Individual Eligibility Appeals Webinar
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.
Strategies for Developing Monitoring and Evaluation Plans for Health Insurance Marketplaces Webinar
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.
ACA Implications for State Network Adequacy Standards
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.
Tools and Policy Considerations for State Medicaid Expansion Analyses
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?
Rate Review and Next Steps in Health Reform
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.
Illinois: A Strong Partner in RWJF’s State Network
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.
Advance Premium Tax Credits and Cost-Sharing Reductions: A Primer for Assistors
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.
Using Data from the National Association of Insurance Commissioners for Health Reform Evaluation
The following brief, prepared by experts at the University of Minnesota, provides background on data collected by the National Association of Insurance Commissioners (NAIC), including new types of data being collected for health reform monitoring purposes.
Premium Allocation and Employer Contribution Strategies for SHOP
This brief, prepared by Wakely Consulting Group, analyzes different options for premium rating methods for the Small Business Health Options Program (SHOP) Exchange. The details of the billing/employer contribution approaches are explored and insights are given into the benefits and challenges of each method.
Updated: Medicaid State Plan Amendment Requirements of the Affordable Care Act
A number of provisions in the Affordable Care Act (ACA), from changes to income eligibility (section 2002) to coverage for freestanding birth center services (section 2301), require states to alter Medicaid eligibility guidelines, service benefits, or payment criteria.