Managing State-Level ACA Implementation Through Interagency Collaboration
Shelly Ten Napel, MSW, MPP, Kyla Hoskins, MPH, Enrique MartinezVidal, MPP and Heather Howard, J.D
“Managing State-Level ACA Implementation Through Interagency Collaboration” was developed by Shelly Ten Napel and the State Network team to describe the early lessons learned from state officials and technical experts related to the leadership and coordination strategies needed to successfully implement the Affordable Care Act (ACA) at the state level. The brief:
– Discusses the value of leadership and a clear vision;
– Outlines specific interagency collaboration strategies being used by states, from low-tech solutions, such as regular meetings and clear delineation of roles and responsibilities, to higher-tech tools including document-sharing and project management software;
– Provides concrete examples of work plans and formal memorandums of understanding (MOUs); and
– Explores issues raised by:
– the need to procure and develop new information technology (IT) systems;
– the imperative to consult with various stakeholders; and,
– the unique challenges related to Health Benefit Exchanges (Exchanges), which may or may not be a formal part of state government.
The brief is designed to provide practical insights and tools for states. For states in which planning is already well underway, it provides suggestions on ways to get beyond existing challenges and barriers. It can be used to check current task lists to ensure that all important topics are being contemplated. For states in which planning is just getting started, it can serve as a comprehensive primer. You will find the following tools:
– Model high-level Exchange timeline
– Milestones for ACA implementation
– Exchange work plan template
– Division of Insurance work plan template
– Division of Insurance self-audit timeline
– Medicaid work plan template
– Checklist of areas where Exchanges will need MOUs with Medicaid programs and Divisions of Insurance
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.
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.
On March 27, for the second time, a federal judge vacated the Centers for Medicare & Medicaid Services (CMS) approval of Kentucky’s Medicaid 1115 demonstration waiver to test, among other things, a work requirement as a condition of Medicaid eligibility. In a related case of Arkansas’s Medicaid work requirements demonstration, the judge likewise vacated the federal approval, remanding it to CMS for further consideration. Notably, because Arkansas, unlike Kentucky, had already implemented the work requirements, the decision requires the state to cease its work requirement and related Medicaid disenrollments. This expert perspective reviews the court’s decision and its implications for both Kentucky and Arkansas and other states with similar approved or pending waiver requests, as well as for states contemplating imposing work or other “community engagement” requirements on Medicaid beneficiaries.
