Medicaid Managed Care Contract Language: Health Disparities and Health Equity
This document provides excerpts of health disparities and health equity contract language from Medicaid managed care (MMC) contracts from 12 states and the District of Columbia as well as the contract for California’s state-based marketplace, Covered California. The criteria for inclusion in this compendium were contracts that explicitly addressed health disparities and/or health equity. Website links to the full contracts are included where available.
New Hampshire COVID-19 Directed Payment
On April 30, 2020, New Hampshire received approval from the Centers for Medicare & Medicaid Services (CMS) to require its managed care organizations (MCOs) to make a directed payment to six types of essential Medicaid providers in order to help them keep their doors open during the COVID-19 pandemic. Numerous states across the country share New Hampshire’s interest in directing MCOs to use some of their capitation funds to support providers facing sharp declines in utilization due to COVID-19. This regulatory analysis provides an overview of New Hampshire’s directed payment and the documents used in the New Hampshire approval.
Considerations for a State Health Insurer Fee Following Repeal of the Federal 9010 Fee
The recent repeal of the federal health insurer fee may create an opportunity for states to secure funding to support health coverage, without increasing costs on consumers or the health care industry.
Enacting a fee to replace the federal one presents several design questions for states, including what lines of insurance to include, timing, rate, and targeted exemptions. Frequent SHVS partner and ACA tax expert Jason Levitis prepared slides to help states understand these issues. For states interested in learning more, SHVS is happy to make Jason available to provide technical assistance. If you have questions or are interested in assistance, contact Jason directly at jason.levitis@gmail.com.
Protected: Resources to Collect Race, Ethnicity, and Language Data
As a follow-up to the November 20th SHVS office hour on the collection of REL data, this resource page provides links to a few resources that were mentioned on the call.
Work and Community Engagement Requirements in Medicaid: State Implementation Requirements and Considerations
The Centers for Medicare & Medicaid Services (CMS) has approved state work/community engagement (CE) waivers in Arkansas, Indiana, Kentucky, and New Hampshire, and additional states have submitted or are poised to submit similar waivers. Manatt Health has produced a series of charts that outline the legal, policy, financial and operational tasks and issues that states will face in adding a work/CE condition to their Medicaid program. This information is intended to highlight for states the complexity of administrative tasks associated with implementing a work/CE requirement.
Model Legislation for State Individual Mandate
[*Updated Feb. 21, 2018*] The tax bill passed in December 2017 repealed the penalty associated with the Affordable Care Act’s individual shared responsibility provision, also known as the individual mandate. The provision required those who could afford health coverage to either maintain coverage, qualify for an exemption, or make a payment with their federal income tax return. The Congressional Budget Office projects that repealing the mandate penalty will increase insurance premiums by 10 percent on average and result in 13 million more persons being uninsured. A number of states have expressed an interested in examining a state-level individual mandate, which Massachusetts has had in place since before the ACA.
State Medicaid Financing Fact Sheets
As states seek to understand the impacts of proposed changes to Medicaid financing, comparative data on where states stand can be very valuable. The memos included here use state-specific data to analyze the impact of proposals to limit federal Medicaid funding on all 50 states and the District of Columbia.
States Expanding Medicaid See Significant Budget Savings and Revenue Gains
In addition to the impact that state decisions to expand Medicaid have had on coverage rates across the country, there is an increasing body of evidence showing consistent economic benefits among these states. This report, prepared by Manatt Health, is an update to an April 2015 State Network report, and examines data regarding Medicaid expansion in eleven states, demonstrating that states continue to realize budget savings and revenue gains as a result of expanding Medicaid.
Qualified Health Plan Review in Marketplaces with State Plan Management: An Analysis of the Division of Labor Between State Exchanges and Other State Agencies
States have implemented a variety of different methods to handle the review and certification of qualified health plans (QHPs). The Health Insurance Exchanges (HIX) Research Group at the Leonard Davis Institute of Health Economics at Wharton (LDI) recently collected data from 30 states, including those with State Based Marketplaces (SBMs), State Partnership Marketplaces (SPMs), Supported State Based Marketplaces (SSBMs), and Federally Facilitated Marketplaces (FFMs) with state plan management. This brief summarizes the findings within this dataset, which outlines the various plan management and certification functions assumed by different state agencies across these marketplace models.
Health Insurance Literacy Memo and Resources
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.