The recently released Proposed Payment Notice for 2017 formalizes a fourth model of marketplace – State-Based Marketplace/Federal Platform. Along with State Based Marketplaces, State Partnership Marketplaces and the Federally Facilitated Marketplace, states have a range of choices for what their Marketplace looks like. A key question for states will be how these different models help to achieve coverage goals.
Developing a State-based Quality Measurement Program Using an Episode-of-Care Framework: Recommendations for State Purchasers
In attempting to move toward value-based payments, there exist the inherent challenges posed by the availability of data. States wishing to accelerate the transformation of the existing delivery system into one that delivers high quality and affordable health care have to take action to develop a comprehensive data collection and reporting mechanism. Such an approach can be taken using episodes of medical care as the central unit of measure.
Federally Qualified Health Centers (FQHCs) traditionally provide health care services primarily to low-income individuals who are covered by Medicaid or who are uninsured. As state Medicaid programs increase their focus on value-based payment, it is important to consider how FQHCs may participate in payment reform strategies. This brief provides an overview of FQHC cost reporting, delves into state payment reform strategies that Include FQHCs, and offers considerations for states and FQHCs alike.
Recently, the Centers for Medicare and Medicaid Services (CMS) announced plans to increase the range of Medicaid services furnished by Indian Health Services (IHS) eligible for 100 percent federal match. This proposal, which will effectively reduce states’ costs for Medicaid expansion and buffer the impending decrease in the federal matching rate for newly eligible adults after 2016, may be of particular interest to states with a significant American Indian and Alaskan Native (AI/AN) population.
Medicaid Expansion and Criminal Justice Costs: Pre-Expansion Studies and Emerging Practices Point Toward Opportunities for States
The expansion of Medicaid under the ACA in many states has generated substantial interest in the potential role that Medicaid may play in tackling pressing criminal justice issues. Recent research by Manatt Health Solutions has examined the fiscal implications of Medicaid expansion. This issue brief, the fourth in this series, examines state experiences prior to expansion, focusing on state savings associated with providing health care services and social support to justice-involved individuals through state-funded programs, and also highlights some of the new approaches being adopted by states with Medicaid expansion to connect justice-involved individuals to coverage and care.
Tax year 2014 marked the first year during which all health insurance marketplaces were required to report information about Advance Premium Tax Credits (APTCs) to enrollees through Form 1095-A, which was developed by the Internal Revenue Service (IRS) and used by enrollees to fill out new tax forms. In order to address potential concerns leading up to the execution of this process, the State Network convened a workgroup of states, led by Manatt Health Solutions, which enabled discussion of implementation challenges and solutions. Many of the expected challenges associated with this process were addressed in advance, allowing the marketplaces to provide most forms in a timely fashion and develop solutions to challenges as they arose.
Qualified Health Plan Review in Marketplaces with State Plan Management: An Analysis of the Division of Labor Between State Exchanges and Other State Agencies
States have implemented a variety of different methods to handle the review and certification of qualified health plans (QHPs). The Health Insurance Exchanges (HIX) Research Group at the Leonard Davis Institute of Health Economics at Wharton (LDI) recently collected data from 30 states, including those with State Based Marketplaces (SBMs), State Partnership Marketplaces (SPMs), Supported State Based Marketplaces (SSBMs), and Federally Facilitated Marketplaces (FFMs) with state plan management. This brief summarizes the findings within this dataset, which outlines the various plan management and certification functions assumed by different state agencies across these marketplace models.
Nationwide on a given night in January 2014, more than 578,000 people were homeless, and one third of these people were sleeping on the streets, in cars, or other places not meant for human habitation. Over the course of a year, about 1.42 million people used a shelter or transitional housing program for homeless individuals or families. Homeless people often have significant health and behavioral health needs that can be very difficult to manage without stable housing, and many people who experience homelessness are Medicaid beneficiaries. As purchasers of health care, state Medicaid agencies have critical roles to play in the delivery of more appropriate and cost-effective care for people with complex health and behavioral health care needs who experience homelessness.
Financing Shared Administrative Functions Between State-Based Marketplaces and State Medicaid Programs: Cost Allocation Methodologies
The Affordable Care Act (ACA) provides opportunities for expanded access to health coverage through both the expansion of Medicaid and the establishment of health insurance marketplaces. State-based marketplaces (SBMs), as pathways to both public and private health coverage, are required to perform cross-program functions that support access to both qualified health plans (QHPs) available through the marketplace, as well as coverage through Medicaid. While these shared functions create an opportunity for savings through enhanced efficiency, they also require states to properly attribute funding to both through a process known as cost allocation.
Assessing a New Option: The Feasibility of Contracting With a Single Firm to Build and Operate a State’s Marketplace
Since the passage of the Affordable Care Act (ACA), the design of state health insurance exchanges has evolved to include several distinct models. This evolution has led to the possibility that a state’s exchange development and operations could be delegated to a private vendor. States operating their own state-based marketplaces (SBMs) may begin to consider other options as they confront budget challenges and look to streamline operations.