Bookmark and Share

January 2014 St@teside

Health Reform Resources

SCI keeps its Federal Reform Resources webpage 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 Exchanges

Realizing Health Reform’s Potential: What States Are Doing to Simplify Health Plan Choice in the Insurance Marketplaces
The Commonwealth Fund

The new health insurance marketplaces aim to improve consumers’ purchasing experiences by setting uniform coverage levels for health plans and giving them tools to explore their options. Marketplace administrators may choose to limit the number and type of plans offered to further simplify consumer decision-making. This issue brief examines the policies set by some state-based marketplaces to simplify plan choices: adopting a meaningful difference standard, limiting the number of plans or benefit designs insurers may offer, or requiring standardized benefit designs.

Helping Consumers Enroll in Coverage: A State-by-State Analysis of Consumer Assistance Organizations and Funding

With the launch of Open Enrollment on October 1, 2013, millions of individuals and families started to enroll in Medicaid, CHIP, or private insurance with or without federal subsidies through Health Insurance Marketplaces. As the Marketplaces’ doors opened for business, technological glitches surfaced, making the role of consumer assistance organizations even more important. This report examines states’ health coverage consumer assistance efforts to date. Based on the major categories of consumer assistance entities – Navigators, In-Person Assisters, Certified Application Counselors, and Health Centers – the report takes a closer look at each state’s consumer assistance and health center entities and the funding used to support these efforts.

Health Insurance Marketplace: January Enrollment Report
Department of Health and Human Services
This is the third in a series of issue briefs highlighting national and state-level enrollment-related information for the Health Insurance Marketplace. This brief includes data for states that are implementing their own Marketplaces, and states with Marketplaces that are supported by or fully run by the Department of Health and Human Services. This brief also includes some preliminary data on the characteristics of persons who have selected a Marketplace plan (by gender, age, and financial assistance status), and of the plans that they have selected (by metal level).

Data Collection and Use in the New Health Insurance Marketplaces
Health Information and the Law
This brief discusses the new Health Insurance Marketplaces created under the Affordable Care Act (ACA) and associated structural and process-related regulations that aim to ensure the quality and value of plans sold. To qualify to be sold in these marketplaces, new plans must be certified as a "Qualified Health Plan" (QHP), meet quality accreditation standards, and implement a quality improvement strategy. These steps require the collection of information from insurers, which will result in the disclosure of information about health insurance policies, practices, cost, and quality.


New Evidence on the Affordable Care Act: Coverage Impacts of Early Medicaid Expansions
Health Affairs
The ACA expands Medicaid in 2014 to millions of low-income adults in states that choose to participate in the expansion. Since 2010, California, Connecticut, Minnesota, and Washington, D.C. have taken advantage of the law’s option to expand coverage earlier to a portion of low-income childless adults. Using administrative records, the authors documented that the ramp-up of enrollment was gradual and linear over time in California, Connecticut, and D.C. Enrollment continued to increase steadily for nearly three years in the two states with the earliest expansions.

Hospital Presumptive Eligibility

Health Affairs and Robert Wood Johnson Foundation
Presumptive eligibility is a Medicaid policy option that permits states to authorize specific types of "qualified entities," such as federally qualified health centers, hospitals, and schools, to screen eligibility based on gross income and temporarily enroll eligible children, pregnant women, or both in Medicaid or the Children’s Health Insurance Program (CHIP). Presumptive eligibility serves a dual purpose of providing immediate access to needed health care services while putting people on a path to ongoing coverage. The ACA extends presumptive eligibility beyond children and pregnant women and expands the role of hospitals in determining eligibility presumptively. Given the current status of ACA implementation, presumptive eligibility may be an important tool to expedite access to coverage as states fine-tune their business processes and tweak new eligibility and enrollment systems.

An Introduction to Medicaid and CHIP Eligibility and Enrollment Performance Measures

Kaiser Family Foundation
The Centers for Medicare & Medicaid Services (CMS) recently established twelve new Medicaid and CHIP eligibility and enrollment performance indicators for states to report beginning in October 2013. These indicators provide insight into the performance of new eligibility and enrollment policies established under the ACA. In December 2013, CMS released initial reports for a subset of the indicators. This brief provides an overview of the new performance indicators; the initial data; and the opportunities and challenges associated with reporting, analyzing, and interpreting the data.

Strategic Planning

Tracking Marketplace and Medicaid/CHIP Enrollment by State

State Refor(u)m
This map tracks enrollment data from state marketplaces, the federal marketplace and Medicaid/CHIP agencies for individuals and families enrolling in Qualified Health Plans (QHPs) and Medicaid/CHIP. The map also provides state-by-state estimates for those eligible for marketplace and Medicaid/CHIP coverage from Kaiser Family Foundation and Urban Institute analyses.

Delivery System Redesign

Realizing the Potential of All-Payer Claims Databases
Robert Wood Johnson Foundation
States and regional collaboratives are moving ahead with creating all-payer claims databases (APCDs) to support health system measurement and improvement activities. While aggregated claims databases provide an unprecedented view of care across all settings, the process of collecting claims information alone does not improve health care quality or reduce costs. To effectively utilize the APCD and realize its full potential, states have begun to produce reports and analyses based on APCD data—a task requiring careful consideration and planning that has yielded many important lessons. This paper examines the critical components of states’ APCD reporting efforts to date and suggests essential steps to creating credible and robust analytics.

Building Infrastructure to Promote Primary Care Transformation: Lessons from a Four-State Learning Community
National Academy for State Health Policy
As part of the Agency for Healthcare Research and Quality's Infrastructure for Maintaining Primary Care Transformation initiative, NASHP worked with four states (Idaho, Maryland, Montana, and West Virginia) that sought to adapt aspects of North Carolina’s nationally recognized model of primary care practice transformation. This report summarizes the value of primary care transformation for the states, describes the North Carolina model, and outlines states' successes, challenges and lessons learned.