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April 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

Mental Health Parity
Health Affairs

Traditionally, insurers and employers have covered treatment for mental health conditions differently than treatment for physical conditions. Coverage for mental health care had its own (usually higher) cost-sharing structure, more restrictive limits on the number of inpatient days and outpatient visits allowed, separate annual and lifetime caps on coverage, and different prior authorization requirements than coverage for other medical care. Altogether, these coverage rules made mental health benefits substantially less generous than benefits for physical health conditions. This brief explores the various laws that have begun bringing them into balance.

Risk Corridors and Budget Neutrality

Centers for Medicare and Medicaid Services

This set of Frequently Asked Questions addresses several questions about the risk corridor provision of the Affordable Care Act (ACA), including what HHS will do in the event that risk corridor collections are insufficient to fund risk corridor payment for a given year and how insufficient risk corridor payments will impact medical loss ratio calculations.

Insurance Exchanges

Health Reform: Designing a Marketplace
Center for Budget and Policy Priorities

The ACA has created a Health Insurance Marketplace (Marketplace) in every state, which offers individuals and small businesses the opportunity to shop from an array of affordable, comprehensive health insurance plans.  For those states that opted to operate a State-based Marketplace (SBM) or State Partnership Model (SPM), the ACA provides significant flexibility in the design and structure of the Marketplace. Thus, hundreds of policy and operational decisions had to be addressed during the Marketplace implementation process. CBPP has evaluated SBM and SPM states across a number of these Marketplace design questions and compiled the information in this interactive tool.

Young Adults More Likely to Qualify for Special Enrollment

Young Invincibles

Even though the ACA’s first Open Enrollment period has ended, the work of enrolling young adults in health insurance is not done yet, and it does not need to wait until the next round of open enrollment, starting on November 15, 2014. Many situations trigger Special Enrollment Periods, allowing consumers to purchase health insurance plans on the Marketplace outside of Open Enrollment. Importantly, young people are more likely to experience these life events than other age group. This report identifies the events that trigger special enrollment periods and demonstrate how young people are systematically more likely to qualify.


February 2014 Monthly Applications, Eligibility Determinations, and Enrollment Report
Centers for Medicare and Medicaid Services

This report is the fifth in a series of monthly reports on state Medicaid and Children’s Health Insurance Program (CHIP) data, and represents state Medicaid and CHIP agencies’ eligibility activity for the calendar month of February 2014, which coincides with the fifth month of the initial open enrollment period for the Health Insurance Marketplace. This report includes state data and analysis regarding applications to Medicaid and CHIP agencies and the State-based Marketplaces (SBMs) and eligibility determinations made by the Medicaid and CHIP agencies. New for this month, this report also includes state data on total enrollment in the Medicaid and CHIP programs.

Strategic Planning

Health Care Toolkit for State Budget Officers: Resources for Implementing the Affordable Care Act and other Health Care Reforms
National Association of State Budget Officers

State budget officers provide a unique perspective on how the crucial delivery of a key service such as health care fits into the framework of state budgets. This report looks at five core areas pertinent to state budgets as a means to analyze the implementation of the Affordable Care Act and other health reforms. The five core areas are: explaining health care cost trends; bracing for budget volatility; monitoring Health Insurance Marketplaces; evaluating Medicaid managed care expansions; and assessing the impacts of care delivery and payment reforms. This report provides the framework on how to analyze the changes in health care and will launch continued discussions on these crucial issues that have significant budget implications.

Early Estimates Indicate Rapid Increase in Health Insurance Coverage under the ACA: A Promising Start
Urban Institute
By the end of March, enrollment in Marketplace plans created by the ACA was reported at just over 7 million and the Centers for Medicare and Medicaid Services (CMS) reported that Medicaid enrollment increased between the beginning of October 2013 and the end of February 2014. However, neither the Marketplace enrollment figures nor the CMS Medicaid report provide an accurate picture of how many uninsured people have gained coverage since open enrollment began, because both sets of enrollment figures may include newly insured people as well as those who had other sources of coverage before 2014. This report uses the March 2014 Health Reform Monitoring Survey to examine changes in health insurance coverage in early March 2014 relative to coverage over the prior year, including more disaggregated information on coverage changes and additional details on the statistical precision of the estimates.

Delivery System Redesign

Financing Prevention: How States are Balancing Delivery System & Public Health Roles
National Academy for State Health Policy and ChangeLab Solutions
This report highlights leading states’ approaches to support community-based prevention initiatives by bridging health care delivery and public health systems. It examines various mechanisms – both previously existing and those created through health reform – that states can leverage to implement sustainable community-based prevention programs. They include Medicaid waivers, federal grants, accountable care and medical home models, pooled funding, and new federal requirements for nonprofit hospitals. The report includes opportunities and lessons from featured states (California, Maryland, Massachusetts, Minnesota, North Carolina, Oregon, Texas, and Vermont).

Engaging Providers in Building Managed Care Delivery Systems: Tips for States
Center for Health Care Strategies, Inc.

As states develop managed care programs for individuals who are dually eligible for Medicare and Medicaid or who use long-term services and supports, it is important for states to engage medical, behavioral health, and home- and community-based service providers as well as hospitals and nursing facilities. Providers can serve as an important channel for communication with state policymakers and administrators about how the managed care program is faring, and they can help highlight best practices and identify problems before they occur. This brief, developed through support from The Commonwealth Fund and The SCAN Foundation, provides tips to help states engage providers in designing, implementing, and overseeing a managed care delivery system for individuals with complex care needs.

The Role of Medicaid Managed Care in Health Delivery System Innovation
The Commonwealth Fund
States are increasingly turning to Medicaid managed care as a key strategy to manage costs and encourage innovation in health care delivery. This report examines health care providers’ perspectives on the role of managed care in improving health services for low-income adults in four communities: Milwaukee, WI; Oakland, CA; Seattle, WA; and Washington, DC. It finds that providers do not generally perceive Medicaid managed care as a catalyst for delivery system reform. Fragmented delivery systems, limits on the types of services for which managed care organizations are at risk, and the volatility in managed care markets all present challenges to improving care delivery. Policy and operational changes could enhance the role of Medicaid managed care in promoting patient-centered, coordinated, and high-quality care.