Establishing Performance Standards for Hospital-based Presumptive Eligibility
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.
Reducing Overuse and Misuse: State Strategies to Improve Quality and Cost of Health Care
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.
Realizing the Potential of All-Payer Claims Databases: Creating the Reporting Plan
This paper examines the critical components of states’ APCD reporting efforts to date and suggests essential steps to creating credible and robust analytics. Drawn from interviews with APCD leaders, state-specific documents, and the experience of the authors, this paper is intended to help states with functioning and developing APCDs identify the building blocks necessary to create and evolve a comprehensive analytic program. This information may also be useful to those charged with designing APCD outputs, such as datasets and reports.
The Basics of All-Payer Claims Databases: A Primer for States
The purpose of this paper is to assist states embarking on APCD initiatives by highlighting key considerations for building statewide APCDs and potential solutions based on experiences in early-adopting APCD states.
Report from the States: Early Observations about Five State Marketplaces
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.
How State-based Marketplaces Can Better Meet the Needs of the Unbanked and Underbanked
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.
Operationalizing the New Fast Track Enrollment Options: A Roadmap for State Officials
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.
Advance Premium Tax Credits and Cost-Sharing Reductions: A Primer for Assistors
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.