2013 Finish Line Flash Editions

By Tara Mancini

December 4, 2013

This edition of the Finish Line Flash brings you several resources related to outreach and enrollment under the ACA and dental benefits in Medicaid. The first is a brief from the American Dental Association that compares rates of child dental utilization between Medicaid and commercial plan enrollees. It is followed by a brief from the Center for Studying Health System Change that explores ways to expand dental benefits to the Medicaid expansion population. Next is a brief co-authored by the Kaiser Commission on Medicaid and the Uninsured (KCMU) and Manatt Health Solutions that examines the experiences of states that have implemented CMS’ “fast track” enrollment options. Finally, we bring you news of three upcoming events; a webinar hosted by the National Academy for State Health Policy (NASHP) that will consider states’ early experiences with open enrollment; a National Covering Kids and Families webinar to focus on outreach strategies during the cold and flu season; and finally a live webcast co-hosted by the Urban Institute and NASHP’s Maximizing Enrollment program that will highlight states’ innovations in enrollment strategies as a result of participating in the program.


State Data on Variation in Child Dental Care Utilization between Medicaid and Commercial Plan Enrollees – This brief from the American Dental Association examines data for all 50 states and DC on the percentage of children ages 0-20 continuously enrolled in a dental plan for 90 days or more to compare dental visits for commercial plan enrollees and Medicaid enrollees. Although commercial plan enrollees have a higher average utilization rate (58.1%) than Medicaid enrollees (44.4%) nationwide, the disparity varies by state. In four states (Texas, Oklahoma, Hawaii and Oregon), Medicaid enrollees had higher rates of dental care utilization than commercial plan enrollees and in other states the rate was roughly comparable. The data show which states can serve as models for reaching parity in dental access and which have the most work to do, both for Medicaid and commercial plans.

Strategies to Improve Dental Benefits for the Medicaid Expansion Population – This brief from the Center for Studying Health System Change looks at states expanding Medicaid and their decision-making process around dental coverage for the expansion population. These states are taking several measures to ensure dental access to the expansion population, including the tailoring of outreach strategies, engaging oral health stakeholders, exploring financial and non-financial incentives for providers, and consideration of opportunities to expand the dental workforce. The brief can inform other states as they consider whether and how to offer dental benefits.

Fast Track to Coverage: Facilitating Enrollment of Eligible People into the Medicaid Expansion – This brief from KCMU and Manatt Health Solutions provides an overview of the new “fast track” enrollment options available to states to provide coverage to newly eligible adults. Based on a series of interviews with state officials in the four states that have implemented these enrollment strategies (Arkansas, Illinois, Oregon, and West Virginia), the brief covers how the states implemented the enrollment options, their impacts, and key lessons learned.

Upcoming Events

Webinar on State Experiences with Open Enrollment – On Thursday, December 5, 2013, from 2:30 – 4:00 p.m. Eastern, NASHP will host a webinar to discuss states’ early successes and lessons learned thus far from open enrollment, with particular attention to outreach and messaging as well as operational and systems performance. Panelists will include state officials from Illinois, Washington, and South Carolina, as well as experts from NASHP.

Connecting Kids to Coverage National Campaign Webinar – On Thursday, December 12, 2013 from 2:00 p.m. to 3:00 p.m. Eastern, CMS will host this webinar as part of its Connecting Kids to Coverage National Campaign. During the webinar, staff plan to discuss ways to enrich outreach efforts to enroll eligible families who are seeking health coverage and to share cold and flu season themed outreach materials from the Campaign.

Webinar on Maximizing Enrollment Under the ACA – On Tuesday, December 17, 2013, from 12:30 – 2:00 p.m. Eastern, NASHP and the Urban Institute will co-host a live webcast that draws on lessons learned from NASHP’s Maximizing Enrolling program. The panelists will include state officials from Alabama and Virginia, as well as experts from the Urban Institute and NASHP.

November 14, 2013

In the Finish Line Flash this week, we share the full data released by HHS on applications and enrollments through marketplaces as well as some perspective on initial enrollment figures based on the CHIP experience from the Center on Budget and Policy Priorities.  As we near release of CCF’s annual brief on the number of uninsured children, we provide an important supplement on coverage for low-income 19 and 20 year olds from the National Alliance to Advance Adolescent Health.  Finally, we alert you to two upcoming webinars—one from Enroll America on engaging the faith community and another on assisting consumers with plan selection organized by the State Health Reform Assistance Network.

