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July 2012 St@teside

Health Reform Resources

Insurance Market Reforms:

EHB Final Data Collection Rule
United States Department of Health and Human Services
This final rule outlines the data health plans must provide to determine whether they meet essential health benefit standards, and establishes a process for recognizing entities to certify qualified health plans.

Insurance Exchanges:

Kentucky: Executive Order Establishes Health Insurance Exchange
Kentucky Office of the Governor Steve Beshear
Kentucky joined New York and Rhode Island to become the third state to create an exchange through Executive Order on July 17. The Executive Order establishes the Office of the Kentucky Health Benefit Exchange, which will be housed in the Cabinet for Health and Family Services.

Establishing Health Insurance Exchanges: Three States’ Progress
Commonwealth Fund
This brief outlines differences that stand out in California, Colorado, and Maryland's initial approaches to establishing health insurance exchanges including the numbers and types of people initially appointed to the boards governing the exchanges, the role of the board relative to the state legislature, how the exchanges interact with existing insurance markets, and the involvement of stakeholders in each state.

State Health Insurance Exchange Laws: The First Generation
Commonwealth Fund
This Commonwealth Fund issue brief analyzes the choices being made by the group of states that have already begun establishing exchanges, either through legislation or executive order.


Enrollment and Disenrollment in Subsidized Health Insurance: Lessons Learned in Massachusetts
This report is based on information drawn from structured discussions and focus groups performed under the SAMHSA Financing Center of Excellence contract to explore possible causes, and identify strategies for maximizing coverage among individuals with behavioral health conditions in Massachusetts and across the country.

2014 Medicaid Eligibility Transition Toolkit
National Academy for State Health Policy
The 2014 Medicaid Eligibility Transition Toolkit is designed to assist states in systematically identifying issues and decisions they will face as they convert to 2014. The toolkit was originally provided to two states by the National Academy for State Health Policy (NASHP) as part of the State Health Reform Assistance Network that is funded by the Robert Wood Johnson Foundation. NASHP has updated the toolkit to be applicable to any state and to reflect the final Medicaid eligibility rules.

Analysis of Eligibility Changes in Implications for Selected Medicaid and CHIP Eligibility Groups
National Academy for State Health Policy
In 2014, the changes in eligibility for Medicaid and CHIP categories apply primarily to low-income children and adults whose eligibility is not tied to being elderly, disabled, or needing long-term services and supports. This issue brief provides a detailed overview of the final federal Medicaid eligibility rules, transition issues and decision points that states will need to consider as they prepare to convert to the collapsed eligibility categories in 2014.

Mortality and Access to Care among Adults after State Medicaid Expansions
New England Journal of Medicine
This study of three states, Arizona, Maine, and New York, that have expanded adult Medicaid coverage has found that the expansions reduced deaths.

Making the Medicaid Expansion an ACA Option: How Many Low-Income Americans Could Remain Uninsured
The Urban Institute
This Urban Institute, two page, brief breaks down the potentially impacted uninsured population by income. The brief also contains a table that shows estimates from the 2010 American Community Survey on the number of non-elderly people who could be covered by Medicaid under the ACA, nationally and for each state.

Strategic Planning:

Maryland Health Care Reform Simulation Model: Detailed Analysis and Methodology
Hilltop Institute at the University of Maryland Baltimore County
This Hilltop Institute at the University of Maryland Baltimore County report, conducted for the Maryland Health Benefit Exchange, on the economic impact of health reform in Maryland.

State Network Annual Meeting Plenary Presentations
State Health Reform Assistance Network
Plenary presentations from the State Network Annual Meeting including Oregon Governor John Kitzhaber’s opening plenary speech and keynote speaker Len Nichols' presentation on the next steps for health reform implementation after the Supreme Court decision and lessons to be learned from United States history on the challenges that lay ahead.  Additionally, Jeanene Smith provided an overview of Oregon’s Coordinated Care Organizations and its triple aim of better health, better care, and lower costs.

Delivery System Reform:

Dispelling Myths About Emergency Department Use: Majority of Medicaid Visits Are for Urgent or More Serious Symptoms
Center for Studying Health System Change
According to a new national study by the Center for Studying Health System Change (HSC), the majority of emergency department (ED) visits by nonelderly Medicaid patients are for symptoms suggesting urgent or more serious medical problems rather than for routine care. About 10 percent of nonelderly Medicaid patient ED visits are for nonurgent symptoms, compared with about 7 percent for privately insured nonelderly people. This research brief highlights that there are clearly opportunities to develop less-costly care options than emergency departments for both nonelderly Medicaid and privately insured patients.