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June 2015 St@teside

Health Reform Resources

SCI keeps its Federal Reform Resources webpage up-to-date with the most recent information from the states, the federal government, and health policy organizations in an effort to guide our readers through the health reform implementation process. We know there are several places to go for the latest health reform resources, and we thank you for using SCI as one of your trusted sources. Here are some of the most recent resources that can be found on our Federal Reform page:

Insurance Market Reform

Final Rule: Summary of Benefits and Coverage and Uniform Glossary
Department of Health and Human Services
This document contains final regulations regarding the summary of benefits and coverage (SBC) and the uniform glossary for group health plans and health insurance coverage in the group and individual markets under the Affordable Care Act (ACA). It finalizes changes to the regulations that implement the disclosure requirements to help plans and individuals better understand their health coverage, as well as to gain a better understanding of other coverage options for comparison.

Small Business Health Insurance Coverage in a Post-ACA World
National Institute for Health Care Management
Employees of small businesses have much lower rates of insurance coverage and less generous benefits than their peers at bigger companies, owing largely to challenges unique to the small group market. The ACA introduced significant reforms aimed squarely at these problems, but implementation has moved slowly and the ultimate impact of these changes is unclear. This essay takes a look at developments in the small group market since the passage of the ACA and highlights several issues that could threaten the long-term viability of this market as implementation moves forward.

Insurance Exchanges

Health Insurance Exchange Operations Chart
State Refor(u)m
As states continue to refine the operations of their health insurance exchanges, regardless of the exchange type (state-based exchange, state partnership exchange, or federally facilitated marketplace), it is helpful to compare and contrast operational resources. This chart contains each state's resources and forms for three distinct and fundamentally important areas of exchange operation: applications, appeals, and taxes. With links directly to the states' forms and guides related to these issue areas, this chart serves as a one-stop resource library for those interested in developing new, or revising old, versions of applications, appeals, and tax resources.


Medicaid Balancing Incentive Program: A Survey of Participating States
Kaiser Family Foundation
Eighteen states are currently participating in the Medicaid Balancing Incentive Program (BIP) to increase access to home and community-based services (HCBS) as an alternative to institutional care. Established by the ACA, BIP authorizes $3 billion in enhanced federal funding from October 2011 through September 2015. During the summer of 2014, the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured surveyed BIP states about basic program information, progress with implementing the BIP structural requirements, stakeholder engagement, evaluation activities, and the use of enhanced federal funds in support of other Medicaid LTSS rebalancing efforts. This report documents the key findings.

State Experiences Designing and Implementing Medicaid Delivery System Reform Incentive Payment Pools
National Academy for State Health Policy
Since 2010, eight states have negotiated with the federal government to implement Delivery System Reform Incentive Payment (DSRIP) or “DSRIP-like” programs. These programs are a component of Section 1115 demonstrations that incentivizes system transformation and quality improvements in hospitals and other providers serving high volumes of low-income patients. DSRIPs aim to meet strategic goals, based on the Triple Aim principles of better care, improved health, and lower costs by incentivizing reforms that transition away from episodic treatment of disease toward prevention and management of health and wellness among patient populations. This report provides an in-depth cross-state analysis of current DSRIP and DSRIP-like programs. It describes implementation experiences from the federal, state, and provider perspectives.

How did CHIPRA Quality Demonstration States Employ Learning Collaboratives to Improve Children’s Health Care Quality?

Agency for Healthcare Research and Quality

This new Evaluation Highlight focuses on lessons learned from using learning collaboratives in nine states: Alaska, Florida, Idaho, Maine, Massachusetts, North Carolina, Oregon, Utah and West Virginia. These nine states implemented learning collaboratives and subsequently reported quantifiable improvements in medical home capabilities and quality measure performance for practices that participated in the Children’s Health Insurance Program Reauthorization Act (CHIPRA) quality demonstration.

Strategic Planning

Americans' Experiences with Marketplace and Medicaid Coverage

The Commonwealth Fund

The Commonwealth Fund’s third Affordable Care Act Tracking Survey finds that 86 percent of people who are currently insured through Affordable Care Act (ACA) marketplace plans or newly covered by Medicaid are very or somewhat satisfied with their coverage. Nearly seven of 10 adults with new coverage have used it to get health care; many said they previously would not have been able to afford that care. Fielded between March and May of 2015, this survey monitors how working-age adults who have marketplace or Medicaid coverage through the ACA are using their insurance to get services. The survey also asks people how they view their health plan and physicians.

Understanding the Uninsured Now

Robert Wood Johnson Foundation

The nation’s uninsurance rate has dropped significantly since the ACA was enacted. But millions of Americans remain uninsured. In order to get a full picture of the lives of the uninsured and explore their feelings around enrolling in health insurance, the Robert Wood Johnson Foundation commissioned a national survey, conducted by PerryUndem and GMMB, with uninsured adults at the conclusion of the second open enrollment period for the health insurance marketplace.

The Impact of State Policies on ACA Applications and Enrollment Among Low-Income Adults in Arkansas, Kentucky, and Texas
Health Affairs

This paper presents findings from a study that surveyed nearly 3,000 low-income adults in late 2014 to compare experiences in three states with markedly different policies regarding the ACA: Kentucky, which expanded Medicaid, created a successful state Marketplace, and supported outreach efforts; Arkansas, which enacted the private option and a federal-state partnership Marketplace, but with legislative limitations on outreach; and Texas, which did not expand Medicaid and passed restrictions on navigators. It found that application rates, successful enrollment, and positive experiences with the ACA were highest in Kentucky, followed by Arkansas, with Texas performing worst. The paper explores these findings and the factors that most greatly contributed to successful enrollment.

Delivery System Redesign

Mapping Medicaid Delivery System and Payment Reform

Kaiser Family Foundation

Delivery system and payment reform are dynamic and ever-evolving policy areas of state Medicaid programs; virtually every state has initiatives underway. This interactive map is designed to provide users with an environmental scan of the activity, to help introduce these complex concepts and also dive deeper. It allows users to explore specific initiatives more in depth, and it also provides related briefs that elucidate these concepts.