Health Reform Hub

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4/25/2013

CMS releases latest ACA FAQ

This set of FAQs addressed the federal match for maintenance and operation, communication between federally facilitated exchanges and Medicaid, and 1115 demonstrations.

pdf File CIB-04-25-2013.pdf [download]
 
 

4/23/2013

Consumer Assistance in Health Reform

Consumer Assistance in Health Reform outlines the need for hands-on consumer assistance, the resources available under the ACA to fill this need, and the implementation issues that may impact the effectiveness of consumer assistance efforts. It lays out specific situations, such as determining eligibility for subsidies, that may cause confusion for consumers; distinguishes between different sources of consumer assistance; and identifies factors that vary from state to state that could influence the effectiveness of these efforts.

 
 

4/23/2013

Navigator and In-Person Assistance Programs: A Snapshot of State Programs

Navigator and In-Person Assistance Programs: A Snapshot of State Programs provides additional details on some of the policy decisions states are making as they set up their programs, and briefly describes the programs in a few key states.

 
 

4/23/2013

Request Managed Care Technical Assistance

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the new Medicaid Managed Care Technical Assistance Center on Medicaid.gov. In collaboration with Mathematica Policy Research, Centers for Health Care Strategies, Manatt Health Solutions, and the National Committee for Quality Assurance (NCQA), CMS will provide individualized technical assistance to the states on managed care program operations, including planning and procurement, benefit design and serving the needs of complex populations, access and quality, and the use of data for program oversight and management. The Medicaid Managed Care Technical Assistance Center is part of CMS's larger efforts to provide comprehensive information and guidance on Medicaid managed care program operations.

 
 

4/23/2013

States' Medicaid ACA Checklist for 2014

This checklist prepared by the National Academy for State Health Policy (NASHP) highlights the ACA Medicaid requirements that will take effect in the next two years, nearly all of which will apply to states regardless of whether the state chooses to expand Medicaid eligibility. The checklist also highlights a few important optional provisions that states may want to consider as they plan for modernizing their Medicaid programs and complying with federal requirements. The checklist is divided into five domains of work for states' Medicaid programs: eligibility and enrollment; operations; financing; benefits; and consumer assistance.

 
 

4/22/2013

Key Considerations in Evaluating the ACA Medicaid Expansion for States

A central goal of the Patient Protection and Affordable Care Act (ACA) is to significantly reduce the number of uninsured by providing a continuum of affordable coverage options through Medicaid and new Health Insurance Exchanges. Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion. These decisions will have substantial consequences for health coverage for the low-income population.

 
 

4/22/2013

The Promise of Care Coordination: Transforming Health Care Delivery

There are many different definitions of care coordination, but all of them point to the same goal. At its core, care coordination is just what the name implies: a mechanism through which teams of health care professionals work together to ensure that their patients' health needs are being met and that the right care is being delivered in the right place, at the right time, and by the right person.

 
 

4/20/2013

How is the Affordable Care Act Leading to Changes in Medicaid Long-Term Services and Supports (LTSS) Today? State Adoption of Six LTSS Options

The Kaiser Family Foundation (KFF) has issued a policy brief that provides an overview of six key Medicaid Long Term Supports and Services (LTSS) options contained in the Affordable Care Act (ACA), and looks at ways states can implement these options. The report shows the majority of states have taken steps to implement at least one of the six options.

 
 

4/16/2013

AARP Public Policy Institute Reports on the 2/3 of States Integrating Care for Dual Eligibles

New research from AARP, NASUAD, and Health Management Associates finds that two-thirds of states either have or will launch new initiatives to better coordinate care for people who are dually eligible for Medicare and Medicaid services over the next two years. To contain the growth of costs and improve care, many are moving to risk-based managed long-term services and supports models. This research finds that a number of states are exploring approaches to dual services integration outside of the CMS models.

