This brief, prepared by the Georgetown University Health Policy Institute, explores some of the discrepancies that can arise with varying network adequacy standards and provides examples of how some states have resolved such issues. Network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all health care services included under the terms of the contract.
This brief, prepared by the National Academy for State Health Policy, lays out the major factors states have considered in estimating the cost of a potential Medicaid expansion. The major factors addressed in this brief are: Who will enroll in Medicaid with or without a Medicaid expansion?; How do the alternatives afforded by Medicaid’s Alternative Benefit Plans and Medicaid waivers affect expansion considerations?; How are health care institutions, state agencies, and a state’s broader economy affected by a state’s decision regarding Medicaid expansion?
The Oregon Health Policy Board met on August 6, 2013 to present updates on the 2013 legislative recap, the Coordinated Care Model Alignment workgroup, Health System Transformation Quarterly Report, and rate review and transparency opportunities.
The Illinois Health Reform Implementation Council convened on July 23, 2013 to discuss progress on the state’s partnership Marketplace. Among those updates was a presentation by State Network director, Heather Howard, and deputy director Chad Shearer on the current role of the network in providing technical assistance to Illinois, an overview of the previous/current assistance, and discussion of potential opportunities for assisting the state moving forward.
This educational slide deck, prepared by Manatt Health Solutions, provides detailed information on Advance Premium Tax Credits (APTCs) and Cost-Sharing Reductions (CSRs). It is designed as a tool to educate navigators, certified application counselors, and other assistors, as well as Marketplace staff, eligibility workers, and others that need to understand and be able to explain how APTCs and CSRs work in practice.
The following brief, prepared by experts at the University of Minnesota, provides background on data collected by the National Association of Insurance Commissioners (NAIC), including new types of data being collected for health reform monitoring purposes.
This brief, prepared by Wakely Consulting Group, analyzes different options for premium rating methods for the Small Business Health Options Program (SHOP) Exchange. The details of the billing/employer contribution approaches are explored and insights are given into the benefits and challenges of each method.
A number of provisions in the Affordable Care Act (ACA), from changes to income eligibility (section 2002) to coverage for freestanding birth center services (section 2301), require states to alter Medicaid eligibility guidelines, service benefits, or payment criteria.
The State Coverage Initiatives program, in coordination with the State Network, hosted a webinar Tuesday, July 23 from 1:30 – 3:00 p.m. EDT to discuss Small Business Health Option Programs (SHOP) notices and appeals. Sharon Woda and Adam Block from Manatt Health Solutions, and Lisa Sbrana and Kelly Smith from the New York Health Benefit Exchange (NYHBE) facilitated this event.
Impact of National Health Reform and State-Based Exchanges on the Level of Competition in the Nongroup Market
This brief, prepared by Wakely Consulting Group, analyzes health plan participation in 10 state-based exchanges to provide an early indicator of the level of competition that market reforms and state-based exchanges are generating. In sum, carrier participation increased by 35 percent (52 to 70 issuers) when comparing the number of issuers applying to nongroup exchanges versus the number in the pre-reform base year.