Strategic Planning & Timelines

This brief describes global and episodic bundling and outlines considerations for state Medicaid agencies when evaluating potential implementation, including the relevance of these strategies for Medicaid agencies employing managed care strategies.

This brief discusses the issues that states will face in making decisions about how to structure health insurance exchanges and health insurance markets.
 

The ACA has dramatically increased the pace at which the uninsured rate is falling for Hispanic children. Yet Hispanic children are more likely to be uninsured than other children, making them vulnerable to going without health care and leaving their families exposed to financial risk. Given the high rates of uninsurance among Hispanic children, policymakers, program administrators, and other stakeholders should continue efforts to maximize health coverage for Hispanic children and remove barriers to enrollment. This brief provides a snapshot of uninsured Hispanic children in the U.S., and offers recommendations to further reduce the number of uninsured children.

States control an array of resources that can be used to provide health care and address the social determinants of health. To assist state policymakers seeking to maximize their leverage by working across state agencies to promote health, NASHP has compiled a chart of funding sources that state agencies use to address social determinants, such as stable housing, safe and prosperous neighborhoods and communities, access to healthy food, physical and mental health care, income support, and transportation. While many documents show states how Medicaid resources can be used for social services or housing needs, this chart aims to bring attention to other funding sources that states use specifically to help adult high-cost/high-need residents live healthy and prosperous lives.

This policy brief looks at the issue of enforcing mental health parity five years after the Mental Health Parity and Addiction Equity Act (MHPAEA) took effect. It provides information on the evolution of the Mental Health Parity Act and changes in mental health parity brought about by the implementation of the ACA. The brief also focuses on how MHPAEA is being enforced, a process that has not always been consistent.

This study examines the standards and practices that state agencies and health plans use to ensure access to care in the period following the implementation of the Affordable Care Act (ACA). Based on evidence gathered through surveys of and interviews with key informants in state agencies and plans, the study explores the standards applied by commercial insurance regulators and Medicaid agencies and the practices actually employed by Medicaid managed care organizations (MMCOs) and Qualified Health Plans (QHPs) in Marketplaces to form provider networks and monitor performance. The study paints a picture of the range of standards and practices used and the challenges faced, which provides a basis for identifying gaps in current understanding and strategies and opportunities for developing best practices.

This report examines the ACA’s target population of consumers who were uninsured before the law’s main coverage provisions took effect in 2014. In every state, tax returns were filed for 56% or more of those who now qualify for Medicaid and 84% or more of those eligible for health insurance tax credits. The minority of tax preparers who help their clients apply for health coverage have developed several effective models. States could test the impact of measures to increase tax preparation services’ contribution to enrollment while guarding against unethical or incompetent conduct. Federal policy could also play an important role.

Prescription drug growth rates declined from 2000 to 2013, in part due to patent expiries and decreases in generic prices. This downward trend appears to be reversing; spending on prescriptions is estimated to have spiked upwards in 2014 and 2015 with grow rates of 11.6% and 6.8% respectively. This article explores the current trends in prescription drug spending.

The ACA created new opportunities for health centers and primary care associations (PCA) to play a leading role in supporting outreach and enrollment into new and expanded health coverage programs. Health centers and PCAs received new funding, sometimes from multiple state and federal entities, new training and tools, and a new mandate to find and enroll eligible individuals, both within their patient caseload and in the broader community. This case study examines the new roles of these entities in Kentucky and Montana, where the state PCA and health centers played an important role in their strong enrollment performance, and identifies promising strategies in their coordination with state Medicaid and insurance/exchange agencies.

The ACA extends health insurance coverage to people who lack access to an affordable coverage option. Under the ACA, Medicaid coverage is extended to low-income adults in states that have opted to expand eligibility, and tax credits are available for middle-income people who purchase coverage through a health insurance marketplace. Millions of people have enrolled in these new coverage options, but millions of others are still uninsured. Some remain ineligible for coverage, and others may be unaware of the availability of new coverage options or still find coverage unaffordable even with financial assistance. This analysis provides national and state-by-state estimates of eligibility for ACA coverage options among those who remained uninsured.