Health Reform Resources 

November Report on Health Insurance Enrollment – Yesterday, HHS released estimates of the number of applications and enrollees processed as of November 2 through marketplaces for enrollment in Medicaid, CHIP, and qualified health plans. According to this issue brief from the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE), a little more than 1.5 million individuals have been included on completed marketplace applications and approximately one million have be determined to be eligible to enroll in a marketplace plan. Appendix A of the report provides state-specific figures for 7 enrollment related metrics.

CHIP Shows Health Reform Enrollment Will Take Time to Ramp Up – This report from the Center on Budget and Policy Priorities illustrates how examining the early experience with CHIP can provide a useful context for evaluating the initial enrollment figures from the marketplaces. CHIP enrollment was initially modest, but over several years it ramped up due to collaboration between various federal, state, and community stakeholders. The same cooperation will be needed to maximize enrollment under health reform.

Many Young Adults Living Below the Poverty Level Will Remain Uninsured in 2014 – This fact sheet from the National Alliance to Advance Adolescent Health provides background on the public and private health insurance protections that will be available for lower-income 19 and 20 year olds after the implementation of the Affordable Care Act. The fact sheet also notes that in states that are likely not to expand Medicaid in 2014, 46% of 19 and 20 year olds living below the poverty level will remain uninsured.

Upcoming Events

Webinar on Reaching out to the Faith Community – Enroll America will host this webinar today at 12:00 p.m. Eastern to discuss best practices for engaging different faiths which will coincide with the launch of their Health Care in the Pulpit, Health Care in the Synagogue, and Health Care in the Mosque programs. The webinar will feature several leaders from the faith community as well as Enroll America staff who are engaged in outreach and engagement.

Webinar on Plan Selection Assistance – The State Health Reform Assistance Network will host a webinar on providing plan selection assistance to consumers. Deborah Bachrach and Melinda Dutton of Manatt Health Solutions will review important components of the new marketplaces that states will want to highlight for consumers who are seeking guidance on how to choose among plans. The slide presentation will review the interplay between premiums and cost-sharing across the metal levels and for catastrophic coverage plans. Specific examples will demonstrate the implications of different premium and cost-sharing options for consumers of different ages and with different incomes and health care needs. Finally, the webinar will look at non-financial considerations such as provider networks and formulary designs. The webinar will take place on Friday, November 22 at 3:00 p.m. Eastern.

October 30, 2013

This edition of the Finish Line Flash includes news of recently-released federal regulations related to health reform, including “stair-step” kids, shared responsibility payments, and health insurance enrollment for immigrant families. Next, we include two health reform resources. The first is a brief from the Commonwealth Fund that addresses tools available to improve care for low-income families. It is followed by a MAGI resource guide from the National Health Law Program (NHeLP). We also include another brief from NHeLP on Early and Periodic Screening, Diagnosis, and Treatment (EPSDT).

Federal Guidance

Guidance on ‘Stair-Step’ Kids – On October 18, 2013, CMS released guidance to assist states that need to transition children from their separate CHIP programs to Medicaid to comply with the ACA. The guidance details best practices for a number of considerations including automatic administrative transfer and reported changes in circumstances, notices, and data sharing capabilities between Medicaid and CHIP, among other concerns. Our colleague Wesley Prater discusses the issue and guidance in more depth on our blog, Say Ahhh!

Guidance for Immigrant Families – On October 25, 2013, HHS and the Department of Homeland Security (DHS) simultaneously released guidance informing immigrant and mixed status families that information provided when applying to Medicaid, CHIP, or marketplaces will not be used for immigration enforcement. In addition, CMS’ guidance also clarifies that receiving APTCs will not qualify a recipient as a “public charge.” Our colleague Dinah Wiley delves deeper into the guidance on our blog, Say Ahhh!

Guidance on Shared Responsibility Payments – On October 28, 2013, CMS announced in a Q&A on the Shared Responsibility Provision of the Affordable Care Act that those who enroll in a Marketplace plan by the end of open enrollment will not be subject to a shared responsibility payment for lacking coverage in early 2014. Individuals who enroll before the end of the open enrollment period will be able to claim a hardship exemption for the months prior to the effective date of their plans, without actually having to request an exemption from the marketplace.

