Reports & Analysis

The Affordable Care Act (ACA) dramatically expands Medicaid in 2014 in participating states. Meanwhile, six states have already expanded Medicaid since 2010 to some or all of the low-income adults targeted under health reform. The brief took an in-depth look at these six “early-expander” states — California, Connecticut, the District of Columbia, Minnesota, New Jersey, and Washington — through interviews with high-ranking Medicaid officials.

Prepared by Georgetown University's Center on Health Insurance Reforms, this guide is intended to supplement the Navigator training available from HHS and help answer questions people may have about the private insurance reforms in the Affordable Care Act. This comprehensive resource addresses more than 230 enrollment questions about everything from tax credits and cost standards to enrollment periods, and more.

This paper explores several strategies states could implement beyond federal requirements, using policy decisions in 11 states—Alabama, Colorado, Illinois, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island, and Virginia—to illustrate the choices being made to protect against and mitigate the effects of both “rate shock” and adverse selection in the individual market . The findings indicate that study states had mixed approaches to mitigating rate shock and adverse selection, with some taking steps beyond the required federal measures but with other policy options left unexplored. Minimizing the impact of adverse selection—both against the overall insurance market and the exchanges—will require strong monitoring and oversight.

The term "super-utilizer" describes individuals whose complex physical, behavioral, and social needs are not well met through the current fragmented health care system. As a result, these individuals often bounce from emergency department to emergency department, from inpatient admission to readmission or institutionalization -- all costly, chaotic, and ineffective ways to provide care and improve patient outcomes. To explore how Medicaid could best advance models for this high-need group of patients, the Center for Health Care Strategies, in partnership with the National Governors Association, hosted a Super-Utilizer Summit in February 2013. This report presents the Summit's common themes and key recommendations for building better systems of care for high utilizers.

The federal government and states are exploring new strategies for rewarding value in order to achieve better health outcomes at a lower cost. This report—the second in a series supported by The Commonwealth Fund to explore opportunities for improvement in federal and state policy— highlights relevant policy levers that can support payment reform and a number of current payment reform initiatives at the federal and state level. It also describes opportunities for federal-state alignment identified during a Commonwealth Fund-supported discourse among high-level state and federal officials hosted by NASHP.

This report examines how many of the uninsured in each state would be eligible for health coverage assistance programs - i.e. Medicaid, the Children's Health Insurance Program and subsidized private coverage through the new health insurance marketplaces - under the Affordable Care Act. The report also estimates the anticipated decrease in the uninsured population under the ACA in each state. Finally, the report examines the share of those remaining uninsured under the ACA in each state who would be eligible for, but not enrolled in, assistance programs.

The Affordable Care Act became law more than three years ago, but polls find that the majority of Americans still do not understand the law and how it will affect them. The Marketplaces, run by either states or the federal government, allow people to shop for insurance, find out whether they qualify for federal subsidies, and enroll in a health plan. Educating people about the new Marketplaces, which are now open to consumers, and helping them understand their insurance options will require a massive outreach effort carried out in part by navigators and in-person assisters. The troublesome launch of the Marketplaces, in which most people could not shop online, highlights the importance of consumer assistance in getting people enrolled.

Key provisions of the 2010 Affordable Care Act create new Marketplaces for people who purchase insurance directly and provide new premium tax credits to help people with low or moderate incomes afford that coverage. We estimate that about 17 million people who are now uninsured or who buy insurance on their own (“nongroup purchasers”) will be eligible for premium tax credits in 2014. This issue brief provides national and state estimates for tax credit eligibility for people in these groups.
 

The ACA gives qualified hospitals the opportunity to determine presumptive eligibility (PE) for all Medicaid-eligible populations which will enable hospitals to temporarily enroll individuals in Medicaid, ensuring compensation for hospital-based services, while providing patients access to medical care and a pathway to longer-term Medicaid coverage. This brief, prepared by the Center for Health Care Strategies, provides guidance to aid state Medicaid programs in developing the policies and procedures for hospital PE implementation. It provides valuable insight from the final CMS rule, related CMS guidance, expert sources, and interviews with states currently operating PE programs.

Conducted October 9–27, 2013, the Commonwealth Fund Affordable Care Act Tracking Survey interviewed a nationally representative sample of adults who are potentially eligible for the health reform law’s new insurance coverage options, whether private plans or expanded Medicaid. Among the survey’s key findings: 60 percent of potentially eligible adults are aware of the new marketplaces as a place where they might shop for coverage; 17 percent reported visiting the marketplaces in October to shop for a health plan; about one of five visitors were ages 19 to 29; and one of five visitors enrolled in a plan.