Reports & Analysis

This Neiman Report highlights two of several emerging models being developed by the Harvey L. Neiman Health Policy Institute designed to align provision and payment of specialty care with efforts to ensure a sustainable, high quality health care system.

This issue brief examines the status of community safety-net systems in six regions in California. Under the federal Patient Protection and Affordable Care Act (ACA), large numbers of Californians will become eligible for Medi-Cal in 2014. Even with federal resources to help safety-net providers prepare, however, communities with weaker safety-net systems are lagging in reform preparations. As a result, low-income people in those communities may be left without health coverage and timely access to health care services. Even well-prepared regions will need time and assistance to help people gain health care coverage.

Several of the Affordable Care Act’s (ACA) key provisions are aimed specifically at children, but much of the law focuses on covering the larger uninsured population of adults without dependent children. As states focus on implementing these ACA coverage programs and other systemic changes by January 1, 2014, it will be important that children’s coverage remains a priority as well. This report explains some challenges and opportunities for making health care reform work for children. The report, developed with the support of The Atlantic Philanthropies, draws upon lessons learned from state Medicaid and Children’s Health Insurance Programs (CHIP), federal policy, and relevant research. 

Enroll America recently released an interactive mapping tool using Google Maps to demonstrate where the uninsured are in communities. The map shows the distribution of the nonelderly uninsured in any given state by Public-Use Microdata Area (PUMA; an area within a state that contains at least 100,000 residents).  Clicking on any PUMA in a state provides details about the number of uninsured and their distribution by income, age, and race/ethnicity. The estimates used for the tool were produced by the Centers for Medicare and Medicaid Services (CMS) and the Assistant Secretary for Planning and Evaluation (ASPE) using the 2011 American Community Survey (ACS).

One of the major vehicles in the Affordable Care Act (ACA) to increase health insurance coverage is an expansion of Medicaid to adults with incomes at or below 138% of the federal poverty level (FPL). While the expansion was intended to be implemented in all states, as a result of the Supreme Court decision on the ACA, it is now effectively a state choice. Based on an analysis of 2011 American Community Survey data, this brief examines the implications of current state Medicaid expansion decisions on coverage by race and ethnicity.

This brief explores how state officials and stakeholders are analyzing the fiscal and macroeconomic implications of their choice about whether to expand Medicaid. It focuses on 10 of the 11 states that are participating in the Robert Wood Johnson Foundation’s (RWJF) health reform monitoring and tracking project. The discussion is divided into four sections: the legal and policy context in which states are deciding whether to expand Medicaid; the status of decision-making around Medicaid expansion in our 10 RWJF states; how the fiscal effects of Medicaid expansion are being analyzed; and how the macroeconomic effects of Medicaid expansion are being analyzed.

This paper focuses on states’ roles in implementation of FFEs. It provides an overview of recent regulations issued by CCIIO that describe the possible roles both for states and the federal government in the FFEs. It then provides in-depth descriptions of each of the specific FFE options as implemented in three states—Alabama, Michigan, and Virginia—with an eye to each state’s role in developing mechanisms to carry out their new responsibilities and progress in creating relationships with the federal government in order to ensure successful implementation of the three types of federally facilitated exchanges.

Under the Affordable Care Act and other health reform initiatives, the federal government has begun implementing policies to encourage hospitals to reduce preventable readmissions of patients. Each of the policies holds hospitals primarily accountable for readmissions and assesses performance using risk-standardized readmission rates. Commonwealth Fund–supported researchers examined the change in readmission rates over a two-year period and the relationship between these rates and other commonly used measures of hospital quality.

States looking to implement accountable care organizations in Medicaid understand that payment reform alone is not sufficient to transform care delivery at the practice site level. Primary care providers, particularly those serving the health care safety net, require resources and guidance to meet the substantial quality and cost containment aspirations of the accountable care model. This brief outlines the types of technical assistance supports that state Medicaid agencies can potentially offer to help providers in transforming care delivery. It also provides key considerations for planning, implementing, and sustaining such technical assistance.