The second open enrollment period (OEP) under the Affordable Care Act ended on February 15, with more than 11.4 million people enrolled in coverage through the Federal and state Marketplaces. Attention now turns to the 2014 tax filing season. Many tax filers who were uninsured for all or part of 2014 are learning for the first time that they must pay a penalty, and have missed the opportunity to enroll in 2015 coverage. These gaps in consumer awareness, combined with the timing of this year’s OEP, have led to several Marketplaces allowing certain uninsured consumers additional time to enroll in order to avoid paying a penalty next year.
As of January 27, 2015, two states have received approval from the Centers for Medicare and Medicaid Services to expand Medicaid through private market-based coverage. These premium assistance programs have paved the way for the non-expansion states who continue to discuss how they might expand their Medicaid programs. These new models offer viable alternatives for covering previously uninsured populations while addressing those states’ concerns about some of the budgetary, political, and market challenges associated with traditional Medicaid expansion.
Department of Insurance Consumer Services ACA Toolkit – Marketplace Financial Assistance and Tax Filing Issues, including Form 1095-A
The State Network team at the Georgetown University Health Policy Institute previously developed a toolkit to assist insurance regulators in assuring that Department of Insurance consumer service representatives (CSRs) are well versed in all aspects of insurance basics (for new staff), as well as the changes brought about by the ACA and other recent reforms. The information in this document has recently been added to the consumer services toolkit, and includes updated information on marketplace financial assistance and related tax filing issues, including Form 1095-A.
Excepted benefits and short-term, limited-duration insurance are insurance products that are exempted from the Affordable Care Act’s (ACA) consumer protections. Recent questions from several states have indicated that some confusion exists about which insurance products qualify as “excepted benefits” and are therefore exempt from several requirements of the ACA, such as coverage for preventive health services, a prohibition on lifetime limits, and minimum value requirements…
Reference pricing is intended to reduce medical costs both for insurers and for purchasers of health care services, encouraging enrollees to obtain services from lower-cost providers and motivates higher cost providers to lower their reimbursement rates for those same services. This issue brief, prepared by the Georgetown Health Policy Institute’s Center of Health Insurance Reforms, provides an overview of this pricing method and federal guidance that has been issued to date…
This suite of issue briefs is geared toward states interesting in value-based purchasing for health care. Part 1 deals with strategic considerations, Part 2 offers an implementation guide, while Part 3 includes a planning template for state purchasers.
Individual and Family Engagement in the Medicaid Population: Emerging Best Practices and Recommendations
In this issue brief, The Institute for Patient- and Family-Centered Care (IPFCC) outlines action-oriented recommendations and strategies to support enhanced individual and family engagement efforts in Medicaid. Research shows that engaged individuals and families actively working with their health care teams have better outcomes, often choose less expensive options when participating in shared decision-making, and express greater satisfaction with their health care experiences.
Approaches to the Integration of Services for Individuals with Intellectual and Other Developmental Disabilities
Based on interviews conducted with I/DD staff in six states, this paper highlights approaches to integrating services within the Medicaid program for individuals with I/DD, and lessons learned from states with integration activities underway.
This webinar addressed which ACA provisions are waivable, including the individual mandate, the employer mandate, essential health benefits, and exchange standards; how the coverage and fiscal guardrails might be applied by HHS and Treasury, which have yet to provide much guidance beyond a regulation that defines the waiver application process; and how 1332 waivers might be combined with Medicaid 1115 waivers to better achieve state goals across programs.
This network adequacy planning tool for states provides an overview of the U.S. Department of Health and Human Services (HHS) regulation on minimum network adequacy standards. The tool is in Word format, and is designed to be used as a template to assist states in developing analysis plans that will inform discussions around updating network adequacy standards.