The Affordable Care Act (ACA) sets up a structure with key roles for both federal and state policymakers. From establishing a state-based marketplace to a temporary Maryland supplemental reinsurance program, Maryland has taken steps to make health insurance more affordable. This case study describes the measures taken by the state to improve affordability and coverage, identifies unique program design features, and discusses their bipartisan appeal as experienced in Maryland. Maryland’s efforts can serve as a helpful framework for other similarly situated states seeking to address pressing health coverage affordability issues.
After a dynamic few weeks of negotiations, President Trump signed into law on December 27, 2020 a nearly 6,000-page legislative package (The Consolidated Appropriations Act, 2021) that includes government appropriations through September 30, 2021; COVID-19 relief funding and targeted policy changes, a subset of which impact health programs; extensions of expiring health programs; a ban on surprise billing; and an amalgam of odds-and-ends health policy provisions. This analysis includes a summary of those health care provisions.
The COVID-19 pandemic has highlighted longstanding health inequities which have resulted in an increased risk of sickness and death for people of color. The crisis has also propelled a nationwide focus on understanding and addressing health inequities. This issue brief explores impediments and accelerants to advancing health equity as states are increasingly being called upon to drive change.
This issue brief is designed as a resource for states looking to adopt a measure to assess social risk factor screening rates. It is the result of a series of convenings that the authors facilitated with three states—Massachusetts, Oregon, and Rhode Island—which helped them consider, discuss, and share perspectives related to the development of their own social risk factor screening process measures. The issue brief looks at the progress these states and North Carolina have made in developing their own social risk factor screening measures and highlights considerations for other states either planning to adopt an existing or develop a new screening measure.
The past two years have seen a sharp increase in state Medicaid program interest in how social determinants of health (SDOH) influence Medicaid enrollee health status and spending. This brief provides an introduction to the first step most states are taking in response through their Medicaid managed care programs—screening members for social risk factors (SRFs). It explains why Medicaid managed care members should be screened for SRFs, identifies screening design decisions, identifies common SRFs, and reviews options for screening tool selection.
This issue brief examines examples from two state Medicaid programs and one nonprofit quality measurement and reporting organization of the data sources they use to identify patients’ social risk factors when risk-adjusting payments or quality measure performance. Within the brief, we will examine both their approaches to risk adjustment based on social risk factors and how each entity filled their gaps in data on social risk factors. To inform this issue brief, the author reviewed publicly available documentation and articles on the three profiled examples of risk adjustment based on social risk factors.
Strategies for Supporting and Strengthening Medicaid Information Technology During the COVID-19 Crisis
As states face the extraordinary challenges of the COVID-19 crisis, information technology (IT) is an essential tool to support access to health coverage and the safe and effective evaluation, testing, and treatment of patients nationwide. Under the current statutory and regulatory framework, state Medicaid agencies are authorized to receive federal funding for Medicaid IT and associated activities, and much of it at an enhanced federal matching level. This issue brief outlines potential IT investments in responding to COVID-19 and strategies for states to support these investments, as well as secure current and future IT investments that enable Medicaid program operations. The issue brief also highlights the Medicaid authorities and the provisions that may allow states more expeditious access and flexible use of these funds.
As the coronavirus (COVID-19) crisis continues, state Medicaid and Children Health Insurance Program (CHIP) agencies are rapidly pursuing multiple financing strategies to support their responses. CHIP Health Services Initiatives (HSIs) can provide additional financial support to states and local communities serving low-income children. This issue brief provides an overview of CHIP HSIs and identifies ways that states can leverage them as part of their targeted response to the COVID-19 pandemic.
This issue brief describes select policy and strategy levers that Medicaid agencies can employ to improve maternal health outcomes and address outcome disparities in five areas: coverage, enrollment, benefits, models of care, and quality improvement. In some cases, the Medicaid agency will be responsible for implementing these policies; in other cases, the Medicaid agency can lead collaboration with other state agencies such as the public health department or the state marketplace.
Leveraging American Community Survey (ACS) Data to Address Social Determinants of Health and Advance Health Equity
State Medicaid programs are increasingly seeking to understand and address social factors that contribute to poor health—such as food insecurity, unstable housing, and a lack of access to social supports—in order to lower costs, improve outcomes for their members, and advance health equity. To inform this work of addressing the social determinants of health (SDOH) and advancing health equity, states and Medicaid officials need data in order to identify priority areas of unmet social and economic needs, execute SDOH initiatives, and monitor and evaluate the impacts of these programs. Increasingly, states are leveraging a broad array of data sources to support efforts to address health equity. While those sources closest to the Medicaid program are the most widely used, each has advantages and disadvantages. This brief focuses on how Medicaid programs can use data from one federal survey, the American Community Survey (ACS), to inform and target interventions that seek to address social determinants of health and advance health equity. This brief also highlights relevant examples from states that use SDOH and health equity measures from the ACS, including which measures and what they are used for.