Reports & Analysis

In this article, Alice Weiss examines Oklahoma’s efforts to streamline and modernize Medicaid enrollment. Oklahoma is the only state so far to implement an online application system for Medicaid, and its automated eligibility determination system for Medicaid is among the most modern and efficient nationwide, with the state is expected to achieve a nearly three-to-one return on its investment in 2015.

This brief examines the three proposed federal regulations that detail how the ACA’s rules will operate in private insurance market reforms, essential health benefits and actuarial value, and wellness programs offered or required by employers under group health plans. 

The Affordable Care Act provides new opportunities to integrate care for individuals dually eligible for both Medicare and Medicaid, but states now face challenges in showing how these integrated models improve the quality care. 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. It also describes how performance measures can be shaped by stakeholder input.

Consumers offered employer-sponsored insurance (ESI) can be ineligible for subsidies in health insurance exchanges (HIX), and until better ESI data become available, HHS proposes using post-enrollment audits, rather than pre-enrollment verification for this eligibility requirement. This paper examines two strategies through which exchanges can implement this policy by focusing audits on the consumers who are most likely to be ineligible.

This brief analyzes the factors behind increased spending on private insurance, examining trends in premiums and cost-sharing in the group and non-group markets, how premium dollars are spent by insurers, which sectors are driving premiums upward, and the importance of price increases in explaining spending growth.

This brief provides an overview of the federal guidelines around the EHB benchmark plans, which the states must submit by December 26, in addition to mapping out selections from the 26 states plus the District of Columbia that have already submitted their plans.

This template, prepared by Manatt Health Solutions, is intended to assist states in evaluating the options with respect to transitioning certain Medicaid and state-funded populations and programs into a post-ACA coverage environment.

Leading-edge states across the country are exploring the potential of accountable care organizations (ACOs) to drive improvements in quality, delivery, and cost-effectiveness for Medicaid populations. This brief outlines 10 core considerations to help guide the development and implementation of Medicaid ACO approaches.

Half of state Medicaid programs are taking new approaches to provider payment to help primary care practices become patient-centered medical homes for their low-income patients. This article focuses on trends in Medicaid patient-centered medical home payment that can inform public and private payment strategies more broadly.

The ACA provides for additional means of expanding coverage beyond expanding Medicaid and establishing exchanges, including allowing states to run a so-called Basic Health Program beginning in 2014. This policy brief explores the issues surrounding the Basic Health Program and outlines options for states.