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March 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

Final Rule: HHS Notice of Benefit and Payment Parameters for 2015
Department of Health and Human Services
This final rule sets forth payment parameters and oversight provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also provides additional standards with respect to composite premiums, privacy and security of personally identifiable information, the annual open enrollment period for 2015, the actuarial value calculator, the annual limitation in cost sharing for stand-alone dental plans, the meaningful difference standard for qualified health plans offered through a Federally-facilitated Exchange, patient safety standards for issuers of qualified health plans, and the Small Business Health Options Program.

Proposed Rule: Exchange and Insurance Market Standards for 2015 and Beyond

Department of Health and Human Services
This proposed rule would address various requirements applicable to health insurance issuers, Health Insurance Marketplaces, Navigators, non-Navigator assistance personnel, and other entities under the ACA. Specifically, the rule proposes standards related to product discontinuation and renewal, quality reporting, non-discrimination standards, minimum certification standards and responsibilities of qualified health plan (QHP) issuers, the Small Business Health Options Program, and enforcement remedies in Federally-facilitated Marketplaces.

Navigator Resource Guide on Private Health Insurance Coverage and the Health Insurance Marketplace
Georgetown University's Center on Health Insurance Reforms
This guide focuses on the private insurance reforms of the Affordable Care Act, including the health insurance marketplaces, rating, benefit and cost standards, and premium tax credits. It is intended to supplement the Navigator training available from the U.S. Department of Health and Human Services. This comprehensive resource addresses more than 230 enrollment questions about private insurance reforms, and is divided into four sections: individuals with no coverage; individuals who currently have coverage or an offer of coverage from their employer; coverage for small business employers; and post-enrollment issues.

Insurance Exchanges

Sizing Up Exchange Market Competition
Kaiser Family Foundation
This issue brief offers an early look into how competitive the health insurance marketplaces are under the Affordable Care Act in selected states. Through analysis of enrollment data released by seven states (California, Connecticut, Minnesota, New York, Nevada, Rhode Island, and Washington), this brief finds that exchange markets in California and New York are shaping up to be more competitive than their individual markets were in 2012 while those of Connecticut and Washington show less competition. In several states, market shares of individual insurers have shifted significantly compared to the individual market prior to the ACA, pointing to the potential for greater price competition in the future and the influence of new entrants to the market.

Implementing the Affordable Care Act: State Action to Establish SHOP Marketplaces

The Commonwealth Fund
The Affordable Care Act seeks to help small employers offer coverage by reforming the small-group market and establishing Small Business Health Options Program (SHOP) marketplaces. Seventeen states and the District of Columbia chose to operate their own SHOP marketplaces in 2014, with the federal government operating the SHOP marketplace in 33 states. This brief examines state decisions to enhance the value of SHOP marketplaces for small employers and finds that most have set predictable participation and eligibility requirements and will offer a competitive choice of insurers and plans. While not all SHOP marketplaces are yet functioning as intended, their establishment offers an opportunity to identify successful strategies for improving the affordability and accessibility of coverage for small employers.


Medicaid and Marketplace Eligibility Changes Will Occur Often In All States; Policy Options Can Ease Impact
Health Affairs
Under the ACA, changes in income and family circumstances are likely to produce frequent transitions in eligibility for Medicaid and health insurance Marketplace coverage for low- and middle-income adults. This report provides state-by-state estimates of potential eligibility changes (“churning”) if all states expanded Medicaid under health reform, and identifies predictors of rates of churning within states. The authors found that, even in states with the least churning, more than 40 percent of adults likely to enroll in Medicaid or subsidized Marketplace coverage would experience a change in eligibility within twelve months. Policy options for states to reduce the frequency and impact of coverage changes include adopting twelve-month continuous eligibility for adults in Medicaid, creating a Basic Health Program, using Medicaid funds to subsidize Marketplace coverage for low-income adults, and encouraging the same health insurers to offer plans in Medicaid and the Marketplaces.

Profiles of Medicaid Outreach and Enrollment Strategies: Using Text Messaging to Reach and Enroll Uninsured Individuals into Medicaid and CHIP
Kaiser Family Foundation
Effective outreach, enrollment, and retention efforts are essential for ensuring that these new coverage opportunities under the ACA translate into increased coverage. One potential avenue for targeted outreach is through text messaging and other mobile technology, which has become an increasingly common source of communication, particularly among low-income adults targeted by the coverage expansions. To provide greater insight into the potential role of text messaging as an outreach vehicle, this brief focuses on the use of standard cell phones and smartphones for text messages and internet access and illustrates how one text messaging initiative, Text4baby, a free, personalized maternal child health education text messaging service for pregnant women and new mothers, is helping eligible pregnant women and their families connect to health coverage.

Strategic Planning

Regional Reports: Implementation of the Affordable Care Act in Western States
Rockefeller Institute of Government and University of Pennsylvania Fels Institute of Government
This is the first in a series of regional reports examining ACA implementation, focusing on the start of the initial six-month ACA open enrollment period beginning October 1, 2013. The first report examines the Western region where the state governments have generally embraced the ACA, and includes reports on Arizona, California, Colorado, Idaho, Oregon, New Mexico, Nevada and Washington. An overview report that describes the policy setting and goal alignment of these western states is also available.

America's Underinsured: A State-by-State Look at Health Insurance Affordability Prior to the New Coverage Expansions
The Commonwealth Fund

Before the implementation of the major ACA insurance reforms, data from U.S. census surveys indicated nearly 32 million insured people under age 65 were in households spending a high share of their income on medical care. Adding these “underinsured” people to the estimated 47.3 million uninsured, the state share of the population at risk for not being able to afford care ranged from 14 percent in Massachusetts to 36 percent to 38 percent in Idaho, Florida, Nevada, New Mexico, and Texas. The report provides state baselines to assess changes in coverage and affordability and compare states as insurance expansions and market reforms are implemented.

Delivery System Redesign

Quality Measurement to Support Value-Based Purchasing: Aligning Federal and State Efforts

National Academy for State Health Policy
Public payers are moving to implement payment strategies that reward value in the health care system by linking payment to quality. This report—the third in a series supported by The Commonwealth Fund to explore opportunities for improvement in federal and state policy— highlights quality measurement strategies underpinning value-based purchasing initiatives at the federal and state level. It also describes opportunities for federal-state alignment identified during a Commonwealth Fund-supported discourse among high-level state and federal officials hosted by NASHP.