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June 2012 St@teside

Health Reform Resources

Insurance Market Reforms:

Protecting High-Risk, High-Cost Patients
The Urban Institute
This report by the Urban Institute examines the health care reform law's ability to protect all individuals who purchase insurance through the small group and nongroup markets, especially those who have many health needs, and therefore high costs.

Risk Adjustment and Reinsurance Under the ACA: New York State Recommendations
Wakely Consulting Group
This report by Wakely Consulting Group examines New York’s options and makes recommendations for its risk adjustment approach under health reform.

Insurance Exchanges:

Defining Essential Health Benefits For Delaware
Delaware Department of Health
This report describes Delaware’s options for the essential health benefits (EHB) under the health care reform law. Delaware has opened up a 10-week public comment period on EHB, and will convene the two public forums on the issue.

Kentucky Stakeholder Perspectives on Health Benefit Exchanges
State of Kentucky Cabinet for Health and Family Services
Kentucky's Cabinet for Health and Family Services released a June 2012 Report on stakeholder perspectives on health benefit exchanges. The report contains solicited written comments, issues and concerns related to the establishment of a Kentucky‐specific exchange, including eligibility, functions, insurer participation, market rules qualified health plans, risk sharing, structure and governance, financing, and consumer outreach and education.

Maryland Health Benefit Exchange Board Considers Branding, Appeals, Communications and More
Maryland Health Benefit Exchange
At their latest meeting, the Maryland Health Benefit Exchange Board considered a number of issues including branding, appeals, communications, and performance measures.

Virginia Health Reform Initiative Advisory Council Discusses EHB
Virginia Health Reform Initiative Advisory Council
The Virginia Health Reform Initiative Advisory Council met to discuss SHOP, Essential Health Benefits (EHB), and Navigators/Brokers.

Federal Requirements and State Flexibilities for Verifying Eligibility Criteria
Manatt Health Solutions
This brief prepared by Manatt Health Solutions summarizes some of the key verification requirements, with an emphasis on financial eligibility. The chart in the brief summarizes federal requirements and areas for potential state flexibility when verifying eligibility for both Medicaid and Advance Premium Tax Credits (APTCs).


Toolkit on Coordinating Health Reform and Human Services
Center on Budget and Policy Priorities
This toolkit from the Center on Budget and Policy Priorities is designed to help states think about leveraging resources across human service programs throughout health reform implementation. The document provides states with tools and suggestions for a guided process that can be used to review the current eligibility and enrollment service delivery model and compare the current model to the desired future model. 

Churning Under the ACA and State Policy Options for Mitigation
The Urban Institute
This brief by the Urban Institute explains how states could systematically fight churning between systems of coverage, including through Medicaid premium assistance and the Basic Health Program, and describes how states could limit the harm experienced by families in transition.

Strategic Planning and Timelines:

Government Spending for Health Entitlement Programs
National Institute for Health Care Management
This data brief closely examines the budgetary implications of government spending on health entitlement programs.

Delivery System Reform:

Lessons in Linking After-Hours Care to Primary Care
Center for Studying Health System Change
The study, “After-Hours Care and its Coordination with Primary Care in the U.S.,” by the Center for Studying Health System Change (HSC) published online in The Journal of General Internal Medicine (JGIM) identified five models of after-hours care coordinated with primary care.