Nationwide on a given night in January 2014, more than 578,000 people were homeless, and one third of these people were sleeping on the streets, in cars, or other places not meant for human habitation. Over the course of a year, about 1.42 million people used a shelter or transitional housing program for homeless individuals or families. Homeless people often have significant health and behavioral health needs that can be very difficult to manage without stable housing, and many people who experience homelessness are Medicaid beneficiaries. As purchasers of health care, state Medicaid agencies have critical roles to play in the delivery of more appropriate and cost-effective care for people with complex health and behavioral health care needs who experience homelessness.
The State Network 1332 Waivers Affinity Group continued in October with a new presentation from the team at Manatt Health Solutions. This ongoing series has included presentations providing an overview of the basics around these waivers, including statutory guardrails, discussions on what can and cannot be waived, and potential opportunities available to states through the waiver process, while this presentation focused more deeply on potential coordination between 1332 and 1115 waivers, including general guardrails and budget neutrality.
While millions of Americans have newly gained health insurance coverage under the Affordable Care Act (ACA), there is evidence that coverage alone does not necessarily translate into access to health care. This memo, prepared by the State Health Access Data Assistance Center (SHADAC), provides background information on health insurance literacy, summarizes the research around current consumer knowledge, and offers recommendations for marketplaces on how to build on it. Additionally, the State Network has compiled a library of health insurance literacy materials developed by four marketplaces.
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.
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.
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 State Network hosted its Annual Meeting in New Orleans, LA on April 29 – May 1, 2015, bringing together state officials and technical experts to provide technical assistance and discuss lessons learned on continuing implementation of the coverage provisions of the Affordable Care Act (ACA). The Annual Meeting included peer-to-peer sharing between stakeholders from exchanges, Medicaid agencies, departments of insurance, and governors’ offices throughout the topic specific breakouts on key ACA implementation issues.
Waivers available under Section 1332 of the Affordable Care Act offer potentially great flexibility to states in achieving the goals of the ACA through very different means than originally envisioned. They take effect as early as January 1, 2017, and require legislative authorization, substantial public engagement, and negotiation with the federal government. Moreover, without grant dollars to fund the development process, unlike for the establishment of state-based exchanges, 1332 waiver proposals will present additional time and resource challenges for states.