Implementation of the health insurance marketplaces has been an ongoing challenge across the country in the initial months of open enrollment. While state marketplaces are still evolving, and some are experiencing their own implementation challenges, they are largely working. This brief, prepared by the team at Manatt Health Solutions, looks at five state marketplaces to assess early lessons that might help to explain early enrollment trends.
The Affordable Care Act (ACA) will make health insurance more accessible to millions of Americans. To effectuate coverage, flexible payment methods will help ensure insurance accessibility is not hampered by the absence of a traditional bank account, an all too common scenario for many uninsured households.
Earlier this year, the Centers for Medicare & Medicaid Services (CMS) issued guidance alerting states to the availability of waivers to facilitate the enrollment of eligible individuals into Medicaid using data states already have “on hand” in their Supplemental Nutrition Assistance Program (SNAP) and Medicaid files.
Implementation of the Affordable Care Act’s Hospital Presumptive Eligibility Option: Considerations for States
The Affordable Care Act (ACA) gives qualified hospitals the opportunity to determine presumptive eligibility (PE) for all Medicaid-eligible populations which will enable hospitals to temporarily enroll individuals in Medicaid, ensuring compensation for hospital-based services, while providing patients access to medical care and a pathway to longer-term Medicaid coverage.
dvance Premium Tax Credits (APTCs) and Cost-Sharing Reductions (CSRs) remain critical to the ability of marketplaces to offer affordable coverage. It is especially important that marketplace staff, eligibility workers, navigators, certified application counselors, and other assistors are well-informed regarding the role of APTCs and CSRs in the continuum of coverage created by the Affordable Care Act.
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.