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 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 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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