Health Reform Resources 

New Tools to Improve Care for Low-Income Families – This brief from the Commonwealth Fund reviews provisions of the Affordable Care Act that may be of special benefit for low and moderate-income individuals. In addition to more obvious tools like the Medicaid expansion, subsidized coverage in the marketplaces, and enhanced payments to primary care providers, other strategies include improving coordinated care for dual-eligibles, bolstering the capacity of community health centers, and investing in prevention and public health. The brief comes on the heels of the 2013 Commonwealth Fund Scorecard on State Health System Performance for Low-Income Populations, which found wide gaps by income in access to care, quality of care received, and health outcomes in all states.

Advocate’s Guide to Modified Adjusted Gross Income (MAGI) – Beginning in 2014, the new MAGI methodology will be used to determine eligibility for most applicants for Medicaid, CHIP, and Advanced Premium Tax Credits. This new reference guide from NHeLP uses guidelines developed by CMS to explain how MAGI works at the federal level, while also noting areas where states have flexibility to shape policies.

Lessons Learned from EPSDT –This brief from NHeLP explains EPSDT, a benefit mandate available to all Medicaid-eligible children under age 21.  It also discusses challenges to EPSDT implementation at the state level and recent developments in EPSDT via the ACA, federal regulation, and litigation. Links to other key resources on EPSDT are also provided.

October 16, 2013

In this edition of the Finish Line Flash, we highlight a recent report from RAND that looks at the effects of the ACA on consumer health care spending and the risk of catastrophic costs. Next we highlight a list of FAQs on health reform created by the Kaiser Family Foundation (KFF). Two briefs on consumer assistance, also from KFF, follow it. We also include a brief from the Center on Budget and Policy Priorities that corrects five common myths about Medicaid. Finally, we share with you an op-ed from Finish Liners in Utah spurred by recent participation rates that calls for changes to the state’s eligibility system.

Health Reform Resources 

The Effects of the ACA on Consumer Health Care Spending – This recent study from RAND examines the likely effects of the Affordable Care Act (ACA) on average annual consumer health care spending in 2016.  It finds that the average out-of-pocket spending is expected to decrease for all groups considered in the analysis, although decreases in out-of-pocket spending will be largest for those who would otherwise be uninsured. The report also examines catastrophic costs in 2016 for two levels of spending (more than 10% and more than 20% of household income on health care). The authors find that, overall, the risk of catastrophic health care spending will decrease for individuals of all income levels for the three insurance transitions considered: uninsured who move to Medicaid under the ACA, uninsured who move to the ACA-regulated individual market, and those who move from the pre-ACA individual market to the ACA-regulated individual market.  Finally, the report considers the effects of the ACA on consumer spending and the risk of catastrophic medical costs for Texas and Florida, two large states that have decided not to expand their Medicaid programs. In both states, individuals below 100% and between 100 and 138% FPL will spend more on medical care without the expansion.

Frequently Asked Questions About Health Reform – At a time when we are all getting a lot of questions about health reform, the Kaiser Family Foundation offers this great resource that you can point people to instead of responding to each question yourself.  The searchable index of Q&As cover a myriad of topics of interest, including: marketplace eligibility, enrollment periods, plans and premiums; individual responsibility to have health coverage; minimum essential coverage; help for paying private insurance premiums; cost-sharing reductions; the tobacco surcharge for premiums; marketplace verification and appeals; young adults and students; non-traditional households, and more.

A Look at State Consumer Assistance – The Kaiser Family Foundation released two informative briefs on the status of consumer assistance in state-based and partnership marketplaces. The first looks at states that have awarded assister grants, highlighting key differences in their funding and structure. The second issue brief provides insight from three state-based exchanges (MD, NV, and OR) that are among the states leading the way in preparing for outreach and enrollment.


Setting the Record Straight on Medicaid – This brief from the Center on Budget and Policy Priorities corrects five myths being circulated about Medicaid by some federal policy makers who want to radically change the structure of the program. For each of the myths the brief provides the corresponding reality about Medicaid and its beneficiaries.

