Qualified Health Plan Review in Marketplaces with State Plan Management: An Analysis of the Division of Labor Between State Exchanges and Other State Agencies
States have implemented a variety of different methods to handle the review and certification of qualified health plans (QHPs). The Health Insurance Exchanges (HIX) Research Group at the Leonard Davis Institute of Health Economics at Wharton (LDI) recently collected data from 30 states, including those with State Based Marketplaces (SBMs), State Partnership Marketplaces (SPMs), Supported State Based Marketplaces (SSBMs), and Federally Facilitated Marketplaces (FFMs) with state plan management. This brief summarizes the findings within this dataset, which outlines the various plan management and certification functions assumed by different state agencies across these marketplace models.
As health insurance exchanges approach the third open enrollment period under the Affordable Care Act (ACA), social media platforms continue to represent vital channels through which exchanges can reach consumers. Using social media to inform and educate consumers about the availability of affordable coverage options through the marketplace can be a critical component of an exchange's communications plan, but also requires an understanding of some of the most effective ways of using them. This slide deck, prepared by GMMB, provides an overview of several social media channels, as well as key insights and tips for making sure that exchanges are utilizing them as effectively as possible.
The State Network 1332 Waivers Affinity Group continued in October with a new presentation from the team at Manatt Health Solutions. This ongoing series has included presentations providing an overview of the basics around these waivers, including statutory guardrails, discussions on what can and cannot be waived, and potential opportunities available to states through the waiver process, while this presentation focused more deeply on potential coordination between 1332 and 1115 waivers, including general guardrails and budget neutrality.
While millions of Americans have newly gained health insurance coverage under the Affordable Care Act (ACA), there is evidence that coverage alone does not necessarily translate into access to health care. This memo, prepared by the State Health Access Data Assistance Center (SHADAC), provides background information on health insurance literacy, summarizes the research around current consumer knowledge, and offers recommendations for marketplaces on how to build on it. Additionally, the State Network has compiled a library of health insurance literacy materials developed by four marketplaces.
Financing Shared Administrative Functions Between State-Based Marketplaces and State Medicaid Programs: Cost Allocation Methodologies
The Affordable Care Act (ACA) provides opportunities for expanded access to health coverage through both the expansion of Medicaid and the establishment of health insurance marketplaces. State-based marketplaces (SBMs), as pathways to both public and private health coverage, are required to perform cross-program functions that support access to both qualified health plans (QHPs) available through the marketplace, as well as coverage through Medicaid. While these shared functions create an opportunity for savings through enhanced efficiency, they also require states to properly attribute funding to both through a process known as cost allocation.
The State Network 1332 Waivers Affinity Group continued with another presentation from the team at Manatt Health Solutions. Following prior presentations providing an overview of the basics around these waivers, including statutory guardrails, a discussion on what can and cannot be waived, and potential opportunities available to states through the waiver process, this presentation investigated more deeply the potential coordination between Section 1332 and Section 1115 waivers.
Assessing a New Option: The Feasibility of Contracting With a Single Firm to Build and Operate a State’s Marketplace
Since the passage of the Affordable Care Act (ACA), the design of state health insurance exchanges has evolved to include several distinct models. This evolution has led to the possibility that a state’s exchange development and operations could be delegated to a private vendor. States operating their own state-based marketplaces (SBMs) may begin to consider other options as they confront budget challenges and look to streamline operations.
The State Network 1332 Waivers Affinity Group, hosted by Manatt Health Solutions, continued with a presentation on the process of applying for a 1332 waiver, as well as a discussion on the potential and limitations of these waivers for states relying on the federal marketplace. Previous installments of this webinar series included presentations on the basics of the waiver process and information on statutory guardrails, as well as a deeper analysis of specific examples of what can be waived through this process.
State action to prevent discriminatory benefit designs has been prompted, in part, by vital input from consumer advocacy organizations. Recognizing the important role that they can occupy in this process, the Georgetown University Health Policy Institute's Center on Health Insurance Reforms sought to gather a directory of these organizations. Georgetown gathered those organizations willing to be made available to states as resources to insurance regulators in need of assistance with identifying discriminatory benefit designs or for other regulatory tasks that require expertise related to a certain disease group or consumer concern.
In order to ensure that Consumer Services Divisions within state insurance regulatory agencies are equipped with the necessary resources to assist consumers experiencing insurance problems, the State Health Reform Assistance Network (State Network) team at the Georgetown University Health Policy Institute has developed a toolkit intended as a guide for consumer service representatives (CSRs).