In recent months, states have increasingly introduced proposals for individuals above Medicaid eligibility levels to “buy-in” to Medicaid or leverage the Medicaid program to strengthen coverage across the individual market and Medicaid. State Health and Value Strategies is tracking current state activity and has mapped out which states are pursuing a program and those that are establishing task forces to understand the impact of a Medicaid buy-in program.
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.