Media Materials

Utah Finish Liner Calls for Cutting Red Tape – In a Deseret News op-ed, Voices for Utah Children’s Lincoln Nehring responds to a recent article that reported that Utah is second to last in terms of children’s CHIP and Medicaid participation. He argues that the high rate of uninsured children and families in Utah and the corresponding low rate of enrollment in Medicaid and CHIP indicate the presence of too much unnecessary red tape in the state’s eligibility system. He then offers four measures that could reduce the problem, concluding that, “Medicaid and CHIP work. Other states show they can reach more of the kids who need them. Let’s demonstrate our commitment to putting Utah children on a pathway to success by getting every uninsured child enrolled in health coverage.”

October 2, 2013

This edition of the Finish Line Flash includes several resources on Medicaid and health reform. The first is an update from the Urban Institute on Medicaid and CHIP participation rates for children. Next is a fact sheet from the Kaiser Commission on Medicaid and the Uninsured (KCMU) that compares Medicaid eligibility levels for adults in 2013 and after the conversion to MAGI methodology. Our picks for health reform resources include a new brief from the Georgetown University Center on Health Insurance Reforms that profiles people who have benefitted from health reforms under the ACA, another factsheet from KCMU that compares and contrasts the key components of the Arkansas and Iowa Medicaid expansion waivers, and a slideshow on how to develop marketplace monitoring and evaluation plans from the National Governors Association and the State Health Reform Assistance Network.


Update on Medicaid/CHIP Participation Rates – This brief from the Urban Institute provides updated Medicaid/Children’s Health Insurance Program (CHIP) participation rates and the number of uninsured children who are eligible for Medicaid or CHIP for each state. From 2008 to 2011, the national Medicaid/CHIP participation rate increased by 5.5 percentage points among children to 87.2 percent. In 2011, twenty states (including D.C.) had participation rates at or above 90 percent and four states (AK, MT, NV, UT) had rates below 80 percent. Over the same time, the number of eligible-but-uninsured children declined by 18 percent nationally. These findings suggest that state and federal policy efforts aimed at reducing the number of eligible but uninsured children have been effective, but that lower-performing states still have ground to cover. The brief is accompanied by an infographic that summarizes the national data.

Medicaid Eligibility for Adults – The Kaiser Commission on Medicaid and the Uninsured released this fact sheet yesterday that provides the Medicaid income limits for each state using Modified Adjusted Gross Income (MAGI) methods that will be in effect as ofJanuary 1, 2014 (or sooner for some states).  It compares these to the limits that were in effect in January 2013.  Regardless of whether a state decides to expand Medicaid, under the ACA all states must determine eligibility for most groups using MAGI. This fact sheet also provides a graph that illustrates the coverage gaps that will remain for adults in states not currently moving forward with the expansion.

Health Reform Resources

Real Stories, Real Reforms – Today the Georgetown University Center on Health Insurance Reforms (CHIR) released a brief that provides an overview of the major private health insurance reforms that were implemented by the Affordable Care Act. The reforms are coupled with stories that illustrate how the reforms are making a real difference in the lives of individuals and families across the country.  It can be a good resource while media outlets are hungry for stories about the effects of the ACA even if it’s too early to assess marketplaces.

Arkansas and Iowa Waiver Applications Compared – The Kaiser Commission on Medicaid and the Uninsured created a table that compares and contrasts the key components of the two states’ premium assistance waivers. This may prove useful to advocates in states that have not yet expanded Medicaid and who want to understand what is meant by officials that want to “do Arkansas” or “do Iowa.”

Evaluating Marketplaces – Now that the marketplaces are open, it’s time for stakeholders to think about how they will evaluate their performance. You can now access slides from a webinar hosted earlier this month by the National Governors Association and the State Network that explored a framework for developing monitoring and evaluation plans. The webinar also included an overview of CMS’ reporting requirements, examples of evaluation plans from Oregon and West Virginia, and other tools and resources for developing consumer experience surveys – including how to leverage those that are already available.

September 18, 2013

This edition of the Finish Line Flash features several new studies and three upcoming webinars. First, we highlight a new article from Health Affairs that measures the effectiveness of 12-month continuous eligibility in curbing churn. Next is a new scorecard from the Commonwealth Fund that examines how well each state’s health care system is working for the low-income population. It is followed by a new analysis from the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) on the price of coverage for those who will receive tax credits. We also call your attention to three upcoming webinars that will discuss hot topics such as: outreach to young African Americans and Latinos, eligibility determination appeals, and immigrant eligibility for health coverage under the ACA.

