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October 2013 St@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

New Employer Mandate Toolkit: Facts, Analysis and Experts
Alliance for Health Reform

This new Alliance for Health Reform Toolkit, produced with the support of the Robert Wood Johnson Foundation, details the ACA's employer requirements and penalty. It also provides information about the delay in the employer mandate to 2015, and analysis about its impact on employer-based coverage. The Toolkit includes: key facts about the employer mandate; data about trends in employment-based health coverage; links to news articles and reports explaining and analyzing the issue; and health care experts who understand the issue and its implications, along with contact info.

Insurance Exchanges

Program Integrity Final Rule: Exchange, Premium Stabilization Programs, and Market Standards
Department of Health and Human Services

This final rule outlines financial integrity and oversight standards with respect to Affordable Insurance Exchanges, qualified health plan (QHP) issuers in Federally-facilitated Marketplaces (FFMs), and States with regard to the operation of risk adjustment and reinsurance programs. It also establishes additional standards for special enrollment periods, survey vendors that may conduct enrollee satisfaction surveys on behalf of QHP issuers, and issuer participation in an FFM, and makes certain amendments to definitions and standards related to the market reform rules.


Medicaid in a Historic Time of Transformation: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2013 and 2014
Kaiser Family Foundation and Health Management Associates

The findings in this report are drawn from the 13th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA). The report highlights trends in Medicaid spending, enrollment and policy initiatives for FY 2013 and FY 2014 with an intense focus on eligibility and enrollment changes tied to the implementation of the ACA as well as payment and delivery system changes. The report provides detailed appendices with state-by-state information and a more in-depth look at four case study states:  Arizona, Florida, Kentucky, and Washington.

The Advocate’s Guide to MAGI
National Health Law Program

One of the significant changes brought about by the Affordable Care Act (ACA) is the introduction of a new methodology to evaluate eligibility for Insurance Affordability Programs (IAPs): Modified Adjusted Gross Income (MAGI). MAGI will be used to evaluate available income for most Medicaid and Children’s Health Insurance Program (CHIP) applicants and enrollees beginning in 2014. MAGI will also be used to determine eligibility for Advance Premium Tax Credits (APTCs) and Cost Sharing Reductions (CSRs) through the health insurance Marketplaces.  This Advocate’s Guide explains how MAGI works, and sets forth the guidelines that CMS has developed to implement and govern this new methodology.  The Guide will be an ongoing reference for advocates providing direct services to clients who have questions or problems pertaining to eligibility for health care affordability programs. While this Guide is meant for national use, it points out the few areas where states have leeway to shape policies that affect the MAGI calculations.

Strategic Planning

Moving Back Home: Unexpected Implications of the ACA on Adult ‘Boomerang’ Children

Jackson Hewitt Tax Service, Inc.
The Affordable Care Act (ACA) has implications for “boomerang children” and their parents. “Boomerangs,” young adults who (often for financial reasons) move in with their parents, may expose their parents to significant tax penalties, even if the rest of the family has health coverage. This brief summarizes the available demographic information about the boomerang population, and provides an analysis of a common example to illustrate the ACA’s implications to such families.

The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid

Kaiser Family Foundation

In states that do not expand Medicaid, nearly five million poor uninsured adults have incomes above Medicaid eligibility levels but below poverty and may fall into a “coverage gap” of earning too much to qualify for Medicaid, but not enough to qualify for Marketplace premium tax credits. Most of these people have very limited coverage options and are likely to remain uninsured. This brief describes the coverage gap and presents estimates of the population that falls into this situation.

Assessing the Potential Impact of the Affordable Care Act on Uninsured Community Health Center Patients: A Nationwide and State-by-State Analysis
George Washington University

This brief estimates the number of uninsured community health center (CHC) patients who would gain coverage under the Affordable Care Act using data from the 2009 HRSA Survey of CHC patients and 2011 Uniform Data System. The authors find that were all states to implement the Affordable Care Act Medicaid expansion, an estimated 5 million uninsured health center patients would be eligible for coverage. However, over one million uninsured patients – 72 percent of whom live in southern states – who would have been eligible for coverage will remain uninsured because of states’ decisions to opt out of the expansion. The spillover effects of the decision to opt out of the Medicaid expansion are likely to be significant. Health centers in opt-out states can be expected to struggle, falling further behind their expansion state counterparts in terms of service capacity, number of patients served (both insured and uninsured), and in their ability to invest in initiatives that improve the quality and efficiency of health care.

ACA Enrollment and Affordability Research Findings
Robert Wood Johnson Foundation and PerryUndem

The Robert Wood Johnson Foundation sponsored an in-depth research study examining perceptions around the affordability and value of new health insurance options available through Health Insurance Marketplaces. Engaging uninsured individuals and people who have self-purchased plans on the individual market, the ACA Enrollment and Affordability study examines people’s reactions to potential costs of plans sold through the Marketplace, including premiums, copays, deductibles and out-of-pocket maximums. The study also explored messages around cost and value, examining where people find value in health insurance and what makes it worth the cost.

Delivery System Redesign

Establishing a Coalition to Pursue Accountable Care in the Safety Net: A Case Study of the FQHC Urban Health Network
he Commonwealth Fund
The Federally Qualified Health Center Urban Health Network is a coalition of 10 federally qualified health centers (FQHCs) in the Minneapolis–St. Paul area that pursued an accountable care organization (ACO) through a Medicaid demonstration project with Minnesota. Under the ACO model, the coalition has assumed responsibility for the total cost and quality of care delivered for an assigned patient population. This case study explores: the state context under which the ACO contract emerged; origins of the coalition; the members’ motivations to participate; strategies and processes established to work toward cost and quality benchmarks; challenges faced in pursuing accountable care; and the organizational strengths that facilitated the health centers’ shift from competition to collaboration.

Improving Quality and Patient Experience: The State of Health Care Quality 2013

National Committee for Quality Assurance

NCQA’s 2013 State of Health Care Quality Report summarizes Healthcare Effectiveness Data and Information Set (HEDIS) results from calendar year 2012 from health plans covering a record 136 million people, or 43 percent of the US population. The report comes at a pivotal time, amid implementation of the Affordable Care Act (ACA) and that law’s diverse effects on access and quality. The 2013 report’s key findings include: stagnant or declining performance in appropriate use of antibiotics; continued improvement in childhood obesity measures; mixed results regarding childhood immunization; sustained decline in initiation of alcohol and drug treatment; and better experience of care in Medicaid HMOs.