Resources from the Federal Government

This analysis uses evidence from the economics and health policy literatures to quantify several important consequences of States’ decisions not to expand Medicaid. That evidence, which is based primarily on careful analysis of the effects of past policy decisions, is necessarily an imperfect guide to the future, and the actual effects of Medicaid expansion under the ACA could be larger or smaller than the estimates presented below. However, this evidence is clear that the consequences of States’ decisions are far‐reaching, with implications for the health and well‐being of their citizens, their economies, and the economy of the Nation as a whole.

On November 9, 2015, the Centers for Medicare & Medicaid Services released the final 2017 essential health benefits benchmark plan for each state. A summary of benchmark plan coverage and the supporting plan document, as well as a list of how many prescription drugs are covered in each United States Pharmacopeia (USP) category and class were posted. The final list includes feedback received during the 30-day comment period.

A central aim of the Affordable Care Act is to increase the number of Americans with health insurance coverage. Over the past two years, significant progress has been made towards this goal as measured by the decline in the proportion of Americans who lack health insurance coverage, with an estimated 17.6 million uninsured people having gained health insurance coverage since several of the ACA coverage provisions took effect. This brief examines the composition of people that remained uninsured though the first quarter of 2015 and may be eligible to purchase insurance coverage from a Qualified Health Plan through the Marketplaces. It also presents data on the attitudes and experiences of the uninsured, drawn from a number of private surveys.

This letter to state health officials and Medicaid directors clarifies and expands upon the opportunities for facilitating Medicaid and the Children’s Health Insurance Program (CHIP) enrollment. In particular, it is offering states a new opportunity under Medicaid state plan authority to use Supplemental Nutrition Assistance Program (SNAP) gross income to support Medicaid income eligibility determinations at both initial application and renewals for certain populations.

A central feature of the Affordable Care Act (ACA) is the establishment of health insurance marketplaces. The marketplaces offer consumers organized platforms to shop for health insurance coverage, apply for financial assistance, and purchase coverage without any medical underwriting or premium adjustment based on pre-existing conditions. A key objective of the marketplaces is to foster competitive environments in which consumers can choose from a number of affordable and high quality health plans. This issue brief provides a progress report on the evolution of the competitive dynamics of the marketplaces.

This document contains final regulations regarding the summary of benefits and coverage (SBC) and the uniform glossary for group health plans and health insurance coverage in the group and individual markets under the Affordable Care Act (ACA). It finalizes changes to the regulations that implement the disclosure requirements to help plans and individuals better understand their health coverage, as well as to gain a better understanding of other coverage options for comparison.

This proposed rule would extend enhanced funding for Medicaid eligibility systems as part of a state’s mechanized claims processing system, and would update conditions and standards for such systems, including adding to and updating current Medicaid Management Information Systems (MMIS) conditions and standards. These changes would allow states to improve customer service and support the dynamic nature of Medicaid eligibility, enrollment, and delivery systems. Comments on this proposed rule are due by June 15, 2015.

This guidance describes the alternative procedures for eligibility redetermination for enrollment in a qualified health plan through the Marketplace and insurance affordability programs for benefit year 2016. These procedures incorporate some modifications from the alternative procedures specified by the Secretary for benefit year 2015, and will be implemented by each Federally-facilitated Marketplace (FFM). Like the alternative procedures for benefit year 2015, the alternative procedures preserve a core feature of the annual redetermination process, namely that an enrollee may take no action and retain coverage for 2016, which is important in promoting continuity of coverage while limiting administrative burden for enrollees, issuers, and Marketplaces.

This proposed rule would extend enhanced funding for Medicaid eligibility systems as part of a state’s mechanized claims processing system, and would update conditions and standards for such systems, including adding to and updating current Medicaid Management Information Systems (MMIS) conditions and standards. These changes would allow states to improve customer service and support the dynamic nature of Medicaid eligibility, enrollment, and delivery systems.

This final rule sets forth payment parameters and provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also finalizes additional standards for the individual market annual open enrollment period for the 2016 benefit year, essential health benefits, qualified health plans, network adequacy, quality improvement strategies, the Small Business Health Options Program, guaranteed availability, guaranteed renewability, minimum essential coverage, the rate review program, the medical loss ratio program, and other related topics.