New Data

The Experience of Continuous Coverage for Children Holds Lessons for Adults – A new article in Health Affairs examines state continuity ratios for Medicaid coverage, that is, the average proportion of a fiscal year that beneficiaries are enrolled.  It measures differences by state implementation of 12-month continuous eligibility for children. States that implemented the policy experienced a 1.8 percentage-point increase in the average length of child enrollment during fiscal year 2010 and increased annual costs for children by about 2.2 percent.  The findings suggest that continuous coverage for adults could be cost effective.

Disparities in Health System by Geography and Income – The Commonwealth Fund released a scorecard examining the health care experiences of low-income individuals. Using 30 indicators to rate states on access, prevention and quality, potentially avoidable hospital use, and health outcomes, the report finds great disparities within and between states. It also reinforces the notion that having low-income does not necessarily correspond with subpar health care. “In fact, in the top states, many of the health care benchmarks for low-income populations were better than average and better than those for higher-income or more-educated individuals in lagging states,” according to the executive summary. The report is accompanied by a chartpack with state statistics and a slide show that illustrates disparities for the low-income using New York, Florida, Iowa and Missouri as examples.

Marketplace Coverage Costs After Tax Credits – This new report from ASPE estimates that more than half of those currently uninsured will be able to purchase coverage for less than $100 per month per person or enroll in Medicaid or CHIP. If all states expanded Medicaid, more than three-quarters of the uninsured would be able to gain coverage for that price or less.

Upcoming Events 

Reaching Young African Americans and Latinos – Enroll America will host this webinar to discuss best practices for conducting outreach to African American and Latino youth. Panelists will include leaders from the National Coalition on Black Civic Participation, Young Invincibles, and the League of United Latin American Citizens, three organizations doing outreach to this critical population The webinar will take place Thursday, September 19, 2013, 2:00-3:00 pm EDT.

Understanding Individual Eligibility Appeals – The State Coverage Initiatives program, in coordination with the State Health Reform Assistance Network, will host a webinar to discuss individual eligibility appeals for applicants who disagree with their eligibility determinations. Panelists Melinda Dutton and Kinda Serafi from Manatt Health Solutions will provide an overview of requirements put forth in the final HHS regulations and also discuss open policy and operational issues for the design of coordinated appeal processes. The webinar will take place on Monday, September 23 from 1:00 – 2:30 p.m. EDT.

Health Insurance For Immigrant Families –Georgetown CCF and the National Immigration Law Center will host a webinar on September 26th during which Georgetown CCF’s Dinah Wiley and NILC’s Jenny Rejeske will discuss the specifics of immigrant eligibility for healthcare under the ACA and tips for overcoming barriers for these families. The webinar will begin at 1:00 p.m. Eastern on the 26th.  Check your inbox for an e-mail with the registration link.

September 4, 2013

This issue of the Finish Line Flash includes a number of health reform resources. We include a toolkit from Enroll America designed for hospital administrators who want to implement presumptive eligibility, a primer from Manatt Health Solutions that explains the basics on premium tax credits and cost sharing reductions, and a recent blog post from the National Academy for State Health Policy (NASHP) highlighting efforts to expand access to care for adults at school-based health centers. We also include news of a NASHP webinar on state plans for consumer assistance and a reminder about Georgetown CCF’s upcoming webinar on the American Community Survey (ACS). Last but not least, we’ve included a link for our video tribute to Gene Lewit.

Health Reform Resources

Presumptive Eligibility Toolkit – The Affordable Care Act created a unique opportunity for hospitals to help enroll the uninsured using presumptive eligibility (PE).  Enroll America created this toolkit that includes resources on federal law and regulations, financing, state-specific information and more, to help hospital administrators understand and implement PE. If you have not already, click over to Tricia Brooks’ blog post on Say Ahhh!, where she explains some of the questions that surround this new opportunity for hospitals.

