This brief, prepared by the Georgetown University Health Policy Institute, explores some of the discrepancies that can arise with varying network adequacy standards and provides examples of how some states have resolved such issues. Network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all health care services included under the terms of the contract.
This brief, prepared by the National Academy for State Health Policy, lays out the major factors states have considered in estimating the cost of a potential Medicaid expansion. The major factors addressed in this brief are: Who will enroll in Medicaid with or without a Medicaid expansion?; How do the alternatives afforded by Medicaid’s Alternative Benefit Plans and Medicaid waivers affect expansion considerations?; How are health care institutions, state agencies, and a state’s broader economy affected by a state’s decision regarding Medicaid expansion?
This educational slide deck, prepared by Manatt Health Solutions, provides detailed information on Advance Premium Tax Credits (APTCs) and Cost-Sharing Reductions (CSRs). It is designed as a tool to educate navigators, certified application counselors, and other assistors, as well as Marketplace staff, eligibility workers, and others that need to understand and be able to explain how APTCs and CSRs work in practice.
The following brief, prepared by experts at the University of Minnesota, provides background on data collected by the National Association of Insurance Commissioners (NAIC), including new types of data being collected for health reform monitoring purposes.
This brief, prepared by Wakely Consulting Group, analyzes different options for premium rating methods for the Small Business Health Options Program (SHOP) Exchange. The details of the billing/employer contribution approaches are explored and insights are given into the benefits and challenges of each method.
A number of provisions in the Affordable Care Act (ACA), from changes to income eligibility (section 2002) to coverage for freestanding birth center services (section 2301), require states to alter Medicaid eligibility guidelines, service benefits, or payment criteria.
Impact of National Health Reform and State-Based Exchanges on the Level of Competition in the Nongroup Market
This brief, prepared by Wakely Consulting Group, analyzes health plan participation in 10 state-based exchanges to provide an early indicator of the level of competition that market reforms and state-based exchanges are generating. In sum, carrier participation increased by 35 percent (52 to 70 issuers) when comparing the number of issuers applying to nongroup exchanges versus the number in the pre-reform base year.
The National Academy of State Health Policy (NASHP) compiled this checklist to highlight the Affordable Care Act (ACA) Medicaid requirements that will take effect in the next two years, nearly all of which will apply to states regardless of whether the state chooses to expand Medicaid eligibility.
To ensure a seamless system of coverage, the Affordable Care Act (ACA) requires a single streamlined application for all Insurance Affordability Programs (IAPs) and a coordinated process for IAP eligibility and enrollment. States looking beyond the eligibility and enrollment process can utilize this chart to explore different mechanisms to address the cost-sharing cliff in the Exchange and also to promote continuity of coverage and care as consumers transition across IAPs.
This brief, prepared by State Network staff, outlines important policy issues for states to consider while implementing their Navigator and In-Person Assistor (IPA) programs as well as summarizes the basic information and guidance released to date. The brief concludes with a compilation of resources, program structures, and ideas from leading State Network states.