September 4, 2014

This week’s Finish Line Flash contains a slew of interesting pieces from open enrollment to improving provider networks. As the second open enrollment period is coming soon, we provide the State Health Reform Assistance Network’s lessons learned from the first open enrollment and Enroll America’s messaging framework to assist with the second open enrollment period. Health insurance literacy also plays an important roll in enrollment, as Enroll America finds in recent research. Medicaid expansion is still a hot topic, and the Urban Institute recently released a report detailing what is happening in states that have not expanded coverage. In addition to the pieces on coverage, we provide an interesting brief on communities of color and the additional challenges they face in terms of provider networks. Finally, we round out the Flash with an upcoming CCF webinar on the first look at how children and parents are faring under health reform, and the Urban Institute’s upcoming event on public spending trends on children.

Enrollment

Boosting Enrollment: Lessons Learned from 2013-2014 – The State Health Reform Assistance Network and Wakely Consulting interviewed staff at five different state-based marketplaces (Colorado, Connecticut, Kentucky, Rhode Island, and Washington) to learn how to improve uptake during the next open enrollment period. This report details observations from the five states and provides recommendations with each observation.

Messaging Framework for the Second Open Enrollment Period – In order to prepare for the second open enrollment period, Enroll America has developed a messaging framework targeting both the uninsured and those that need to renew coverage under one umbrella. The framework describes a unified messaging strategy and provides messaging recommendations so consumers “Get Covered. Stay Covered.”

Knowledge Is Power: Focusing on Health Insurance Literacy May Increase Health Coverage Retention – Enroll America teamed up with PerryUndem Research to conduct a national survey in 11 states to get a better understanding of why consumers did or did not take action to enroll in coverage. Their research finds that health insurance literacy plays a large part in enrollment. Enrolled individuals had higher levels of health insurance literacy than the remaining uninsured and had more confidence in their ability to pay premiums and renew coverage. Check out the report for more findings.

Medicaid

What is the Result of States Not Expanding Medicaid? – The big Medicaid expansion news is Pennsylvania’s approved waiver. But what’s happening in states that haven’t expanded coverage? The Urban Institute provides us with a timely analysis of what is happening to states that have not expanded Medicaid. The brief provides a state-by-state breakdown of federal funding lost, the number of uninsured who would otherwise qualify for coverage, and hospital reimbursement lost. The brief also touches on the effects of not expanding on state economies and budgets.

Provider Networks

Improving Private Health Insurance Networks for Communities of Color - Even with expanded health coverage from the ACA, communities of color continue to face obstacles in accessing health care to meet their needs. In this brief, Families USA delves into the barriers that people of color face, describes the components of an adequate provider network for communities of color, and outlines strategies to facilitate implementation of policies to achieve sufficient provider networks.

Upcoming Events

How Children and Parents are Faring under the Affordable Care Act – A First Look – Join Genevieve Kenney of the Urban Institute and Joan Alker of CCF for a webinar on the first published reports examining how coverage rates have changed for parents and children under health reform. The webinar is on Tuesday, September 9, 2014 at 2:00 pm ET. Please register here.

How Our Current Budget Priorities are Shaping Our Children’s Future – On Thursday, September 18 from 12:00-1:30 pm ET, the Urban Institute will host an event to discuss the Kids’ Share project, which delves into public spending on children. The panel will go into details about these trends and the future of childhood investments given other budgetary pressures. Registration is required for the event.

August 20, 2014

This week’s Finish Line Flash provides relevant information on Medicaid expansion, a compilation of questions for navigators, an explainer on QHP renewals, and a guide related to CHIPRA quality measures. For Medicaid expansion resources, we direct you to Families USA’s analysis on who would get covered if 10 states expanded coverage and a Robert Wood Johnson Foundation and Urban Institute report on the consequences of not expanding Medicaid. Next, we link you to CHIR and CCF’s compilation of questions for navigators and assisters. We also link you to a Wakely Consulting brief explaining the merits of encouraging enrollees to return to the marketplace for the next open enrollment period. We round out the Flash by providing an AHRQ guide for state officials on involving stakeholders in children’s health quality improvement.

Medicaid

Medicaid Expansion across Ten States — Families USA highlights the economic benefits of expanding Medicaid in 10 states and provides an insightful look into those who currently fall into the coverage gap. Families USA has examined data from Alabama, Florida, Indiana, Missouri, North Carolina, Pennsylvania, Tennessee, Texas, Utah, and Virginia.

Consequences of Not Expanding Medicaid — The Robert Wood Johnson Foundation and the Urban Institute provide an analysis of the consequences of not expanding Medicaid. The report finds that the 24 states not expanding Medicaid are foregoing $423.6 billion in federal funds from 2013 to 2022 and includes a state-by-state breakdown of each state’s lost funds. The report also analyzes the effect of non-expansion on coverage and hospital reimbursement. Head to Say Ahhh! to read Adam Searing’s blog post on the report.

Navigators

Compilation of Assister Questions – The Georgetown University Center on Health Insurance Reforms (CHIR) and Center for Children and Families (CCF) have compiled a list of pertinent questions from navigators and assisters. As part of a RWJF-funded project, CHIR and CCF provide technical assistance to navigators and assisters in five states. The questions included in this compilation are likely to be asked frequently and may be useful for assisters in any state.

QHP Renewals

QHP Renewals: Why Consumers Will Benefit from Shopping—This quick 4-page brief from Wakely Consulting explains why enrollees should be encouraged to shop for plans again in the next open enrollment period, even if their enrollment would be automatically renewed with no action on their part. Due to the FFM renewal process and the way premium tax credits are calculated, many enrollees could end up paying more than necessary if they don’t shop and choose a new plan. The brief makes recommendations for state insurance departments, marketplaces, and organizations assisting consumers for helping consumers take full advantage of the tax credits for which they are eligible.

Quality Improvement

Engaging Stakeholders in Children’s Health Quality Efforts—As part of its administration of the CHIPRA Quality Demonstration Grants, the Agency for Healthcare Research and Quality has produced a guide for state officials with best practices for involving stakeholders in quality improvement efforts.  The guide offers five major steps and associated tasks for defining, collecting, and assessing stakeholder input. A great resource to share with state officials who you want to encourage to engage more with outside stakeholders.

 

August 6, 2014

Though summer is going by in a flash, this week’s Finish Line Flash takes the time to provide important information and resources regarding CHIP, health reform, Medicaid, and upcoming events. Materials pertaining to CHIP include a CHIP and QHP comparison, a study on the relationship between premiums in Medicaid/CHIP and children’s retention in the programs, and a toolkit on communicating the success of CHIP to policymakers. In health reform resources, we supply new data from the Urban Institute on health reform’s impact on insurance rates, a handy guide for tax rules, and a look at quality improvement in state-based marketplaces. Finally, we round out this week’s edition with a review of the evidence on Medicaid beneficiaries’ use of emergency departments and an upcoming webinar addressing Medicaid and CHIP outreach to individuals with low literacy skills.

CHIP

CHIP/QHP Comparison—For many reasons—including considerations of CHIP’s future—it’s important to understand how CHIP coverage compares with qualified health plans available through marketplaces. First Focus, the Robert Wood Johnson Foundation, and Wakely Consulting have helped advance our understanding by completing a close comparison for 35 states. The full report from Wakely demonstrates how CHIP and subsidized QHP coverage differ in cost sharing and in coverage of core and child-specific services for families at two different income levels. An appendix includes side-by-side comparisons for each of the included states—definitely a valuable reference if your state is one of the 35. A summary from First Focus helps in highlighting key differences and looking at the national perspective.

Medicaid/CHIP Premiums and Children’s Coverage – As 33 Medicaid or CHIP programs charged premiums in 2013, it is essential to get a better understanding on how these premiums affect the retention of children. AHRQ researchers used 1999-2010 Medical Expenditure Panel Surveys (MEPS) data to show that the relationship between Medicaid/CHIP premiums and coverage rates varies by income level and parental access to employer-sponsored insurance. Researchers found that a $10 increase in monthly premiums reduces coverage for children with family incomes below 150% at a greater magnitude than children with incomes above 150% FPL. Parents’ access to employer coverage is another key factor in the rate of uninsurance for children.

August Recess CHIP and Open Enrollment Toolkit – August recess is an opportune time to reach out to your members of Congress as well as state policymakers. To help facilitate these conversations, Community Catalyst has created a toolkit on sharing open enrollment and CHIP successes. The toolkit provides tips on educating policymakers, encouraging supporters to speak out, and other tools for communicating supportive messages.

Health Reform Resources

The Remaining Uninsured as of June 2014 – The Urban Institute released June 2014 data from their Health Reform Monitoring Survey (HRMS), which takes a look at the remaining uninsured adults under health reform. Major findings include that, compared to data from September 2013, uninsured adults were more concentrated in states that did not expand Medicaid. Additionally, two thirds of uninsured adults in June 2014 had incomes at or below 138 percent of the FPL. The report covers more results on uninsured adults and includes interesting data breakdowns that show demographic differences and the reasons why some remain uninsured.

Guide to Tax Rules—For many of us, implementation of the ACA has led to a crash course in tax rules—the complex regulations on how dependents are determined, who is requited to file, and how income is counted across households have become key elements in health coverage determinations. The Center on Budget and Policy Priorities has assembled a helpful guide to tax rules relevant for health coverage. The guide can be a useful reference whether you are assisting consumers directly or just trying to keep all of these tax and household rules straight.

Quality Improvement in State-Based Marketplaces – The Commonwealth Fund published an issue brief describing actions taken in 13 state-based marketplaces to implement the Affordable Care Act’s initiatives to improve the quality of health plans. The issue brief focuses on three strategies to drive health plan quality: 1) using selective contracting to drive quality and delivery system reforms; 2) informing consumers about plan quality; and 3) collecting data to inform quality improvement.

Medicaid

Facts on Use of Emergency Departments by Medicaid Beneficiaries—MACPAC has published an issue brief that addresses several common beliefs related to Medicaid enrollees’ use of emergency departments. The authors review research findings that show Medicaid beneficiaries tend to use EDs more frequently than the privately insured and the uninsured. However, research also indicates that such use is most often for urgent problems, it is not clear that such use is increasing, and it is often because Medicaid beneficiaries struggle to access primary care elsewhere.

Upcoming Event

Outreach to Individuals with Low Literacy Skills Webinar – As low literacy serves as a barrier to enrolling in Medicaid or CHIP, CMS has organized a webinar on outreach and enrollment for individuals with low literacy skills. Part of the Connecting Kids to Coverage Campaign, the webinar will present research and practical experience from three presenters. It will take place on Wednesday, August 13 at 3:00 pm Eastern.

 

July 9, 2014

In the latest Finish Line Flash, we alert you to the challenges healthcare.gov users may face in resolving inconsistencies related to coverage applications and share a quick Q&A on premium tax credit reconciliation.  We pass along a study that links increased Medicaid premiums to reduced enrollment as well as a comparison of hospitals’ Medicaid billing in expansion versus non-expansion states. Finally, we link to two useful resources from NASHP—a map showing CHIP coverage for pregnant women and an upcoming webinar.

Health Reform Resources

Helping Consumers with Inconsistencies—This fact sheet from the Center on Budget and Policy Priorities aims to increase understanding of the ongoing process of resolving inconsistencies in some healthcare.gov applications.  It explains that consumers may face requests for additional information and could risk the loss of premium subsidies if they are not provided.  It also suggests ways assisters and outreach organizations can help consumers respond to these requests.

Reconciliation and Medicaid—The State Health Reform Assistance Network released a brief by Manatt Health Solutions experts that addresses two questions regarding reconciliation of premium tax credits and individuals with income in the Medicaid-eligible range.  The brief explains how reconciliation will affect those who receive advanced tax credits but whose year-end income is below the tax credit range.  It also discusses how questions remain for those who are determined eligible for Medicaid, but nonetheless enroll in QHPs without advanced tax credits.

Medicaid

Medicaid Premiums and Enrollment—A new study in the Journal of Health Economics reinforces the finding that Medicaid premiums depress enrollment.  The study examined Wisconsin’s premiums and concluded that an increase from $0 to $10 a month in premiums increased the likelihood of an individual leaving the program by 12-15 percent.  However, it found no or relatively small effects for other premium changes, such as from $10 to $29 a month.

Medicaid Expansion’s Impact on Hospitals—A short brief from the Colorado Hospital Association show the differences in payer mix for a sample of hospitals in Medicaid expansion states versus non-expansion states.  Looking at hundreds of hospitals across 30 states, the brief shows that, in expansion states, the number of Medicaid patients increased dramatically while the number of self-pay and charity care cases decreased.  No such change was observed in non-expansion states.  The brief can be helpful in making the case for expansion or for showing the value of your state’s choice to expand.

CHIP

CHIP Pregnancy Coverage—Does your state cover pregnant women in CHIP?  Does it use the state plan option, the unborn child option, or CHIPRA’s option to remove the five year waiting period for new immigrants?  How many were enrolled last year?  NASHP’s StateRefo(u)m has collected the answers to these questions for each state.  A new webpage shows 18 states and DC use one or more of the CHIP authorities to provide services to pregnant women and it outlines the covered services.

Upcoming Event

State Enrollment Efforts, Past and Future—NASHP will host a webinar on Tuesday, July 22, in which state officials will reflect on their efforts to enroll eligible individuals during the first open enrollment under the ACA and look forward to the next one.  Exchange, insurance, and Medicaid officials from Kentucky, Montana, and Washington will provide their perspectives and NASHP will share new findings from research on promising enrollment strategies.

 

June 18, 2014

This edition of the Finish Line Flash offers resources on Medicaid, CHIP and marketplace coverage.  A number of them come from government agencies—MACPAC’s new report provides a good summary of CHIP issues, while HHS crunched numbers on marketplace premiums and provides guidance for those new to using health coverage.  We also link you to the Children’s Dental Health Project’s look at CHIP’s future from an oral health perspective and two useful items from Community Catalyst—one on connecting consumers to coverage and another on Medicaid for former foster youth.

CHIP

CHIP and the New Coverage Landscape—The Medicaid and CHIP Payment and Access Commission recently released its June report to Congress.  The first chapter provides an excellent summary of the issues facing CHIP as the ACA is implemented and Congress considers how long to extend CHIP’s funding.  The chapter addresses questions such as CHIP’s actuarial value, covered benefits, and the effects of federal financing changes.  It’s a great reference for anyone who wants to get up to speed quickly on CHIP and its future.  The commission recommends that CHIP remain in place while issues like the family glitch, QHP cost-sharing levels, and network adequacy are addressed and improved for children.

Kids’ Oral Health at Stake in CHIP’s Future—The Children’s Dental Health Project released a brief that considers the potential impacts on access to oral health services if CHIP funding expires.  It finds that CHIP provides crucial affordability protections for working families that are not available in marketplace plans.

Health Reform Resources

From Coverage to Care—HHS has assembled a guide to using health coverage for those newly insured or unfamiliar with how coverage works.  Through written materials and short videos (many available in Spanish), it explains common insurance terms and walks through the steps to accessing appropriate care.

Enrollment and Premium Report—HHS released a report this week that examines the choices of plans consumers faced in federally facilitated marketplaces and what they are paying for the coverage they enrolled in.  In addition to presenting valuable basic information on the average size of premiums and tax credits, the report analyzes the effects of plan participation and finds that more competition can reduce premiums.  An appendix provides state-by-state data (for FFM states) on the average size and distribution of premiums.

Connecting Consumers to Coverage—Community Catalyst produced a report to highlight the efforts and best practices of consumer advocacy organizations in enrolling consumers during the ACA’s first open enrollment period.  The report identifies five essential strategies and shares stories from many states as it relates the successful efforts of many organizations to provide outreach, education, and enrollment assistance.

Medicaid

Coverage for Former Foster Youth—Community Catalyst also authored a brief on the opportunities and challenges for states in covering former foster youth in Medicaid.  It explains the ACA provision that authorizes their coverage, discusses the challenges for youth who aged out in a state other than where they currently reside, and offers lessons learned from a number of states.

 

June 4, 2014

This edition of the Finish Line Flash includes research and analysis on the value of health coverage and streamlined enrollment.  We point you toward a study linking kids coverage expansions to higher achievement in school, Tricia Brooks’ piece for Health Affairs looking ahead to the next open enrollment period, and research that shows the success of express lane eligibility in enrolling children.  We also pass along a helpful paper on network adequacy, updated state-level data from HHS on recent Medicaid and CHIP enrollment, and news of two webinars.

Medicaid & CHIP

Medicaid and School Completion—A new report from researchers at Harvard and Cornell Universities shows the effects of Medicaid expansions to children on kids’ long-run success in school.  The study finds that Medicaid expansions in the 1980s and 1990s had strong effects on educational attainment, increasing high school completion, college attendance, and bachelor’s degree attainment for groups of children who benefited from the expansions.  It also found that expansions translated into better health among teenagers.

ELE Increases Enrollment and Retention—Urban Institute experts measured the effects of express lane eligibility policies in eight states between 2007 and 2011.  They found that, as intended, ELE led to higher Medicaid enrollment among children as well as higher combined Medicaid and CHIP enrollment.  ELE boosted a state’s enrollment of kids between 4 and 7.3 percent.

Latest HHS Medicaid & CHIP Enrollment Report—HHS this week released the latest in its series of reports that share state data on total combined Medicaid and CHIP enrollment.  The report compares enrollment levels in April 2014 with each state’s monthly average for July-September 2013.  Enrollment levels vary by state, but several Medicaid expansion states show increases of over 30%.  You can also check to see how many applications and Medicaid/CHIP determinations your state reported to HHS.

Health Reform Resources

Regulating Plan Networks—Georgetown’s Center for Health Insurance Reforms partnered with Urban Institute scholars to describe and analyze the issues around narrow health plan networks.  They show how regulators must balance the breadth of networks with premium costs and call for more transparency and meaningful consumer choice around networks in ACA plans.  The brief paper is a great introduction to an issue that will likely receive more and more attention going forward.

Open Enrollment, Take Two—Tricia Brooks’ piece in the newest issue of Health Affairs reviews the challenges of the first ACA open enrollment period and outlines the improvements that would help the next open enrollment serve families more effectively.  She discusses Medicaid and CHIP coordination, renewals, outreach, consumer assistance, and more.

Upcoming Events

NASHP Oral Health Webinar—The National Academy for State Health Policy will hold a webinar exploring promising strategies for providing children in Medicaid with the oral health services they need.  Federal and state officials will speak on addressing challenges such as provider shortages and measuring quality.  The webinar will take place on Wednesday, June 18 at 2:00 pm Eastern.

Enroll America Webinar—Enroll America will host a webinar to review the results of polling it commissioned to explore the experiences of those who did and did not sign up for coverage during open enrollment.  Click the link to register for the webinar, which will be on June 10 at 11:00 am Eastern.

 

May 21, 2014

This week’s Finish Line Flash covers a range of relevant kids coverage topics—CHIP, Medicaid, qualified health plan coverage, and eligibility and enrollment.  First, we link you to Enroll America’s new report on families’ experiences in signing up for ACA coverage.  Next, we point you toward Gene Lewit’s look at CHIP’s lessons for ACA enrollment.  Families USA studied silver QHPs to identify consumer-friendly cost-sharing features.  And a brief from the Corporation for Supportive Housing identifies ways Medicaid can finance supportive housing.  Finally, we alert you to a webinar that is part of the Connecting Kids to Coverage campaign.

Health Reform Resources

Enrollment Experiences—Enroll America engaged PerryUndem to research the impressions of those who enrolled in coverage during open enrollment as well as those who did not.  The report provides insight into why some enrolled and others did not, the level of satisfaction with the enrollment process, and differences among demographic groups.  The polling provides valuable information not just for reviewing the first open enrollment period, but for planning the next.

CHIP Lessons for ACA—First Focus released the latest in its series of briefs from Gene Lewit on ways CHIP can inform ongoing enrollment activities.  This brief considers outreach strategies tested in Medicaid and CHIP and draws lessons for connecting with hard-to-reach populations, sharing data from other means-tested programs, and improving retention.

Finding Silver Plans with Affordable Cost Sharing—Families USA studied silver qualified health plans to find examples of plans that do not require enrollees to pay thousands of dollars in costs before the plan begins paying for medical services.  They found several plan designs that had no deductible or that exempted certain services from the deductible.  The brief suggests strategies for bringing more plans with affordable upfront cost-sharing to the marketplaces.

Medicaid

Using Medicaid to Finance Supportive Housing—A range of services can improve health, including access to supportive housing.  The Corporation for Supportive Housing produced a brief that suggests ways to integrate housing into state Medicaid policy.  It considers some of the challenges to using Medicaid funds for supportive housing services but also highlights activities in several states where Medicaid funds have successfully been accessed to provide services and make investments.

Upcoming Event

Connecting Kids to Coverage Webinar—The campaign will host a webinar tomorrow, May 22, on enrolling vulnerable youth, including those who experience homelessness or who receive foster care.  The webinar will feature speakers from multiple federal agencies as well as advocates and will be held on Thursday between 2:00 and 3:30 Eastern.

May 7, 2014

This edition of the Finish Line Flash contains a variety of resources on CHIP and marketplace plans, with a focus on costs and coverage for consumers.  First, we assure that you have the link for the new report CCF released jointly with the National Academy for State Health Policy on benefits and cost sharing in separate CHIP programs.  We also highlight a new database you can check to find cost sharing information on the marketplace plans in your state.  Another NASHP report lays out the various issues with dental coverage in marketplaces and Enroll America gives an early look at its experiences enrolling consumers in coverage.

CHIP Benefits and Cost Sharing—CCF and the National Academy for State Health Policy partnered to review the benefits and cost sharing in separate CHIP programs across the country.  Looking at 42 separate programs in 38 states, the new report shows benefit coverage, limits, and cost-sharing amounts in a way that allows for consistent comparisons across states.  An appendix includes a table for each covered state which can serve as a helpful starting point in comparing coverage and cost to families in CHIP to that in qualified health plans in your state.

New Info on Marketplace Premiums and Cost Sharing—The Robert Wood Johnson Foundation has published a dataset known as Health Insurance Exchange Compare.  It contains data on virtually all of the health plans offered through marketplaces across the country.  It details premiums for certain family scenarios and the cost-amounts for plans in each rating area.  Complete and comparable information on cost sharing in QHPs has been hard to come by, so this resource may be helpful in gathering in one place the cost sharing amounts for your state’s QHPs.  It does not, however, include information on cost-sharing amounts in silver plan variations offered to those who qualify for cost-sharing reductions.

Dental Benefits in Marketplaces—NASHP has produced a report that outlines several interrelated issues that affect how dental benefits are provided to those who buy health coverage through marketplaces.  The report considers the challenges surrounding benefit design, affordability, and the consumer experience of purchasing coverage.  It suggests several actions states can consider to address some of the barriers to dental coverage both for children and adults.

Enroll America Reports on Early Lessons—Enroll America released a report describing its activities between November and February and drawing some lessons.  Particularly interesting is the information presented on consumers’ enrollment experiences.  For those Enroll America was able to follow up with ,the report shows how many consumers attempted to enroll in coverage, how many succeeded, what barriers they faced, and what type of assistance they preferred.  The information can be useful in advocating for continued enrollment assistance.

 

April 23, 2104

In this edition of the Finish Line Flash, we include a new report on state trends on children’s coverage from the State Health Access Data Assistance Center and a brief from the National Health Law Program that reviews the literature on premiums and cost sharing in Medicaid. Our picks for health reform resources include a new database from the Center on Budget and Policy Priorities that tracks marketplace decisions and a table from Enroll America that explains which consumers qualify for an exemption from the individual mandate and how to claim it.

 Children’s Coverage

 State Trends in Children’s Coverage from SHADAC—The State Health Access Data Assistance Center published a range of information on children’s coverage in 2012.  Like CCF’s annual report on coverage rates, it is based on data from the American Community Survey from the Census Bureau.  SHADAC provides information for each state on coverage variation by income and by race and ethnicity.  It also helpfully provides a two-page fact sheet for each state. You can also find an overview of the report, including graphics, in the Washington Post.

Medicaid

Premiums and Cost Sharing—This guide from NHeLP reviews literature from the last four decades on the impact of premiums on cost sharing on enrollment, service utilization, and health status. It also discusses the flexibility that Medicaid law gives states to establish premiums and cost sharing, highlighting changes brought about by new cost sharing regulations and the legal and policy ramifications of proposals by some states to charge beneficiaries even higher cost sharing and premiums.

Health Reform Resources

CBPP Collects States’ Marketplace Decisions—The Center on Budget and Policy Priorities has compiled information on the many policy and implementation decisions made by states that operate their own marketplaces or that partner with the federal government.  The database allows easy access and comparison of state decisions related to eligibility and enrollment, consumer assistance, plans offered, and much more.  It is a valuable resource for checking how other states have handled a marketplace decision that your state may be facing.

Who Qualifies for an Individual Mandate Exemption and How to Claim It—Enroll America created an easy to use table for assisters and other stakeholders to explain which individuals without coverage may be subject to the individual mandate. It also provides information on how those that qualify for an exemption from the mandate may obtain one.

Upcoming Events

Reminder: Georgetown CCF webinar on Benefits and Cost Sharing in Separate CHIP Programs—Our webinar on Wednesday, May 7, 2014 from 1:30-2:30 p.m. EDT will highlight findings from a forthcoming report Georgetown CCF co-authored with the National Academy for State Health Policy (NASHP). The report examines the covered benefits, limitations, and premium and cost-sharing provisions of separate CHIP programs. This analysis can inform state and national policymakers and stakeholders about the scope of benefits and cost sharing requirements in separate CHIP programs in advance of the Secretary’s comparability determination and as the role of CHIP is considered in the changing health insurance landscape.

April 9, 2013

In this edition of the Finish Line Flash we highlight several new studies on health reform, including two new surveys that estimate the decline in uninsured adults over the last several months and another that investigates access to care for new patients. We also include a brief on how to facilitate seamless health coverage for juvenile justice-involved youth and a Health Affairs blog post on the importance of continuous coverage. Finally, we bring you news of an upcoming webinar from the National Academy for State Health Policy (NASHP) that will discuss state efforts to measure performance of their health coverage programs.

Health Reform Resources 

First Looks at Changing Rates of Insurance Coverage – This past week, the results of two surveys that measured changes in the number of uninsured were released. RAND’s Health Reform Opinion Survey estimated that 9.3 million adults gained health insurance through employer-sponsored insurance, Medicaid, or the health insurance marketplaces. The Urban Institute’s Health Reform Monitoring Survey indicated that approximately 5.4 million adults gained insurance. The surveys are closer in their estimates of the uninsured rate just prior to the end of open enrollment: 15.8% (RAND) v. 15.2% (Urban Institute). While both surveys tracked changes in insurance from September 2013 to March 2014, their differing end dates present one reason for the different estimates.

Availability of Primary Care Appointments by Coverage Source
  – A new study from the University of Pennsylvania and the Urban Institute compared the ease with which privately insured, Medicaid covered, and uninsured “patients” were able to get appointments when calling primary care providers for a first time appointment. Callers who said they had Medicaid were less likely than the privately insured to be able to receive a first time appointment, but much more likely than callers who said they were uninsured and seeking low-cost appointments. Urban also released an issue brief with additional context and our colleague Martha Heberlein wrote a great blog post for Say Ahhh! delving deeper into the research and its implications for access to care in Medicaid.

Facilitating Access to Health Coverage for Juvenile Justice-Involved Youth – The goal of the ACA is to provide seamless access to coverage for millions more people. However, this can be more difficult to realize for populations with complex situations. This report from NASHP outlines federal and state eligibility, enrollment, and outreach strategies that have helped to facilitate seamless access to care for juvenile justice-involved youth. Included are examples from states (including several from the Finish Line project: Colorado, Oregon, Ohio, and Texas) that have successfully implemented Medicaid options to ease community reentry for these youth.

Medicaid 

The Case for Continuous Eligibility in Medicaid – This Health Affairs blog post from Paul Cotton, Director of Federal Affairs at the National Committee for Quality Assurance, discusses how less than 12-months of continuous coverage can increase coverage costs and negatively impact quality measurement and improvement efforts.  Providing links to many sources of supporting evidence, Cotton argues that policies to reassess Medicaid eligibility more frequently than once per year were created to save money, but have had the opposite effect. He concludes by endorsing federal legislation that has been introduced to require 12-month continuous eligibility.

Upcoming Events

Measuring State Health Coverage System Performance – This webinar will explore how states are using data to measure performance in their coverage programs and opportunities for leveraging data to support broader health reform goals. Panelists will include state officials from California and Connecticut, as well as an expert from the State Health Access Data Assistance Center (SHADAC). Genevieve Kenney of the Urban Institute will moderate. The webinar will take place on Wednesday, April 23, 2-3:30pm EDT.

March 26, 2014

This edition of the Finish Line Flash includes a multitude of resources for advocates. Our picks for Medicaid and CHIP resources include a toolkit from Community Catalyst to help advocates engage on issues around coverage churn, as well as the latest data on Medicaid and CHIP participation rates for children. The health reform resources we highlight include a toolkit for state department of insurance consumer service representatives from the Georgetown University Center on Health Insurance Reforms, a plan comparison worksheet for consumers from the Center on Budget and Policy Priorities, and a brief from the National Health Law Program on premium assistance. We also include news of two upcoming webinars. The Child and Family Policy Center (CFPC) and the BUILD Initiative will discuss healthy early childhood development.  The State Health Access Reform Evaluation (SHARE) network will explore the issue of care utilization patterns among childless adults.

Medicaid and CHIP

Toolkit to Stabilize Coverage for Children and Families – Community Catalyst created this toolkit for advocates to understand the scope and causes of churn within their state’s Medicaid/ CHIP Program.  Among the resources are a questionnaire designed to help identify churn data, a list of policy approaches to reduce churn, and success stories from states that have taken efforts to reduce churn.

New Medicaid and CHIP Participation Rates Released – In an update of data we’ve shared for past years, Medicaid and CHIP participation rates for children in 2012 are now available for all 50 states and Washington D.C. on InsureKidsNow.gov. Nationally, the participation rate was 88.1 percent.

Health Reform Resources 

DOI Consumer Service Toolkit – The Center on Health Insurance Reforms at the Georgetown University Health Policy Institute created this toolkit for the State Health Reform Assistance Network. It is designed to aid consumer service representatives (CSRs) at state departments of insurance as they work in real time with consumers. It includes four tools: a reference manual that covers topics ranging from insurance basics to notice requirements, a glossary, a benefits template to help CSRs crosswalk state mandated benefits with ACA essential health benefits, and a reference table that illustrates the applicability of ACA provisions to grandfathered and self-funded plans. Advocates can use the toolkit to educate themselves and can also encourage its use by their state’s Department of Insurance Consumer Services Division.

Marketplace Plan Comparison Worksheet – The Center on Budget and Policy Priorities developed this worksheet to assist consumers as they sort through their plan options in the marketplace. It considers cost sharing, providers, and also includes definitions of important insurance terms.

Medicaid Expansion and Premium Assistance – This brief from the National Health Law Program (NHeLP) answers some of the key questions raised by expanding Medicaid with a premium assistance model. The brief explains premium assistance, its benefits and challenges, and why the models approved to date in Arkansas and Iowa are problematic. As a reminder, NHeLP also has a Medicaid Expansion toolbox that includes resources on litigation, federal guidelines, issues and advocacy, and more.

Upcoming Events

Healthy Early Childhood Development – This webinar produced by the Child and Family Policy Center (CFPC), a Finish Line alum, and the BUILD Initiative will focus on the importance of using a health equity lens in efforts to promote early childhood development. This webinar will provide an overview of research in this area and then explore where states are in developing effective policies and practices in early childhood to ensure health equity. The session will assist CFPC and BUILD in further developing ideas to establish a Learning Community on Health Equity and Young Children which can support state leaders to improve results and reduce disparities in children’s healthy development. The webinar will take place on Monday, April 7, 2014 from 2:00 – 3:30 p.m. ET.

Demand for Care Among Low-Income Childless Adults – The State Health Access Reform Evaluation (SHARE) network will host this webinar to discuss the demand for services that states might expect to see after expanding coverage to low-income childless adults. Dr. DeLeire of Georgetown University will present the findings from the evaluation that he is leading on utilization patterns among Wisconsin’s BadgerCare Core Plan Enrollees.  The webinar will take place on Friday, March 28, 2014 from 12:00 – 1:00 p.m. ET.

March 12, 2014

This edition of the Finish Line Flash includes resources for consumer assistance and ACA implementation. Consumer assistance resources we recommend include a guide from the Children’s Dental Health Project and Families USA on choosing children’s dental coverage, a series of consumer assistance guides from Manatt Health Solutions, and a new website from the Robert Wood Johnson Foundation. Under ACA Implementation resources we suggest a brief from Health Reform GPS on the recent CMS guidance on retroactive premium tax credits (PTCs) and cost-sharing reductions (CSRs), a report from the Urban Institute on the financial impact of Medicaid expansion in selected states, and a new resource from SHADAC on marketplace enrollment data.

Consumer Assistance Resources

Consumer Guide for Choosing Children’s Dental Coverage – The Children’s Dental Health Project and Families USA produced this list of frequently asked questions (FAQs) to help parents understand how the children’s dental benefit works in marketplace plans. The FAQs range from which dental services health plans cover to figuring out which dental coverage option is more affordable.

Consumer Assistance Resource Guides – Manatt Health Solutions prepared a series of consumer assistance resource guides for the State Health Reform Assistance Network. The series is intended to help educate those who are working directly with consumers as they sign up for coverage.  It includes a guide on each of the following topics: minimum essential coverage, household composition eligibility rules, MAGI household income rules, and immigrant eligibility.

Financial Help for Health – This new website from the Robert Wood Johnson Foundation is broken down into three components: Real Numbers, Real Stories, and Real Coverage. Real Numbers illustrates how much one might pay or save in health costs by using examples of consumers from around the country; it also includes a link to the Consumer Reports tool for premium tax credits. Real Stories connects the user to videos with positive consumer stories. The Real Coverage section connects users to either healthcare.gov or a state-based exchange depending on where the user lives.

ACA Implementation

Guidance on Retroactive PTCs and CSRs – This brief from Health Reform GPS addresses the bulletin issued by CMS on February 27, 2014, regarding retroactive advance payments of premium tax credits and cost sharing reductions in 2014 due to exceptional circumstances. It explains why the guidance was issued, poses questions raised by the guidance, and suggests how those questions might be answered. The questions addressed include whether the retroactive enrollment period is mandatory, if it includes individuals who were unable to file completed applications, and what is the time frame for retroactive determinations.

Marketplace Enrollment Reports – The State Health Access Data Assistance Center (SHADAC) created a repository of marketplace enrollment reports. It includes enrollment reports issued by the Assistant Secretary for Planning and Evaluation (ASPE) at HHS as well as from states operating their own State-Based Marketplace (SBM).  SHADAC uses the data from SBMs to create info graphics, which are also housed here. It is a useful resource for pulling together the latest available data from different sources.

Financial Impact of the ACA on Selected States – The Urban Institute recently released a series of reports that look at the launch of the ACA, comparing a selection of states that have embraced the law to those that have actively opposed it.  This particular report examines the changes in federal and state expenditures under full implementation of the ACA for eight states (CO, MD, MI, MN, NY, OR v. AL and VA). The report concludes that states expanding Medicaid will receive a larger influx of federal dollars than those that do not. Maryland, New York, and Oregon will also see a reduction in their state spending on Medicaid in the short term, while Maryland and New York will continue to see a reduction through 2022.

February 26, 2014

This edition of the Finish Line Flash includes two briefs from NASHP. The first showcases ideas for state and federal collaboration on consumer assistance. The second NASHP brief discusses the results of states’ efforts to simplify enrollment as a result of participating in the Maximizing Enrollment project. It is followed by map resources from Enroll America and Georgetown CCF to target enrollment efforts among the uninsured. We also share a brief from Enroll America on strategies to implement hospital presumptive eligibility and resources for advocates on network adequacy that were developed by Community Catalyst.

Health Reform Resources

Tips for Strengthening Consumer Assistance – This brief from NASHP explores three key areas in which states using the Federally Facilitated Marketplace (FFM) or State Partnership Model (SPM) are sharing the responsibility of consumer assistance: marketing and advertising, the work of navigators and in-person assisters, and the development of a system for appeals of eligibility determinations. The case studies from Arkansas, Illinois, Kansas, Montana, Nebraska, New Hampshire, and South Carolina illustrate how states can work within the existing structure to strengthen consumer assistance.

Simplifying Enrollment and Renewal – This NASHP report, supported by the Robert Wood Johnson Foundation’s Maximizing Enrollment project, explores the results of states’ efforts to update applications, harness existing data to make eligibility determinations, simplify renewals and transfers, make notices more readable, and improve business processes. Other states can learn from the experiences of the Maximizing Enrollment project as they move forward with implementing eligibility and enrollment simplifications required by the ACA.

City and County Maps of the Uninsured and Enrollment Assisters – Enroll America developed maps for cities with high populations of the uninsured. The maps indicate areas with high-densities of the uninsured, as well as resources for enrollment assistance within those areas. The maps combine data collected by Enroll America and the Department of Health Human Services (HHS). Also, CCF’s Tara Mancini used Google maps to plot county data from the American Community Survey on uninsured kids.

State Approaches for Hospital Presumptive Eligibility – Hospital Presumptive Eligibility is one of the tools created by the ACA to connect children and pregnant women to Medicaid coverage.  While it is too early to tell what impact HPE has had on Medicaid coverage, this Enroll America brief discusses promising approaches emerging out of collaboration between hospitals and state Medicaid agencies (including California, Pennsylvania, Iowa, and Virginia).

Resources on Network Adequacy – Community Catalyst created a toolkit to guide consumer advocates on the issue of network adequacy, that is the ability of a health plan to give enrollees timely access to in-network providers and important health care services.  The toolkit includes information on what advocates need to know about network adequacy, network adequacy principles, talking points for advocates to educate policymakers, and advocacy strategies.

February 12, 2014

In this edition of the Finish Line Flash, we bring you news of an HHS report detailing the large share of uninsured Latinos who are eligible for subsidized coverage under the Affordable Care Act (ACA).  It is followed by a report from the National Academy for State Health Policy (NASHP) that describes states’ challenges during open enrollment and their work around strategies. Next is a brief from the Center for Health Care Strategies, Inc. that discusses key state considerations to mitigate churn. We also highlight a new brief from the Kaiser Family Foundation on Section 1115 Medicaid waivers and an Enroll America webinar on enrollment outreach strategies.

Health Reform Resources

Eighty Percent of Eligible Uninsured Latinos Qualify for Subsidized Coverage –– Yesterday, the Department of Health and Human Services (HHS) released a report finding that nationally, 8 in 10 uninsured Latinos may qualify for Medicaid, the Children’s Health Insurance Program (CHIP), or lower costs on monthly premiums through the Health Insurance Marketplace. That share would rise to nearly 95% if all states expand Medicaid.  The report provides a breakdown of demographic characteristics of eligible uninsured Latinos nationally and also the number of eligible Latinos by state.

Early State Experiences with Open Enrollment –– This new NASHP report, supported by the Robert Wood Johnson Foundation’s Maximizing Enrollment project, describes states’ experiences with implementing enrollment systems during the first three months of the ACA’s inaugural open enrollment period. It considers enrollment implementation challenges including consumer education and assistance, application and enrollment, and Medicaid and open enrollment. The early challenges and state work-around strategies may prove instructive for future enrollment efforts.

Minimizing Churn Between the Marketplace and Medicaid –– This brief from the Center for Health Care Strategies, Inc. discusses how the range of coverage options under the ACA may complicate the issue of churn. States can mitigate churn and this brief explains some of the key steps to do so, such as understanding which populations are more likely to churn and leveraging health plan contracting. The brief also highlights select state experiences with these techniques.

The ACA and Recent Section 1115 Medicaid Demonstration Waivers – The expansion of Medicaid under the ACA allows states to expand coverage to adults without obtaining a waiver, but states may wish to continue to utilize them. This brief from the Kaiser Family Foundation explains how the implementation of the ACA changes the use of Section 1115 waivers. Post-ACA, states seeking 1115 waivers fall into two groups, those that seek to tailor the ACA Medicaid expansion while still receiving federal matching funds for newly eligible adults, and those that want to maintain coverage that was in place prior to the ACA, but do not qualify for enhanced federal funding.  The brief also provides an overview of the key 1115 waiver provisions that CMS has and has not approved.

Upcoming Events

Outreach Ideas from Enroll America—Enroll America will host a webinar on February 19 at 4:00 pm Eastern.  It will highlight several outreach strategies to use right away to reach uninsured consumers, including working with community colleges, conducting a phone-a-thon, engaging faith communities, getting earned media coverage, and running an effective enrollment event and how to get support.

January 29, 2014

This edition of the Finish Line Flash includes a bevy of health reform resources. First, we include a brief from the Urban Institute on how the ACA market reforms are impacting individuals and families. Next is a report from the Bookings Institution on how the ACA has the potential to reduce income inequality. That is followed by a Say Ahhh! blog post on why risk corridors are a necessary component of the ACA.  Finally, we include a brief and an upcoming webinar from the National Academy for State Health Policy (NASHP). The brief provides an overview of Medicaid trainings for consumer assisters in federally facilitated marketplace states and the webinar will cover how some states are working to improve EPSDT.

Health Reform Resources

Early ACA Market Reforms
 – This brief is one of the first in a series from the Urban Institute’s Health Reform Monitoring Survey that examines the effects of the Affordable Care Act. This particular brief explores whether survey respondents or their families have benefited from seven early market reforms, including access to coverage for children with pre-existing conditions and expanded access to coverage for young adults. Responses are also broken out by poverty level. Overall, 41.3% of respondents note that they or their family have benefited from at least one of the ACA market reforms.

Can the ACA Reduce Income Inequality? – Yesterday, the Brookings Institution released the preliminary results from its study that examines the impacts of the ACA as of 2016 on income. The authors suggest that the ACA “[M]ay do more to change the income distribution than any other recently enacted law.” By defining income as wages plus the fungible value of employer and public health insurance, those with income in the bottom 30 percent will feel most of the effect. Workers in the bottom second and third decile see gains in income. However, those in the bottom 10% actually see a loss when accounting for the small number who switch from an employer-sponsored plan to Medicaid, as the fungible part of government and employer sponsored contributions are counted differently. See table 5b for a closer look.

Risk Corridors Are Not Bailouts for Insurance Companies – Georgetown University Health Policy Institute researcher Jack Hoadley explains in a Say Ahhh! blog post why repealing risk corridors, as Sen. Rubio has proposed, would be a bad idea. Risk adjustment, reinsurance, and risk corridors (or the “3 Rs” included in the ACA) are modeled after the success of such components in the Medicare Part D program. Moreover, “In contrast to the view that risk corridors are a means of bailing out plans, the experience in Part D suggests that they have actually protected the taxpayer,” Hoadley writes.

Medicaid Training for Marketplace Assisters – This brief from NASHP provides an overview of federally developed Medicaid training for Marketplace assisters. It also summarizes state-specific trainings that have been developed in Arizona, Illinois, Montana, and South Carolina to provide assistance to federal Marketplace assisters and/or traditional Medicaid staff.

Upcoming Events

Improving Care Delivery for Children in Medicaid – NASHP will host a webinar on Wednesday, February 5th from 3:00-4:30 pm (EST) to explore how Washington D.C., Iowa, and Minnesota are working to improve service delivery under Medicaid’s Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit. Specifically, the discussion will focus on efforts to better coordinate care, collect data for quality improvement, and enhance access and delivery of behavioral health services for children.

January 8, 2014

This is the first edition of the Finish Line Flash for 2014 and we hope everyone’s New Year is off to a great start. Below we share a report from the Government Accountability Office that compares CHIP and private plans on benefits, affordability, and access. It is followed by news of a FAQ from the Centers for Medicare and Medicaid Services that addresses three Medicaid and CHIP eligibility and financing issues. Our picks for health reform resources include two new products from the Kaiser Family Foundation. The first is a set of fact sheets explaining how the ACA will impact the uninsured in each state. The second is a report that examines the causes and consequences of medical debt and what the ACA can and cannot do to prevent or reduce it. Finally, we alert you to the Center on Budget and Policy Priorities’ upcoming Beyond the Basics webinar.

Medicaid and CHIP

GAO Compares CHIP, Private Plans—The Government Accountability Office (GAO) in December released a study that takes an initial look at the benefits, affordability, and access in CHIP compared to private plans.  It examined benefits and costs to families in five states and analyzed nationwide data on access from the Medical Expenditure Panel Survey for the years 2007 through 2010.  GAO concluded that, in the five states, the benefits in CHIP were generally comparable to those in the private plans that serve as the states’ EHB benchmarks, while CHIP was almost always more affordable for families.  CHIP families’ reports of their access to care was similar in CHIP and private plans, but their reported use of some providers like orthodontists and emergency departments varied somewhat.  Because it covers only five states and was completed before full information became available for 2014 qualified health plans, the study offers a useful but limited preview of the assessment of comparability between CHIP and QHPs that the Secretary of HHS is required to perform by April 2015.

CMS Issues FAQ on Medicaid and CHIP Issues—Just before the New Year, CMS published a FAQ document on three Medicaid and CHIP eligibility and financing issues.  The document answers questions and makes clarifications on how states can claim federal funds for the Medicaid expansion population, on Medicaid eligibility for individuals who age out of foster care, and on financing for CHIP, including when the enhanced CHIP match rate applies to costs for children who may switch between Medicaid and CHIP due to ACA changes.

Health Reform Resources

How Will the Uninsured Fare in Your State? – The Kaiser Family Foundation released a set of fact sheets detailing how the ACA will expand coverage in each of the 50 states and the District of Columbia. Each state profile explains the expanded health insurance options and also estimates the share of uninsured individuals who fall into the following groups: Medicaid eligible adults, Medicaid/CHIP eligible children, individuals eligible for tax credits, individuals with ESI or unsubsidized marketplace coverage, and those who are not eligible due to their immigration status.

Medical Debt Among the Insured – This report, authored by researchers at the Kaiser Family Foundation and the Georgetown University Center on Health Insurance Reforms, examines the common causes and consequences of medical debt.  The report draws on case studies with 23 individuals who experienced medical debt to find that high cost-sharing is a primary factor, while the consequences range from damaged credit and emotional distress to depleted long term assets and difficulty accessing care.  Also discussed in the report are the many new protections under the ACA that may prevent or reduce the likelihood of medical debt, as well as some of the causes that will remain, such as high cost-sharing and limits on Essential Health Benefits.

Upcoming Events

CBPP Schedules Next Beyond the Basics Webinar—The Center on Budget and Policy Priorities will hold the next Beyond the Basics webinar on marketplace applications on Wednesday, January 15 from 2:00-3:30 Eastern.  For those who have not yet joined a BtB webinar, they provide high quality, detailed, and accessible training on ACA eligibility and enrollment topics.

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