Premium Tax Credits and Cost-Sharing Reductions – This slide deck prepared by Manatt Health Solutions for the State Health Reform Assistance Network is designed to be a primer for marketplace staff, eligibility workers, navigators, certified application counselors and other individuals and organizations that assist consumers with Advanced Premium Tax Credits (APTCs) and Cost Sharing Reductions (CSRs). The presentation includes a glossary of key terms, an overview of the role of APTCs and CSRs, as well as plain-language explanation of the more technical components of APTCs and CSRs, including eligibility criteria and income measurement.  The primer providers a great grounding in the basics to complement the Center on Budget and Policy Priorities’ Beyond the Basics materials.

School-Based Health Care for Adults, Too – Throughout the course of health reform implementation, a lot of attention has been given to whether the newly insured will be able to access care. This new blog post from NASHP’s Andy Snyder discusses innovative efforts in Oregon and California to expand access to care for adults by building on the capacity of school-based health centers (SBHCs).

Upcoming Events

American Community Survey Webinar – As a reminder, Georgetown CCF will host a webinar on Monday, September 9th at 4:00 PM Eastern (our standing group Finish Line call time) on the American Community Survey (ACS).  The webinar will provide an overview of the ACS and CCF’s release plans for our annual brief on kids coverage, a short tutorial for advocates on how to easily access top-level data, and what additional ACS data Georgetown CCF can process and provide to advocates.  Check your inbox for a registration link in an e-mail sent earlier today.

Webinar Highlighting State Plans for Consumer Assistance – NASHP will host this webinar to highlight the key features of consumer assistance strategies that are being employed by marketplaces. The webinar will feature three states panelists; two from state-based marketplaces and one from a partnership marketplace to discuss their experiences thus far coordinating consumer assistance and implementation issues they anticipate encountering during open enrollment. The webinar will take place on Wednesday, September 11, 2013, from 1:30 – 3:30 pm Eastern.

Thanks, Gene!

Video Tribute to Gene Lewit – We’d like to share this video collaboration from Georgetown CCF and the Packard Foundation with those that were not able to attend Georgetown CCF’s annual conference in July. There we debuted this tribute to Gene Lewit to thank him for his many years of service as the program officer and manager in the Children, Families, and Communities Program at Packard.

August 20, 2013

This week’s edition of the Flash includes a number of health reform resources and data sources. Among health reform resources, we highlight Georgetown CCF’s new brief authored for the Kaiser Commission on Medicaid and the Uninsured on children moving from CHIP to Medicaid, a Kaiser Family Foundation brief that estimates tax credits for current enrollees of the individual market, and a new State Refor(u)m table that tracks state decisions on education and training for consumer assistance programs. New sources of data include a chartbook on Children with Special Health Care Needs (CSHCN) and a new tool from the Census Bureau that provides easily accessible demographic and economic data for congressional districts. We also include a link to Georgetown CCF’s presentations from our annual conference and news of our upcoming webinar on the American Community Survey.

Health Reform Resources 

Moving Stairstep Kids to Medicaid – This brief, authored by Georgetown CCF’s Wesley Prater and Joan Alker for the Kaiser Commission on Medicaid and the Uninsured, examines how the transition of certain children from CHIP to Medicaid will affect children and families as well as states. It includes state-specific estimates of the number of children who will be moved to Medicaid in 2014 and discusses some of the changes with regard to benefit packages, cost-sharing, enrollment and renewal procedures, and access to care.  It also discusses the fiscal impact to states and how the transition can reduce administrative burdens. The brief concludes with lessons learned from Colorado and New York, two states that implemented early transitions of stairstep children. You can also read Wesley Prater’s blog post summary of the brief.

State Approaches to Consumer Assistance Training -This table from NASHP’s State Refor(u)m is tracking the steps that states have taken to develop education and training for their consumer assistance programs.  It can be helpful for both monitoring requirements in your own state or comparing across states. Among other information, it tracks who will perform assister training, its format, and the number of training hours required.  In addition, the table lists any other conditions for certification, how assisters will be evaluated, and any continuing education requirements. The table also has links to RFPs where available.

Tax Credits for Those Currently Buying Insurance on the Individual Market – This issue brief from the Kaiser Family Foundation explains how premium tax credits work and estimates that tax credits can potentially cover a large portion of the premium paid by current individual market enrollees. For example, about half of those currently buying insurance on the individual market will be eligible for premium assistance in the marketplace under the ACA. Of that half, the average subsidy would be $5,548 per family, reducing the premium for the average second lowest-cost silver plan ($8,250) by an average of 66 percent.

