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
On January 27, 2023, the Centers for Medicare & Medicaid Services released a State Health Official (SHO) letter, “Medicaid Continuous Enrollment Condition Changes, Conditions for Receiving the FFCRA Temporary FMAP Increase, Reporting Requirements, and Enforcement Provisions in the Consolidated Appropriations Act, 2023.” The SHO letter is the second in a series of guidance related to section 5131 of the Consolidated Appropriations Act, 2023 (CAA), which established a fixed end date for the Medicaid continuous coverage requirement, a gradual phase-down for the enhanced federal match, and new guardrails for mitigating coverage loss for individuals who continue to be eligible. This expert perspective reviews the additional detail and operational expectations of states during the unwinding of Medicaid continuous coverage as laid out in the SHO letter.
On January 26, 2023, the Centers for Medicare & Medicaid Services approved California’s request to amend the California Advancing and Innovating Medi-Cal Section 1115 demonstration. This expert perspective describes the amendment, a centerpiece of which is approval for California Medicaid to provide a targeted set of Medicaid services to youth and adults in state prisons, county jails, and youth correctional facilities for up to 90 days prior to release. By providing re-entry services to Medicaid-enrolled individuals who are incarcerated, California aims to build a bridge to community-based care for justice-involved enrollees, offering them services to stabilize their physical and behavioral health conditions and establishing, prior to release, a re-entry plan for their community-based care.
On January 23, 2023, the Federal Communications Commission issued an important ruling that provides states with new flexibility to support enrollee outreach and communication efforts as part of their processes to unwind the Medicaid continuous coverage requirement. The ruling permits state agencies and their partners to send text messages and make phone calls to individuals about enrollment-related issues not only for Medicaid but for other state-run health insurance programs, including marketplace coverage. This expert perspective reviews the ruling and implications for states.