 
 

4/16/2013

An Independent Evaluation of the Integrated Care Program: Results from the First Year

The State of Illinois Department of Healthcare and Family Service (HFS) is implementing a pilot project for integrated care for Medicaid recipients who are disabled or older adults, known as the Integrated Care Program (ICP). A main goal of this program is to improve the quality of care and services that consumers receive and to do so in an efficient and cost-effective manner. The state has committed to an independent evaluation of the program, which is being conducted by the University of Illinois at Chicago (UIC), to determine the extent that these goals have been met. This evaluation considers qualitative and quantitative data from a variety of sources, including focus groups with stakeholders, a consumer satisfaction survey, analysis of Medicaid encounter and managed care organization (MCO) data, and stakeholder, MCO, and HFS meetings. The longitudinal consumer surveys include data from 181 participants at baseline and one year after ICP was implemented. The focus groups included 17 groups and 2 individual interviews with 110 consumers, caregivers, providers, MCO employees, and state employees. Results from the first year of the Integrated Care Program (May 1, 2011 to April 30, 2012) are summarized below.

pdf File An Independent Evaluation of the Integrated Care Program with logo (Narrative and Appendix).pdf [download]
 
 

4/16/2013

CMS Announces Opportunity To Apply for Marketplace navigator grants

The Centers for Medicare & Medicaid Services (CMS) announced the availability of new funding to support Navigators in Federally-facilitated and State Partnership Marketplaces. Navigators are individuals and entities that will provide unbiased information to consumers about health insurance, the new Health Insurance Marketplace, qualified health plans, and public programs including Medicaid and the Children�s Health Insurance Program.

 
 

4/16/2013

HHS Finalizes Rule Guaranteeing 100 Percent Funding for New Medicaid Beneficiaries

The Department of Health and Human Services (HHS) has announced a final rule, effective January 1, 2014, that the federal government will pay 100 percent of the cost of certain newly eligible adult Medicaid beneficiaries. These payments will be in effect through 2016 and will be phasing to a permanent 90 percent matching rate by 2020. States will claim the matching rates available for Medicaid expenditures of individuals with incomes up to 133 percent of poverty and who are enrolled in the new eligibility group.

 
 

4/16/2013

Kaiser Family Foundation Report on Medicare Health Plans for Dually Eligible Beneficiaries

Policymakers are debating how to improve the efficiency and effectiveness of health care for beneficiaries dually eligible for Medicare and Medicaid. The federal government and states are beginning to test ways to financially align Medicare and Medicaid benefits for beneficiaries served by both programs; some of these demonstrations will enroll dually eligible beneficiaries into capitated managed care plans for both their Medicare and Medicaid benefits, and many will be managed by some of the firms that also offer Medicare Advantage plans. Over the past few years, these firms have also seen a growth in enrollment of dually eligible beneficiaries into Medicare Advantage plans, Special Needs Plans (SNPs) in particular, and this growth, as well as changes in policies and requirements for SNPs focused on dual-eligible beneficiaries (D-SNPs), has caused some firms to more closely manage the care of their dual-eligible enrollees. In addition, the future role of D-SNPs has been debated.

 
 

4/16/2013

New Technical Assistance Center for States on Medicaid Managed Care

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the new Medicaid Managed Care Technical Assistance Center on Medicaid.gov. In collaboration with Mathematica Policy Research, Centers for Health Care Strategies, Manatt Health Solutions, and the National Committee for Quality Assurance (NCQA), CMS will provide individualized technical assistance to the states on managed care program operations, including planning and procurement, benefit design and serving the needs of complex populations, access and quality, and the use of data for program oversight and management. The Medicaid Managed Care Technical Assistance Center is part of CMS�s larger efforts to provide comprehensive information and guidance on Medicaid managed care program operations.

 
 

4/16/2013

Proposed Rules for Helping Consumers Navigate the New Health Insurance Marketplace

On April 3, The Centers for Medicare & Medicaid Services (CMS) released a proposed rule outlining standards that Navigators in Federally-facilitated and State Partnership Health Insurance Marketplaces must meet, and clarifying earlier guidance about the Navigator program. The proposed rule describes the role of Navigators--which are organizations designated to provide accurate and impartial assistance to consumers about their health insurance options, the new Health Insurance Marketplace, qualified health plans, and public programs including Medicaid and the Children's Health Insurance Program (CHIP).

 
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