administrative Functions Between State-Based Marketplaces and State Medicaid Programs: Cost Allocation Methodologies

Tricia Leddy, Mark Larson, and Christian Heiss, Center for Health Care Strategies

The Affordable Care Act (ACA) provides opportunities for expanded access to health coverage through both the expansion of Medicaid and the establishment of health insurance marketplaces.  State-based marketplaces (SBMs), as pathways to both public and private health coverage, are required to perform cross-program functions that support access to both qualified health plans (QHPs) available through the marketplace, as well as coverage through Medicaid.  While these shared functions create an opportunity for savings through enhanced efficiency, they also require states to properly attribute funding to both through a process known as cost allocation.  This issue brief, prepared by the Center for Health Care Strategies, builds on a previously released analysis of cost allocation methodologies, by providing an in-depth view of the mechanics of implementing cost allocation between Medicaid and marketplace programs.


Expert Perspectives

January 7, 2025

Release of New E&E Guidance Related to Renewal Forms and Medicaid/Separate CHIP Transitions

Following the November release of guidance to support states’ efforts to verify eligibility and conduct renewals in compliance with federal Medicaid and CHIP requirements, the Centers for Medicare & Medicaid Services issued on December 20 two additional Center for Medicaid and CHIP Services Informational Bulletins (CIBs). This expert perspective summarizes the requirements outlined in the CIBs.

New CMS Guidance on Compliance Requirements for Provision of Medicaid/CHIP Services to Incarcerated Youth

On December 19, the Centers for Medicare and Medicaid Services released State Health Official (SHO) letter 24-006, “Provision of Medicaid and CHIP Services to Incarcerated Youth – FAQs,” which provides several clarifications for states on compliance expectations for implementing section 5121 of the Consolidated Appropriations Act of 2023. This expert perspective describes key clarifications addressed in the SHO letter.