Bookmark and Share

May 2013 S@teside

Resources on Pressing Medicaid Implementation Issues

The State Network hosted a Small Group Convening in Baltimore, MD on April 25-26, 2013, bringing together state officials and technical experts to discuss pressing Medicaid implementation issues. Selected presentations from the meeting, outlined below, are compiled and listed by session at the State Network’s website
This session focused on the decisions states are making to take full advantage of the flexibilities offered by the ABP guidance to date. In addition to level-setting information on the options, this session included discussions of specific benefits of concern, early process and policy lessons from states, and a discussion of the intersection of ABP and mental health parity.
This session focused on the FMAP claiming guidance released on March 29 and how that guidance interacts with work states have already been doing on income verification plans focused on implementation of the Modified Adjusted Gross Income (MAGI) conversion. Specific issues of focus included difficult household composition reconciliation issues and how states should respond to the claiming algorithms in the final rule.
This session focused on the must-haves and contingencies necessary for states to effectively manage the mass of consumers hitting the system beginning October 1, 2013. Specific topics included early MAGI implementation, pending enrollment, treatment of “oldly” vs. newly eligibles, etc.
The State Network has worked with many states on the policy and operational issues surrounding the transition of certain waiver populations (e.g., existing 1115 populations, pregnant women, family planning, HIV/AIDS, breast and cervical cancer) to the new coverage paradigm. This session focused on lessons from work with those states and ongoing operational challenges to making those transitions seamless from the beneficiary perspective.

Insurance Affordability Program Eligibility Appeals
This session focused on the requirements states must have in place to ensure that beneficiaries have sufficient due process in challenging Medicaid eligibility and covered service determinations. The discussion focused on the operationalization of appeals processes given the vast number of newly eligibles accessing the system and possibly receiving notice of their appeal rights. The discussion also considered how Medicaid can/should work with Marketplaces (exchanges) to coordinate appeals processes.

Continuity of Coverage/Care
This breakfast roundtable focused on options states have been considering to limit the impact of churn including the bridge plan, Qualified Health Plan (QHP) and Medicaid Managed Care Organization contract language, etc.