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.
The State Network 1332 Waivers Affinity Group continued with another presentation from the team at Manatt Health Solutions. Following prior presentations providing an overview of the basics around these waivers, including statutory guardrails, a discussion on what can and cannot be waived, and potential opportunities available to states through the waiver process, this presentation investigated more deeply the potential coordination between Section 1332 and Section 1115 waivers.
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.
The State Network 1332 Waivers Affinity Group, hosted by Manatt Health Solutions, continued with a presentation on the process of applying for a 1332 waiver, as well as a discussion on the potential and limitations of these waivers for states relying on the federal marketplace. Previous installments of this webinar series included presentations on the basics of the waiver process and information on statutory guardrails, as well as a deeper analysis of specific examples of what can be waived through this process.
State action to prevent discriminatory benefit designs has been prompted, in part, by vital input from consumer advocacy organizations. Recognizing the important role that they can occupy in this process, the Georgetown University Health Policy Institute’s Center on Health Insurance Reforms sought to gather a directory of these organizations. Georgetown gathered those organizations willing to be made available to states as resources to insurance regulators in need of assistance with identifying discriminatory benefit designs or for other regulatory tasks that require expertise related to a certain disease group or consumer concern.
In order to ensure that Consumer Services Divisions within state insurance regulatory agencies are equipped with the necessary resources to assist consumers experiencing insurance problems, the State Health Reform Assistance Network (State Network) team at the Georgetown University Health Policy Institute has developed a toolkit intended as a guide for consumer service representatives (CSRs).
State health care purchasers are increasingly shifting toward value-based purchasing (VBP) strategies that reward providers for value or outcomes as a means of improving care, improving health and reducing overall costs. This webinar examines how states are currently advancing payment reform in their managed care provider networks by moving away from fee-for-service (FFS) and identifies key considerations for states interested in implementing VBP strategies in this environment. Representatives from Arizona and Tennessee share ground-level experiences in adopting VBP strategies in their Medicaid managed care programs.
The Impact of Medicaid Expansion on Uncompensated Care Costs: Early Results and Policy Implications for States
Since implementation of the Affordable Care Act (ACA), the 30 states that have expanded Medicaid have enrolled more than 10 million people in Medicaid or the Children’s Health Insurance Program and the collective rate of uninsured individuals in these states has fallen from 18 percent to less than 11 percent. Recent research by Manatt Health Solutions looked at the fiscal implications of expansion and found that, in addition to coverage gains, expansion states experienced significant budget savings and revenue gains. This issue brief, the third in this series prepared by Manatt Health Solutions, examines early data on expansion-related decreases in uncompensated care costs and related state budget implications.
The State Network 1332 Waivers Affinity Group continued with a webinar presentation by the team at Manatt Health Solutions. The initial webinar for this affinity group focused on the basics of the waiver process, as well as information on statutory guardrails and what can and cannot be waived. This most recent webinar investigates waiver possibilities more deeply, with more information on specific examples of what can be waived through this process.
The Robert Wood Johnson Foundation’s Plan Choice Challenge: Winning Tools and Considerations for States
The Robert Wood Johnson Foundation’s “Plan Choice Challenge” was a recent competition facilitated by Health 2.0 to spur the development of innovative technology applications that better support consumers as they shop for and purchase health insurance. The State Network and the National Academy for State Health Policy (NASHP) recently hosted a webinar featuring background on the challenge from Health 2.0, an overview of the winning apps, and insights on what states should consider as they explore plan selection tools.