Reports & Analysis

One major concern about the Medicaid expansion is that a high level of need among the newly eligible may lead to runaway costs, which could overwhelm state budgets when federal subsidies no longer cover 100 percent of the expansion population's costs in 2017. Although cost increases as a result of the newly eligible are likely, an important question is whether these increases will be temporary or permanent. Evidence from California's Low Income Health Program suggests that cost and utilization increases among newly eligible Medicaid beneficiaries will be mostly temporary.

This new report captures insights from those who helped consumers navigate the ACA’s first open enrollment period, including lessons for the second, which is set to start Nov. 15. The report draws on the experiences of 80 program leaders who participated in a roundtable discussion convened by the foundations in June. The group talked about consumer education and engagement, options for improving consumer notices and technical support for assisters, ways to better help people make informed choices, and the need to continue assisting consumers after enrollment.
 

To help enrollees new to the system keep their insurance, the ACA provides a ninety-day grace period before an insurer can discontinue someone's coverage for failure to pay a monthly premium. This applies only to those who have received an advance premium tax credit to purchase health insurance through the Marketplaces and have previously paid at least one month's full premium in that benefit year. This Health Policy Brief focuses on CMS's implementation of the ACA grace period and concerns from hospitals and physicians about potential financial liability now that millions of people have signed up for subsidized health insurance on the Marketplace exchanges.
 

During the transition to new health plans and new marketplaces under the ACA, many insurers revamped their approach to network design, and many now offer narrower provider networks than they have in the past. In this study for the Robert Wood Johnson Foundation’s project to monitor ACA implementation, researchers assessed network changes and efforts at regulatory oversight in six states: Colorado, Maryland, New York, Oregon, Rhode Island, and Virginia. Researchers found that insurers made significant changes to the provider networks of their individual market plans, both inside and outside the marketplaces, and that insurers took varying approaches to network design.
 

The Affordable Care Act (ACA) includes certain requirements regarding the adequacy of provider networks developed by health insurers to deliver covered services to their enrollees. The requirements provide broad parameters within which insurance regulators and other state officials responsible for network adequacy must evaluate the networks of Qualified Health Plans operating in their markets. This network adequacy planning tool for states has been updated to reflect the most recent U.S. Department of Health and Human Services regulation on minimum network adequacy standards, and can assist states in developing analysis plans that will inform discussions around updating network adequacy standards.
 

The federal government, commercial health plans, and other organizations are increasingly using measures of healthcare spending for the purposes of rewarding or penalizing physicians, hospitals, and other healthcare providers, defining provider networks, and encouraging patients to use particular providers. This report describes six fundamental problems with the current attribution and risk adjustment systems that are being used in these measures and explains how these problems could seriously harm both patients and healthcare providers. The report also describes how these problems can be solved using improved methodologies.

The Urban Institute’s Health Reform Monitoring Survey (HRMS) has been tracking health insurance coverage among nonelderly adults since the first quarter of 2013.1 The HRMS, which was designed to provide early feedback on implementation of the ACA, found that uninsured rates had declined by 4.0 percentage points among nonelderly adults between September 2013 and June 2014, with larger declines found in states that have expanded Medicaid. Beginning in June 2013, the HRMS added a supplement to track changes in coverage and other outcomes for children under the ACA. This brief examines findings from the HRMS children’s supplement.

The number of uninsured nonelderly adults fell by an estimated 10.3 million between September 2013 and early March 2014 because of provisions in the Affordable Care Act for private insurance reforms, the establishment of the Health Insurance Marketplace, and Medicaid expansion. Yet the remaining uninsured population is expected to reach 30 million by 2017. While the health care safety net is able to provide care to many of the remaining uninsured, a number of public and private initiatives at the state and local levels have sought to find additional solutions. This fact sheet describes a number of such examples.
 

States across the country are embracing integrated care delivery models as part of their efforts to deliver high-quality, cost-effective care to Medicaid beneficiaries with both physical and behavioral health needs. The Medicaid expansion authorized by the ACA brings greater import to these efforts, as millions of previously uninsured low-income adults—many at increased risk of having behavioral health conditions—gain coverage. Drawing on a review of the literature and interviews with consumers, providers, payers, and policymakers, this report explores strategies states are deploying to promote integrated care for this medically complex and high-cost Medicaid population.
 

The Medicaid primary care rate increase, a provision of the Affordable Care Act, requires Medicaid programs to reimburse primary care providers at Medicare levels for two years. The increase was intended to ensure sufficient provider participation as the Medicaid population expands. As the temporary provision enters its final months, a number of state and federal policymakers are considering extending the rate increase into 2015 and beyond. This new brief draws from interviews with policy experts and stakeholders across the country to assesses the policy's successes and failures. The brief examines the rate increase through the provider's lens, reviews its impact in meeting access and quality goals, and outlines considerations for states interested in extending and strengthening the provision to better meet its goals.