Reports & Analysis

Wakely Consulting Group has prepared this policy brief to aid state Exchanges in the process of certifying, recertifying, de-certifying and managing the relationship with qualified health plans (QHPs).

This white paper from the Kaiser Family Foundation examines the various insurance market changes that may affect health insurance premiums for people buying nongroup insurance when the Affordable Care Act is fully enacted in 2014, including the higher level of benefits, the better protection against catastrophic costs, and wider access to coverage.

This brief examines the provisions in the ACA oriented towards transforming the American health care delivery system from a system that rewards volume to a system that rewards quality and value. These provisions hold the potential to reduce the rate of cost growth and improve the quality of care delivery through more coordinated care delivery models and reimbursement methods that reward coordinated care.

The Centers for Medicare and Medicaid Services (CMS) has finalized memoranda of understanding (MOUs) with Massachusetts and Ohio to test a capitated financial alignment model to integrate care and align financing for people who are dually eligible for Medicare and Medicaid in 2013. This fact sheet compares the key components of the Massachusetts and Ohio demonstrations.

The Center on Budget and Policy Priorities has updated its guide “State Policy Decisions in State-Based Exchange Implementation”. This guide is a compilation of the policy decisions states will need to make when building a state-based exchange. This guide identifies areas where states have flexibility in the design of their exchanges and helps advocates, policymakers, and other stakeholders look for ways to get involved in this process.

This brief summarizes efforts to develop quality of care measures for Medicare-Medicaid enrollees. It provides guidance to states in developing measurement approaches for proposed integrated programs, including assessment of quality in specific domains of integrated care such as long-term services and supports and behavioral health services.

The Commonwealth Fund Commission on a High Performance Health System analyzed a set of synergistic provider payment reforms, consumer incentives, and system-wide reforms to confront costs while improving health system performance with the goal of holding increases in national health expenditures to no more than long-term economic growth. 

The Center for Budget and Policy Priorities released a toolkit that aims to help states coordinate their health reform activities with other human service programs. It is designed to help states develop eligibility and enrollment systems and processes that not only meet ACA standards, but also enable enrollees (primarily poor & near-poor families) to access all of the benefits available to them through other programs.

This survey provides a snapshot of Medicaid and CHIP enrollment and eligibility policies and procedures and highlights the changes that states will need to make in their programs to prepare for the ACA in 2014.