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.
As part of a series on “Helping Consumers Understand the Marketplaces,” Manatt Health Solutions led a webinar reviewing a primer on the reconciliation of advance premium tax credits (APTC), explaining how reconciliation will work when consumers file their taxes, and strategies consumers can use to minimize the risk of repayment.
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.
The State Coverage Initiatives program, in coordination with the State Network, hosted a webinar on September 23, 2013 that discussed individual eligibility appeals. Melinda Dutton and Kinda Serafi from Manatt Health Solutions facilitated this webinar with state respondents from Illinois and Rhode Island.
The National Governors Association (NGA) and State Network hosted a webinar entitled ‘Strategies for Developing Monitoring and Evaluation Plans for Health Insurance Marketplaces’ on September 10, 2013.
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?
The Oregon Health Policy Board met on August 6, 2013 to present updates on the 2013 legislative recap, the Coordinated Care Model Alignment workgroup, Health System Transformation Quarterly Report, and rate review and transparency opportunities.
The Illinois Health Reform Implementation Council convened on July 23, 2013 to discuss progress on the state’s partnership Marketplace. Among those updates was a presentation by State Network director, Heather Howard, and deputy director Chad Shearer on the current role of the network in providing technical assistance to Illinois, an overview of the previous/current assistance, and discussion of potential opportunities for assisting the state moving forward.
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.