Issue Briefs | Jan 1, 2014

The Basics of All-Payer Claims Databases: A Primer for States

 APCD Council—Jo Porter, Denise Love, Ashley Peters, Jane Sachs,  and Amy Costello

Over the past 10 years, a growing number of states have established state-sponsored all-payer claims database (APCD) systems to fill critical information gaps for state agencies, to support health care and payment reform initiatives, and to address the need for transparency in health care at the state-level to support consumer, purchaser, and state agency reform efforts. States with APCDs are responding to a need for comprehensive, multipayer data that allows states and other stakeholders to understand the cost, quality, and utilization of health care for their citizens. The purpose of this paper is to assist states embarking on APCD initiatives by highlighting key considerations for building statewide APCDs and potential solutions based on experiences in early-adopting APCD states.


Expert Perspectives

September 6, 2024

Current Considerations for State Reinsurance Programs

Reinsurance is a long-standing tool for stabilizing health insurance markets and reducing premiums, and has played an important role in the success of the Affordable Care Act’s individual market as part of section 1332 state innovation waivers. Reinsurance increases affordability for consumers ineligible for the premium tax credit (PTC). However, the effects on PTC recipients are smaller, mixed, and have received little attention. This expert perspective summarizes recent research which raises questions about the impact of reinsurance programs on PTC recipients, and highlights related considerations for state policymakers.

CMS Issues Guidance on Renewal Timeliness Post-Unwinding

On August 29, 2024, the Centers for Medicare & Medicaid Services (CMS) released a CMCS Informational Bulletin (CIB) and accompanying slide deck to support states facing renewal backlogs. With this guidance, CMS is providing states additional time—until December 31, 2025—to complete Medicaid and CHIP eligibility renewals, address persistent backlogs in processing redeterminations, and achieve compliance with federal renewal timeliness requirements. This expert perspective provides an overview of the CIB.