Reports & Analysis

Recent cancellations of nongroup health insurance plans generated much policy debate and raised concerns that the Affordable Care Act (ACA) may increase the number of uninsured Americans in the short term. This article provides evidence on the stability of nongroup coverage using US census data for the period 2008–11, before ACA provisions took effect. The findings suggest that the nongroup market was characterized by frequent disruptions in coverage before the ACA and that the effects of the recent cancellations are not necessarily out of the norm.
 

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, D.C. 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.

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.
 

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).
 

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.

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.
 

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.
 

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; 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.
 

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.

As part of the federal Financial Alignment Initiative, states have the opportunity to test care models for dual-eligibles that integrate acute care, behavioral health and mental health services, and long-term services and supports, with the goals of enhancing access to services, improving care quality, containing costs, and reducing administrative barriers. One of the challenges in designing these demonstrations is choosing and applying measures that accurately track changes in quality over time—essential for the rapid identification of effective innovations. This brief reviews the quality measures chosen by eight demonstration states as of December 2013.