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February 2014 St@teside

Highlighting State Innovations for Integrating Medicaid and the Marketplace

This year's State Health Research and Policy Interest Group (SHRP IG) breakfast, held in conjunction with AcademyHealth’s National Health Policy Conference (NHPC), focused on “State Innovations for Integrating Medicaid and Exchanges.” The Affordable Care Act (ACA) and other state-level reforms have created an opportunity for states to coordinate their coverage options across their Medicaid program and exchange/marketplace. Many of these integration efforts are designed to mitigate the potential gaps in coverage for those individuals who earn incomes close to the federal poverty level, who could churn between Medicaid coverage eligibility and exchange subsidy eligibility over the course of the year. The session examined the potential for integration across Medicaid and the exchanges, and the opportunities for state innovation to achieve a more integrated strategy.

The first panelist, Joel Ario of Manatt Health Solutions, discussed the strategies available to states to integrate, or converge, Medicaid and Marketplaces. He highlighted the different pathways to convergence, which range from targeted strategies, such as establishing continuity of providers, to full convergence models, such as single-payer systems and diffused purchasing power models.  Mr. Ario stressed the importance of breaking down barriers between these two systems in order to promote continuity of coverage and ensure that ACA’s expansion of coverage is successful.

Charles Milligan from Maryland’s Department of Health and Mental Hygiene then presented on Maryland’s churn population, providing a detailed overview of who they anticipate will move between Medicaid and the Marketplace, and the implications for continuity of care. Mr. Milligan also described Maryland’s current approach to Medicaid-Marketplace integration, which includes using shared consumer support services, as well as employing a shared eligibility and enrollment platform.

John Selig of Arkansas’s Department of Human Services concluded the breakfast by going into more detail on Arkansas’s integration efforts, which arose through the development of its alternative Medicaid expansion plan, called the Private Option. The Private Option provides premium assistance for low-income individuals to enroll in a qualified health plan through the Marketplace, as opposed to enrolling in a Medicaid Managed Care Organization or the Medicaid Fee-for-Service program. While the Private Option helped Arkansas expand its Medicaid program, it also provided them with an opportunity to foster the integration of Medicaid and its Marketplace.

The panelists’ presentations can be found on the SHRP IG’s webpage. Additional resources on churn and continuity of coverage under the ACA are listed below:

For more information on other state-related sessions at NHPC, check-out the following AcademyHealth blog posts: