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February 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 Market Reforms

Shared Responsibility for Employers Regarding Health Coverage
Internal Revenue Service
This document contains final regulations providing guidance to employers that are subject to the shared responsibility provisions regarding employee health coverage enacted by the Affordable Care Act. These regulations affect large employers, those with 50 or more full-time employees, including full-time equivalent employees, during the prior year. Generally, an applicable large employer that, for a calendar month, fails to offer health coverage that is affordable and provides minimum value to its full-time employees may be subject to an assessable payment if a full-time employee enrolls for that month in a qualified health plan for which the employee receives a premium tax credit. These employers will need to begin complying with these regulations in 2015.

The Inevitability of Disruption in Health Reform
Urban Institute
Concern about even modest disruption of existing health insurance coverage by the ACA regenerates the belief that "there's got to be a better way" to make coverage available, adequate and affordable. But this brief shows that disruption is inevitable in any health reform and that the ACA's disruption is remarkably limited—far less than single payer proposals on the left or market-based proposals on the right. Further, unlike even many narrowly targeted reform alternatives, the ACA improves the pooling of risk that is essential to effective insurance.

Insurance Exchanges

Young Adult Participation in the Health Insurance Marketplaces: Just How Important Is It?
The Commonwealth Fund
The participation of young adults in the health insurance marketplaces has received considerable attention. At issue is whether men and women ages 19 to 34—a group uninsured at disproportionately high rates but generally healthier than older adults—will enroll in marketplace health plans at a rate high enough to ensure the marketplaces' success. The conclusion of health insurance actuaries, health plan representatives, researchers, and federal officials invited to participate in a Commonwealth Fund meeting on the topic is that while young adult participation is important for the stability of the marketplaces and 2015 premiums, it was, and will continue to be, one of many factors that affect premiums. There is no single "right" rate of young adult participation that will guarantee success. In fact, health plan actuaries view health status for all age groups as being more important in their pricing decisions.

Shared Responsibility in Consumer Assistance: Examples from Federally Facilitated and Partnership Marketplace States
National Academy for State Health Policy
This brief explores ways that states are sharing the responsibility of consumer assistance with the federal marketplace in three key areas: marketing and advertising initiatives, the work of navigators and other in-person assisters, and the development of a system for eligibility decision appeals. It also provides specific examples of states utilizing the Federally Facilitated Marketplace (FFM) or those partnering with it (SPM) for consumer assistance, and illustrates some of the ways that FFM and SPM states can work with their existing consumer assistance structures and with the federal government to help consumers find their way in a new coverage landscape.

Small Business Insurance Exchanges
Health Affairs
The small-business exchanges, created under the law's Small Business Health Options Program (SHOP), offer group health plans to small companies. Employers with fewer than twenty-five employees must purchase coverage through a SHOP if they wish to take advantage of the small-business tax credit for health insurance established in the ACA. States had the option of creating these as separate exchanges or combining the individual and small-business insurance markets into one exchange. This Health Policy Brief focuses on issues that states have had to confront in designing and operating SHOP exchanges as well as challenges that these exchanges are likely to face in the future.


Alternative Medicaid Expansion Models: Exploring State Options

Center for Health Care Strategies, Inc.
This brief outlines key program design features of alternative Medicaid expansion models. It describes the premium assistance models Arkansas, Iowa, and Pennsylvania developed to use Medicaid funds to purchase private health insurance, as well as Michigan’s proposal to expand Medicaid using a health savings account model. Key themes emerging from these non-traditional proposals include: (1) a preference for solutions relying more on the private insurance market than on traditional Medicaid; and (2) an emphasis on higher enrollee cost-sharing, personal responsibility, and healthy behaviors.

Letter on Application of Liens, Adjustments and Recoveries, Transfer of Asset Rules and Post-Eligibility Income Rules to MAGI Individuals
Centers for Medicare and Medicaid Services
This letter provides guidance to states on how the long-term services and supports-related rules apply to individuals who are eligible for Medicaid under Modified Adjusted Gross Income (MAGI) eligibility rules, and receive coverage for long-term services and supports (LTSS). The vast majority of people in need of Medicaid-covered LTSS will qualify under eligibility categories related to age or disability. The MAGI rules do not apply to these categories, and states generally are not required to offer LTSS in the Alternative Benefit Plans (ABPs) that are available to MAGI individuals. However, some people who need LTSS may qualify for Medicaid under MAGI rules. This guidance is intended to address states’ questions regarding whether the various Medicaid LTSS rules, including the estate recovery rules, will apply to MAGI individuals who are eligible for LTSS coverage.

Study Snapshot: Understanding the Tax Burden of Financing Medicaid with a Matching Grant
Changes in Health Care Financing and Organization
Medicaid comprises a significant portion of state budgets and is expected to grow as states expand coverage under the Affordable Care Act (ACA). Given this projected growth, understanding Medicaid’s financing structure, its burden on taxpayers, and any unintended consequences of the federal matching grant is particularly important. The matching grant, in place since the enactment of Medicaid, uses the Federal Medical Assistance Percentage (FMAP) to reimburse states for the federal share of states’ Medicaid expenditures. This study snapshot presents an overview of the estimated federal and state Medicaid tax burdens per family.

Strategic Planning

Geographic Concentration of the Uninsured
State Health Access Data Assistance Center
This analysis estimates the geographic concentration of the uninsured across U.S. counties. The estimates are from the 2011 Small Area Health Insurance Estimates (SAHIE) program at the U.S. Census Bureau. The SAHIE program models health insurance coverage by combining survey estimates with administrative records, population estimates, and the decennial census.  This method produces annual estimates for all counties and includes a limited set of demographic features. The advantage of using the SAHIE is that it is the only source for annual estimates uninsured for all counties.

Delivery System Redesign

Integrating Physical and Behavioral Health Care: Promising Medicaid Models
Kaiser Family Foundation

Many individuals receiving care for behavioral health conditions also have physical health conditions that require medical attention, and the inverse is also true. Unfortunately, our physical and behavioral health care systems tend to operate independently, without coordination between them, and gaps in care, inappropriate care, and increased costs can result. This brief examines five promising approaches currently underway in Medicaid to better integrate physical and behavioral health care. They can be arrayed along a continuum that ranges from relatively modest steps to coordinate care between the two systems, to more ambitious efforts to implement a single integrated system of care.

Making the Business Case for Payment and Delivery Reform
Network for Regional Healthcare Improvement and Robert Wood Johnson Foundation

In order to support improvements in both health care delivery and payment systems, individuals and organizations that purchase health care services need a clear business case showing that the proposed change in care will achieve sufficient benefits to justify whatever change in payment health care providers need to support the change in care. Health care providers also need a clear business case showing that they will be able to successfully deliver high-quality care in a financially sustainable way under the new payment system. This report describes a ten step process to develop such a business case, and describes the four major types of data that will generally be needed to carry out all of the steps in a good business case analysis. There will also be companion webinar to this brief – for more information, visit AcademyHealth’s website.