All-payer claims databases (APCDs) collect and compile medical, pharmacy, and sometimes dental claims, eligibility, and provider files from public and private payers. APCDs are currently being used for a variety of functions, including population health analysis, comparative analysis of provider and facility quality, cost management for Medicaid and other public programs, support for provider payment reform initiatives, and consumer transparency tools.
Under the Affordable Care Act (ACA), individuals seeking health insurance coverage through a Marketplace are assessed for eligibility for an advance payment of the premium tax credit (APTC) based on projected annual income. When eligible individuals file federal income taxes at the end of the year, the Internal Revenue Service (IRS) will reconcile the premium tax credit received based on estimated annual income with what should have been received based on actual income.
he Affordable Care Act (ACA) is already greatly expanding individual health insurance coverage, particularly among lower-income uninsured individuals. However, this is neither easy nor inexpensive to sustain, and it will require ongoing, effective public-private partnerships on multiple levels. One potential partnership opportunity is with “web brokers” who sell individual health insurance online, functioning as private distribution channels in a fashion similar to the new Marketplaces and offering a choice of health plans from multiple insurers, while relying primarily on websites and call centers for customer service.
With full implementation of the health insurance coverage provisions of the Affordable Care Act (ACA) on January 1, 2014, there has been great interest in assessing the law’s early impact on health insurance coverage in Minnesota.
This issue brief draws from the experiences of six states, Alabama, Colorado, Montana, New Mexico, North Carolina, and Vermont, to identify common policy considerations and action steps for coordinating care in rural environments.
Early evidence from across the nation suggests that consumer assisters are playing a vital role in helping people enroll in the new coverage options made possible by the Affordable Care Act (ACA). The State Health Reform Assistance Network has engaged with a number of states to develop easy to understand materials to educate consumer assisters about various issues that may confuse consumers and the assisters trying to help them during the eligibility determination and enrollment process.
The Affordable Care Act (ACA) has important implications for American Indians and Alaska Natives (AI/AN), including the expansion of Medicaid coverage to nearly 400,000 currently uninsured AI/AN individuals.
The Affordable Care Act (ACA) allows hospitals to use preliminary information to enroll people who appear eligible for Medicaid into coverage on a temporary basis. The goal of this “presumptive eligibility” (PE) option for hospitals is to quickly and efficiently enroll eligible people into Medicaid while insuring immediate health care costs are covered.
Integrating Physical and Behavioral Health: Strategies for Overcoming Legal Barriers to Health Information Exchange
This brief explores the strategies states use to address barriers that impede data-sharing efforts among providers to integrate physical and behavioral health care. The webinar presentation on this issue brief is also available for download.
This issue brief focuses specifically on the key purchasing strategies that state Medicaid agencies and state employee health benefit purchasers can implement in order to reduce the overuse and misuse of health care services, and improve the quality and reduce the cost of care. A webinar presentation on the subject is also available for download.