Reports & Analysis

Young adults’ participation in the nation’s new insurance marketplaces is essential: as a healthier-than-average population, it allows for comprehensive health plans to be offered at affordable prices to all enrollees over time. There is concern that many young adults (ages 19–29) will remain without health insurance in 2014 despite the Affordable Care Act’s reforms, including subsidized private coverage offered in new state marketplaces and expanded Medicaid eligibility. How things turn out will likely depend on outreach efforts and states’ decisions on expanding Medicaid. 

This brief examines the role of Medicaid in providing health coverage to the 9.6 million Medicare beneficiaries who are also eligible for Medicaid. The brief explains the role Medicaid plays in providing supplemental coverage to fill in the gaps in Medicare’s coverage for these dual-eligible beneficiaries. It explains how Medicare beneficiaries become eligible for Medicaid, provides national and state-by-state data on enrollment, and examines national and state-specific data on Medicaid spending for dual-eligible beneficiaries by service and eligibility group.

This brief lays out the major factors that states have considered in estimating the cost of a potential Medicaid expansion, provides examples of state fiscal impact analyses, and highlights the tools created through the State Health Reform Assistance Network that additional states can use to inform their fiscal analyses as they consider the Medicaid expansion decision.

With October's open enrollment for exchanges drawing near, a key issue that remains is premium rates for health plans sold in the exchanges. This map tracks states that have released rate information filed by carriers interested in selling plans in health insurance exchanges in both the individual and small group markets.

This educational slide deck, prepared by Manatt Health Solutions, provides detailed information on Advance Premium Tax Credits (APTCs) and Cost-Sharing Reductions (CSRs). It is designed as a tool to educate navigators, certified application counselors, and other assistors, as well as Marketplace staff, eligibility workers,  and others that need to understand and be able to explain how APTCs and CSRs work in practice. This presentation gives the audience a more visual display to aid in the comprehension of the technical information related to APTCs and CSRs. The document begins with a glossary of key terms and the general role of APTCs and CSRs, and then takes a deeper dive into the technical components. 

Around the country, models are emerging to link primary care providers not only to other medical service providers but also to resources and services in the community. This report—the first in a series supported by The Commonwealth Fund to explore opportunities for improvement in federal and state policy—highlights relevant policy levers and federal and state initiatives to integrate these resources. It also discusses opportunities for policy improvement identified during a Commonwealth Fund-supported discourse among high-level state and federal officials hosted by NASHP. 

This brief calls for an approach to payment reform that harnesses the inherent motivation that doctors and patients have to make good decisions about health care. The authors reject the assumption that health care costs will drop and quality will improve if policymakers and payers simply find the right mix of rewards (“carrots”) and punishments (“sticks”). The report draws on a large body of research that shows external incentives designed to change simple behaviors, like improving productivity in rote tasks, do not work for more complex behaviors. The report also analyzes cost and quality variability data for over 20 health conditions, identifying those (such as diabetes and coronary heart disease) most ripe for incentive experimentation and reform.

The ACA will significantly reduce the number of U.S. residents without health insurance and ensure appropriate access to health services, but the law specifically excludes one group from all its provisions: the approximately 11 million undocumented immigrants residing in this country. Projections show the health reform law will have little impact on health insurance coverage for such individuals, and excluding them from coverage under the law will create new financial pressures on safety-net hospitals. This report includes information on the health status and health usage of undocumented immigrants and suggests policy alternatives that could improve their access to health care.

Since 2009, eight states participating in the Robert Wood Johnson Foundation's Maximizing Enrollment program have worked to streamline eligibility and enrollment systems for children and those eligible for coverage in 2014. Several of the grantee states' technology-based solutions have paved the way for the new simplifications required of all states under the ACA. This Maximizing Enrollment report shares findings and lessons learned from the state grantees' experiences of adopting and piloting inventive technology strategies that go beyond what federal law requires and are worthy of consideration as states move forward with ACA implementation. Strategies were adopted in the four areas: 1) application and renewal simplifications; 2) customer interfaces; 3) system functioning, and 4) workflow management.

The ACA requires that Medicaid cover children with incomes up to 133 percent of the federal poverty level (FPL) as of January 2014. Today, there are “stairstep” eligibility rules for children through which states must cover children under the age of six in families with income of at least 133 percent of the FPL in Medicaid while older children and teens with incomes above 100 percent of the FPL may be covered in separate state Children’s Health Insurance Programs (CHIP) or Medicaid at state option. While many states already cover children in Medicaid with income up to 133 percent FPL, due to the change in law, 21 states needed to transition some children from CHIP to Medicaid. This brief examines how the transition of children from CHIP to Medicaid will affect children and families as well as states. The brief also looks to New York and Colorado for lessons learned from the early transition of coverage.