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January 2016 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

Why Are Many CO-OPs Failing? How New Nonprofit Health Plans Have Responded to Market Competition
The Commonwealth Fund
The Affordable Care Act (ACA) created the Consumer Operated and Oriented Plan (CO-OP) Program to provide consumer-focused health insurance options. But the CO-OP experience to date reveals factors that limit market competition. This report considers the challenges that CO-OPs have faced through analysis of plan, pricing, and enrollment data for six CO-OPs. It describes how CO-OPs responded to the prohibition on using federal loans for marketing, problems associated with outsourcing health plan functions, CO-OP plan design and pricing strategies, dynamics of both high and low enrollment, and challenges related to the ACA’s premium stabilization programs. It includes a discussion of the role of federal and state policy decisions in adding to rather than reducing barriers to market entry for CO-OPs.

Insurance Exchanges

Insurer Participation in State-Based Marketplaces in 2016: A Closer Look
The Commonwealth Fund
At the outset of the third open-enrollment period for the Affordable Care Act’s (ACA) health insurance marketplaces, the U.S. Department of Health and Human Services (HHS) reported that the number of insurance companies participating in the federally run marketplaces would remain relatively consistent from 2015 to 2016. This analysis of the 17 state-based marketplaces also found stable participation. Despite the struggles of many Consumer Operated and Oriented Plans (CO-OPs) and persistent market challenges, most state-based marketplaces have an equal or greater number of insurers competing for business this year.


Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost-Sharing Policies as of January 2016: Findings from a 50-State Survey
Kaiser Family Foundation
This 14th annual 50-state survey of Medicaid and CHIP eligibility, enrollment, renewal, and cost-sharing policies provides a point-in-time snapshot of policies as of January 2016 and identifies changes in policies that occurred during 2015. Coverage is driven by two key elements—eligibility levels determine who may qualify for coverage, and enrollment and renewal processes influence the extent to which eligible individuals are enrolled and remain enrolled over time. This report provides a detailed overview of current state policies in these areas, which have undergone significant change as a result of the ACA.

Both the 'Private Option' and Traditional Medicaid Expansions Improved Access to Care for Low-Income Adults
The Commonwealth Fund
This study examines the experiences of low-income adults during the first year of the ACA Medicaid expansion in three states that took different paths: Kentucky, which expanded traditional Medicaid coverage; Arkansas, which used the private option; and Texas, which did not expand Medicaid. It found that low-income adults in Kentucky and Arkansas were more likely to be insured and less likely to have problems paying medical bills or affording prescriptions than low-income adults in Texas.

Medicaid Expansion Spending and Enrollment in Context: An Early Look at CMS Claims Data for 2014
Kaiser Family Foundation
The Centers for Medicare and Medicaid Services preliminary spending and enrollment data from the Medicaid Budget and Expenditure System (MBES) provide information about the period from January 2014 through December 2014, during which 27 states including D.C., had implemented Medicaid expansion. This brief examines the MBES data to examine the effect the Medicaid expansion on spending and enrollment.

Strategic Planning

Meeting the Health-Related Social Needs of Low-Income Persons: Funding Sources Available to States
National Academy for State Health Policy (NASHP)
States control an array of resources that can be used to provide health care and address the social determinants of health. To assist state policymakers seeking to maximize their leverage by working across state agencies to promote health, NASHP has compiled a chart of funding sources that state agencies use to address social determinants, such as stable housing, safe and prosperous neighborhoods and communities, access to healthy food, physical and mental health care, income support, and transportation. While many documents show states how Medicaid resources can be used for social services or housing needs, this chart brings attention to other funding sources that states use specifically to help adult high-cost/high-need residents live healthy and prosperous lives.

Historic Gains in Health Coverage for Hispanic Children in the Affordable Care Act’s First Year
Georgetown University Center for Children and Families
The ACA has dramatically increased the pace at which the uninsured rate is falling for Hispanic children. Yet Hispanic children are more likely to be uninsured than other children, making them vulnerable to going without health care and leaving their families exposed to financial risk. Given the high rates of uninsurance among Hispanic children, policymakers, program administrators, and other stakeholders should continue efforts to maximize health coverage for Hispanic children and remove barriers to enrollment. This brief provides a snapshot of uninsured Hispanic children in the U.S., and offers recommendations to further reduce the number of uninsured children.

Delivery System Redesign

Implementing Alternative Payment Models Under MACRA: How the Federal Government Can Accelerate Successful Health Care Payment Reform
Center for Healthcare Quality and Payment Reform
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) creates strong incentives for physicians to participate in Alternative Payment Models (APMs), and it specifically encourages the development of “Physician-Focused Payment Models” in order to address the many problems with current payment systems that Merit-Based Incentive Payment Systems cannot solve. This report explains the provisions of MACRA relating to APMs and describes the actions HHS should take in the following areas: the regulations defining APMs and alternative payment entities; the processes for soliciting, reviewing, and approving Physician-Focused Payment Models; and the systems and resources to implement Physician-Focused Alternative Payment Models.

Accountable Care Organizations: Looking Back and Moving Forward
Center for Health Care Strategies
Today, there are roughly 750 ACOs across the nation serving 23.5 million people insured by Medicare, Medicaid, and commercial insurance. This evolving model strives to fulfill the Triple Aim of better health, improved patient experience, and lower costs by shifting more accountability for health outcomes to providers. While not all ACOs have been able to deliver better outcomes at lower costs, many have been able to realize these goals. This brief explores promising trends, emerging opportunities, and potential barriers identified by ACO stakeholders across the country. It also examines how ACOs can build upon initial successes and informs policymakers, researchers, and foundations about key considerations to further the development of effective ACO approaches across the health care market.