Reports & Analysis

Challenges such as geographic isolation, small practice size, heterogeneity in settings and patient population, and low case volume make participation in performance measurement and improvement efforts especially challenging for many rural providers. This report presents 14 recommendations from a multi-stakeholder committee that was tasked to address these and other challenges of healthcare performance measurement for rural providers, particularly in the context of the Centers for Medicare and Medicaid Services pay-for-performance programs. The resulting recommendations can help advance the integration of rural providers into CMS quality improvement efforts. The recommendations also can be used to enhance the quality measurement and improvement efforts of other public- and private-sector stakeholders.

The ACA extends health insurance coverage to people who lack access to an affordable coverage option. Under the ACA, Medicaid coverage is extended to low-income adults in states that have opted to expand eligibility, and tax credits are available for middle-income people who purchase coverage through a health insurance marketplace. Millions of people have enrolled in these new coverage options, but millions of others are still uninsured. Some remain ineligible for coverage, and others may be unaware of the availability of new coverage options or still find coverage unaffordable even with financial assistance. This analysis provides national and state-by-state estimates of eligibility for ACA coverage options among those who remained uninsured.

This brief describes the outreach and enrollment strategies that enrollment assisters can use to help people involved in the criminal justice system get health coverage. By focusing on this population, assisters will not only help these individuals enroll in health coverage and receive needed care, they will reach and enroll more uninsured consumers. Enrollment assisters in many states are working to help the justice-involved population enroll in health coverage. This brief provides an overview of why it is important to focus on this population and offers assisters tangible steps to begin this work.

According to the most recent Commonwealth Fund ACA Tracking Survey, March–May 2015, an estimated 25 million adults remain uninsured. To achieve the ACA’s goal of near-universal coverage, policymakers must understand why some people are enrolling in the law’s marketplace plans or in Medicaid coverage and why others are not. This analysis of the survey finds that affordability—whether real or perceived—is playing a significant role in adults’ choice of marketplace plans and the decision whether to enroll at all. People who have gained coverage report significantly more positive experiences shopping for health plans than do those who did not enroll. Getting personal assistance appears to make a critical difference in whether people gain health insurance.

Through reforms to cost containment and expanded access to health insurance plans, the ACA has begun to shape the delivery and cost of healthcare services to Americans. Many of these reforms are still taking hold, and it is too soon to completely know how they are affecting the healthcare system. But looking beyond these considerations, it appears that many enduring economic challenges persist in the markets that provide health care and health insurance to consumers. This paper offers six economic facts that highlight continuing challenges and complexities in health care and health insurance markets on which the policy debate should focus.

Access to oral health care for low-income adults is a persistent challenge in the U.S. Poor oral health can elevate risks for chronic conditions such as diabetes and heart disease, and can lead to lost workdays, reduced employability, and the preventable use of costly acute care. As many states expand Medicaid coverage for adults through the ACA, there are new opportunities to expand much-needed dental coverage and avoid the dangerous and costly consequences of untreated dental disease. This fact sheet identifies key challenges related to oral health care access and utilization for low-income adults, and outlines states’ current coverage of dental benefits for adults in Medicaid. It also suggests opportunities for states to increase oral health care coverage and access for this population.

This report provides an in-depth examination of the changes taking place in Medicaid programs across the country. The findings in this report are drawn from the 15th annual budget survey of Medicaid officials in all 50 states and the District of Columbia. This report highlights policy changes implemented in state Medicaid programs in FY 2015 and those planned for implementation in FY 2016 based on information provided by the nation’s state Medicaid directors. Policy changes and initiatives described in this report include those in eligibility and enrollment, managed care, delivery and payment system reforms, provider payment rates, and covered benefits. The report also looks at the key issues and challenges now facing Medicaid programs.

This brief uses data submitted by insurers on medical loss ratios (MLRs) from 2010 to 2014 to assess how the Affordable Care Act’s (ACA’s) provisions impacted states’ individual health insurance markets. It compares average net MLRs by state and examines the distribution of net MLRs across insurers in each state. In the individual market, researchers found: average net MLRs rose because of rising net claims relative to net premiums, almost all states had average net MLRs higher than 80 percent by 2014, and average net MLRs varied from 83 percent at the 25th percentile to 99 percent at the 75th percentile.

Under the State Innovation Models (SIM) initiative, launched in 2012 by CMS’ Center for Medicare and Medicaid Innovation, CMS has awarded nearly $950 million in grants to states, the District of Columbia, and the territories to design, implement, and evaluate multi-payer health care delivery and payment reforms aimed at improving the quality of care and health system performance while decreasing costs for Medicaid, CHIP, and Medicare beneficiaries. Under the SIM initiative, the Innovation Center has been making two types of grants to states: Model Design grants through which states develop or refine a State Health Care Innovation Plan; and Model Test grants, which provide funding to states to implement their system transformation plans and evaluate their impact. This fact sheet provides information about the recent grants awarded under SIM Round 2, with a focus on Model Test grants.
 

Provider directory inaccuracies have caused problems for consumers and other stakeholders for many years. This issue brief explains the steps policymakers and health plans can take to improve directories and provides examples of legislation and regulation to help eliminate provider directory inaccuracies. Policymakers at the state and federal levels should make this issue a priority both for private insurance and for public programs like Medicaid, as accurate provider directories are critical to ensuring that coverage works for consumers.