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May 2013 S@teside

Health Reform Resources

SCI keeps its Federal Reform Resources web page 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 Reforms
Consumers Union and the Kleimann Communication Group
Beginning in 2014, the Affordable Care Act (ACA) introduces major reforms, including the start of a new advance payment Premium Tax Credit designed to lower the cost of coverage for qualified families purchasing in the new Health Insurance Marketplaces (exchanges).  While employer-provided coverage receives significant tax preferences, tax credits for individual or non-group health insurance have not been used in a broad way. What’s more, the advanceable and refundable nature of these new tax credits introduce new elements that most consumers have not previously encountered. Taken together, these facts raise the possibility that consumer confusion might be a barrier to using this new program to enroll in affordable coverage. 
Urban Institute and Georgetown University’s Health Policy Institute
Policy experts predict that small employers, especially those with younger and healthier employees, will increasingly establish “self-funded” health plans, leaving the traditional fully-insured market to obtain lower premiums and avoid market reforms under the Affordable Care Act. Through interviews with stakeholders in 10 study states, this paper describes factors that may influence whether and how extensively this change will occur. It also shows that states have minimal data on this potentially growing market, but they would be well served to improve their monitoring efforts so they can identify any increases in small group self-funding and resulting adverse selection, and respond appropriately.
Insurance Exchanges
Families USA
One in four consumers who will apply for health coverage through the new health insurance marketplaces speak a language other than English at home.  The Affordable Care Act and federal civil rights laws require marketplaces to provide language services for people with limited English proficiency (LEP). It is critical that marketplaces develop robust standards to ensure that these language services enable LEP consumers to successfully enroll in, use, and retain coverage. This checklist provides a list of recommendations that advocates can use to encourage their states to address the needs of LEP consumers in their health insurance marketplace.
Association of Community Affiliated Plans
Medicaid provides critical health insurance coverage to tens of millions of children, adults, elderly and people with disabilities every year. Under the Affordable Care Act (ACA), millions more will gain Medicaid coverage, beginning in 2014. However, Medicaid can be like a leaky sieve: every year millions of people enroll, only to subsequently lose their coverage, even though they are still eligible, due to cumbersome paperwork requirements and small, often short-term, increases in income. The problem of beneficiaries entering and exiting Medicaid is sometimes called “churning.” This report examines the impact of churning in every state.  The authors found that the national average continuity of Medicaid coverage improved modestly, from an average of 78.5 percent in 2006 to 81.2 percent in 2010-11, although there are still large differences across the states.
Urban Institute
States expanding Medicaid eligibility under the ACA can substantially expedite Medicaid enrollment and retention for SNAP participants, 97 percent of whom will qualify for Medicaid, according to this study. Even in states where SNAP provides broad-based categorical eligibility that extends SNAP’s gross income limits to at least 185 percent of the federal poverty level, 94 percent of SNAP recipients will qualify for Medicaid. Data showing SNAP receipt can thus verify Medicaid applicants’ financial eligibility, allow administrative renewal for Medicaid beneficiaries, and facilitate Medicaid enrollment for numerous eligible consumers when expanded coverage begins in early 2014.
Kaiser Family Foundation
This brief examines the cost and use of health care among low-income nonelderly adults who are covered by Medicaid relative to their expected service use and costs if they instead had employer-sponsored insurance coverage or were uninsured. The analysis controls for a wide array of factors that also influence utilization and spending in an effort to isolate the specific effects of Medicaid coverage. Consistent with previous research, the analysis underscores how Medicaid facilitates access to care for program beneficiaries.
Strategic Planning
State health insurance exchanges have unique strategies for certifying health plans for people to purchase through the exchange beginning on October 1, 2013. Some exchanges plan to selectively contract and negotiate prices with plans; others plan to add standards for plans beyond the federal requirements; and others are accepting all plans that meet the federal requirements. This chart highlights information about state approaches to qualified health plan certification, providing key insights about state exchanges’ approach to certification in the first few years of exchange operations.
Kaiser Family Foundation
This implementation timeline is an interactive tool designed to explain how and when the provisions of the health reform law will be implemented over the next several years.
Delivery System Redesign
Health Affairs
The best opportunity to pursue cost containment in the next five to ten years is through reforming provider payment to gradually diminish the role of fee-for-service reimbursement. Public and private payers have launched many promising payment reform pilots aimed at blending fee-for-service with payment approaches based on broader units of care, such as an episode or patients’ total needs over a period of time, a crucial first step. But meaningful cost containment from payment reform will not be achieved until Medicare and Medicaid establish stronger incentives for providers to contract in this way, with discouragement of nonparticipation increasing over time. In addition, the models need to evolve to engage beneficiaries, perhaps through incentives for patients to enroll in an accountable care organization and to seek care within that organization’s network of providers.
National Academy for State Health Policy
Across the country, states are increasingly capitalizing on a wave of momentum supporting multi-payer health system transformation. The federal government is building on existing state multi-payer activity, and spurring new public-private payment and delivery system reforms with initiatives like the State Innovation Models (SIM) program. This Multi-Payer Resource Center, a web-based toolkit, is designed to support states and others in answering key questions about convening, infrastructure, payment, attribution, and evaluation as they seek to implement multi-payer initiatives.