Reports & Analysis

States and regional collaboratives are moving ahead with creating all-payer claims databases (APCDs) to support health system measurement and improvement activities. While aggregated claims databases provide an unprecedented view of care across all settings, the process of collecting claims information alone does not improve health care quality or reduce costs. To effectively utilize the APCD and realize its full potential, states have begun to produce reports and analyses based on APCD data. This paper examines the critical components of states’ APCD reporting efforts to date and suggests essential steps to creating credible and robust analytics.

This map tracks enrollment data from state marketplaces, the federal marketplace and Medicaid/CHIP agencies for individuals and families enrolling in Qualified Health Plans (QHPs) and Medicaid/CHIP. The map also provides state-by-state estimates for those eligible for marketplace and Medicaid/CHIP coverage from Kaiser Family Foundation and Urban Institute analyses.

The Centers for Medicare & Medicaid Services (CMS) recently established twelve new Medicaid and CHIP eligibility and enrollment performance indicators for states to report beginning in October 2013. These indicators provide insight into the performance of new eligibility and enrollment policies established under the Affordable Care Act (ACA). In December 2013, CMS released initial reports for a subset of the indicators. This brief provides an overview of the new performance indicators; the initial data; and the opportunities and challenges associated with reporting, analyzing, and interpreting the data.

Presumptive eligibility is a Medicaid policy option that permits states to authorize specific types of "qualified entities," such as federally qualified health centers, hospitals, and schools, to screen eligibility based on gross income and temporarily enroll eligible children, pregnant women, or both in Medicaid or the Children’s Health Insurance Program (CHIP). The Affordable Care Act extends presumptive eligibility beyond children and pregnant women and expands the role of hospitals in determining eligibility presumptively. Given the current status of ACA implementation, presumptive eligibility may be an important tool to expedite access to coverage as states fine-tune their business processes and tweak new eligibility and enrollment systems.

The Affordable Care Act expands Medicaid in 2014 to millions of low-income adults in states that choose to participate in the expansion. Since 2010 California, Connecticut, Minnesota, and Washington, D.C., have taken advantage of the law’s option to expand coverage earlier to a portion of low-income childless adults. Using administrative records, the authors documented that the ramp-up of enrollment was gradual and linear over time in California, Connecticut, and D.C. Enrollment continued to increase steadily for nearly three years in the two states with the earliest expansions.

This brief discusses the new health insurance marketplaces created under the Affordable Care Act and associated structural and process-related regulations that aim to ensure the quality and value of plans sold. To qualify to be sold in these marketplaces, new plans must be certified as a "Qualified Health Plan" (QHP), meet quality accreditation standards, and implement a quality improvement strategy. These steps require the collection of information from insurers, which will result in the disclosure of information about health insurance policies, practices, cost, and quality.

With the launch of Open Enrollment on October 1, 2013, millions of individuals and families started to enroll in Medicaid, CHIP, or private insurance with or without federal subsidies through Health Insurance Marketplaces. As the Marketplaces’ doors opened for business, technological glitches surfaced, making the role of consumer assistance organizations even more important. This report examines states’ health coverage consumer assistance efforts to date. Based on the major categories of consumer assistance entities – Navigators, In-Person Assisters, Certified Application Counselors, and Health Centers – the report takes a closer look at each state’s consumer assistance and health center entities and the funding used to support these efforts.

The new health insurance marketplaces aim to improve consumers’ purchasing experiences by setting uniform coverage levels for health plans and giving them tools to explore their options. Marketplace administrators may choose to limit the number and type of plans offered to further simplify consumer decision-making. This issue brief examines the policies set by some state-based marketplaces to simplify plan choices: adopting a meaningful difference standard, limiting the number of plans or benefit designs insurers may offer, or requiring standardized benefit designs.

The State Innovation Model (SIM) Testing Awards that HHS awarded to six states (Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont) were to support states’ work on multi-payer payment and delivery system reform. Strategies to improve the population's health were a critical aspect of the SIM awards. The SIM Funding Opportunity Announcement (FOA) required that states explain how the model would improve the population’s health in a number of areas including: health disparities, determinants of health, mental health, and substance abuse. The FOA also noted that states should describe how their State Health Care Innovation Plan integrates community health and prevention into their delivery system and payment models. This chart lays out the population health strategies the selected states plan to implement through their SIM initiatives.

The ACA includes coverage options for people across the income spectrum, but there are big differences in eligibility for coverage depending on whether a state expands Medicaid or not. In states that expand Medicaid, all legal residents with incomes up to four times the poverty level are eligible for financial assistance if other coverage is not available. In states that do not expand, some uninsured people (particularly children) are already eligible for Medicaid or CHIP, though many adults below poverty will fall into a “coverage gap” with no assistance. This interactive map allows you to see how many currently uninsured people in each state are estimated to be eligible for Medicaid or tax credits, or in the coverage gap. State profile fact sheets are also available for more details on how the ACA could expand coverage in each state.