Reports & Analysis

The ACA required states to make large-scale changes to their eligibility systems for Medicaid in order to create streamlined processing with the health plan coverage and subsidies that are available through health insurance marketplaces. To support these changes, the U.S. Department of Health and Human Services made enhanced federal Medicaid matching funds available for states to update or build their systems, and states have also been given the opportunity of a cost allocation waiver that allows them to temporarily use this enhanced funding to support technology and services improvements to eligibility systems shared by Medicaid and other health and human services programs. This issue brief highlights examples of technology and services innovations that states are implementing in support of integration among health and human services programs and discusses common themes across efforts.

Across the country’s four largest states, uninsured rates vary for adults ages 19 to 64: 12 percent of New Yorkers, 17 percent of Californians, 21 percent of Floridians, and 30 percent of Texans lacked health coverage in 2014. Differences also extend to the proportion of residents reporting problems getting needed care because of cost, which was significantly lower in New York and California compared with Florida and Texas. These differences stem from a variety of factors, including whether states have expanded eligibility for Medicaid, the state’s uninsured rate prior to the Affordable Care Act taking effect, differences in the cost protections provided by private health insurance, and demographics.

In this brief, researchers from the Maine Rural Health Research Center present findings from a SHARE-funded evaluation of the rural implications of Medicaid expansion under the ACA. The authors examine the following issues: the extent to which prior public health insurance expansions have covered rural populations; whether rural residents who are expected to be newly eligible for Medicaid in 2014 differ from their urban counterparts; the extent to which rural individuals might differentially benefit from the ACA Medicaid expansion in light of the expansion becoming optional; and whether rural enrollees are likely to have adequate access to primary care.

In the states that have chosen not to expand their Medicaid program, there are hundreds of thousands of uninsured, low-income Hispanics who are lagging behind on key measures of access to health care. Whether individuals are insured or uninsured greatly affects their ability to obtain regular health care. And in communities of color, where rates of uninsurance and poor health outcomes are higher than in white communities, the differences between those who have insurance and those who lack it are stark. This series of state-by-state reports illustrates the positive effects (in terms of access to care and certain preventive services) of having insurance for low-income Hispanics in states that have not expanded Medicaid.

People may purchase subsidized health insurance through the ACA exchanges with premiums based on projected future income. However, if actual income is higher than estimated, they may be required to repay part or all of the subsidy when they file tax returns. This "reconciliation" process could raise taxes substantially for many ACA participants. However, analysis of income tax return data suggests that for most lower-income filers, the reconciliation will reduce the refund they receive rather than require them to remit additional tax because their refunds exceed the reconciliation amount. This paper also includes a discussion of ways in which the reconciliation process could be improved.

On February 27, 2015, the U.S. Department of Health and Human Services published the Notice of Benefit and Payment Parameters for 2016 Final Rule, which included several provisions pertaining to form review.  This analysis, prepared by the Georgetown University Health Policy Institute’s Center on Health Insurance Reforms, provides a brief summary of the key provisions specific to form review and other notable provisions specific to the 2016 plan year.  Included in the final rule are provisions on enrollment periods, definition of habilitative services, meaningful access to coverage materials, annual update to cost-sharing limits, pediatric age, and the drug exceptions process.

For the past three years, the Affordable Care Act (ACA) has required health insurers to pay out a minimum percentage of premiums in medical claims or quality improvement expenses—known as a medical loss ratio (MLR). Insurers with MLRs below the minimum must rebate the difference to consumers. This issue brief finds that total rebates for 2013 were $325 million, less than one-third the amount paid out in 2011, indicating much greater compliance with the MLR rule. In the first three years under this regulation, total consumer benefits related to the medical loss ratio—both rebates and reduced overhead—amounted to over $5 billion. This was achieved without a great exodus of insurers from the market.

For the past three years, the Affordable Care Act (ACA) has required health insurers to pay out a minimum percentage of premiums in medical claims or quality improvement expenses—known as a medical loss ratio (MLR). Insurers with MLRs below the minimum must rebate the difference to consumers. This issue brief finds that total rebates for 2013 were $325 million, less than one-third the amount paid out in 2011, indicating much greater compliance with the MLR rule. In the first three years under this regulation, total consumer benefits related to the medical loss ratio—both rebates and reduced overhead—amounted to over $5 billion. This was achieved without a great exodus of insurers from the market.