Data Sources

Chartbook on Children with Special Health Care Needs – The Catalyst Center has developed an online chartbook that provides state-specific data on coverage and financing for children’s health services, many for all children and others for CSHCN.  It provides information on a range of data points, from the number of children served by the state mental health authority, to the number who receive preventive dental services, to state mandated health insurance benefits.  The chartbook also gives you the ability to compare data for two states or one state and the nation and tips on how to interpret and use the data.

My Congressional District – This new tool from the Census Bureau allows users to quickly and easily access selected demographic, social, and economic data for every congressional district. Advocates will likely be interested in the data on health insurance coverage, income, and the percentage of individuals and families living in poverty.

Georgetown CCF Conference Presentations – The Power Point presentations and other materials from this year’s annual conference, Opportunity Knocks: Opening the Door to Coverage, are now available to be viewed on our website.

Upcoming Events

American Community Survey Webinar – On Monday, September 9th at 4:00 PM Eastern (our standing group Finish Line call time), Georgetown CCF will host a webinar to provide an overview of the ACS, including CCF’s release plans for our annual brief on kids coverage, a short tutorial for advocates on how to easily access top-level data, and what additional ACS data Georgetown CCF can process and provide to advocates.  Be on the lookout for a special email alert with more details on the webinar.

August 7, 2013

This edition of the Finish Line Flash is chock-full of health reform resources. We highlight CMS’s description of and application for Certified Application Counselors. It is followed an interactive map from the Kaiser Commission on Medicaid and the Uninsured (KCMU) that provides estimates of the local impact of the ACA Medicaid expansion. Next is a short checklist from Enroll America for organizations that are planning to do outreach on new coverage options. Also included is a new report from Maximizing Enrollment in which state grantees share their efforts to leverage technology for more efficient enrollment. Finally, we bring you news of the latest webinar from the Center on Budget and Policy Priorities (CBPP), which is happening today at 2:00 PM Eastern.

Health Reform Resources

Certified Application Counselors – CMS has rolled out some helpful information on the newest assistor category, Certified Application Counselors (CACs). It provides background on what CACs do, what information organizations will need to provide to CMS when applying, and links to relevant federal regulations and guidance. Also be sure to read Tricia Brooks’ blog post that provides even more info on CACs.

New Estimates of the Local Impact of Medicaid Expansion – A new interactive map from KCMU allows users to zoom in on a state, selected counties, or local areas to view estimates of how expanding Medicaid will impact the share and composition of the uninsured population and enrollment in Medicaid, assuming that the state chooses to expand. Highlights from the data used in the map can be found in the accompanying report

Outreach Planning 101 – This Enroll America guide raises questions that organizations should keep in mind when approaching outreach, including targets, ways to spread the word about new health coverage options, and ideas for tracking outreach efforts and gauging their effectiveness.

Leveraging Technology to Streamline Kids’ Coverage – In this report, the first in a series of final reports from the Maximizing Enrollment project, the eight grantee states (Alabama, Illinois, Louisiana, Massachusetts, New York, Utah, Virginia, and Wisconsin) share findings from adopting and piloting new technology strategies that go beyond what federal law requires.  As states move forward with ACA implementation, they may want to consider the lessons learned from the adopted strategies that cover four domains: 1) application and renewal simplifications; 2) customer interfaces; 3) system functioning, and 4) workflow management.

Upcoming Event

New Webinar on Defining Households for Coverage Applications – The next installment of CBPP’s webinar series on new coverage policies will examine how household size will be calculated for the purposes of determining eligibility for Medicaid and premium tax credits. The webinar will take place today, Wednesday, August 7, 2013, from 2:00-3:30 PM Eastern.

July 24, 2013

This week’s edition of the Finish Line Flash includes five health reform resources and one related to Medicaid. The first two briefs, both from the Kaiser Family Foundation, discuss the financial and societal costs for states that forgo the Medicaid expansion. The briefs are followed by an animated video, also from the Kaiser Family Foundation, that was created to educate the public about health reform. Next is a helpful matrix produced by SHADAC that compiles state and federal survey questions related to health insurance. A report from the Government Accountability Office that provides the range of health insurers’ base premiums in January 2013 rounds out our picks for health reform resources.  Finally, we highlight a recent study that reports on increased dental health care utilization among child Medicaid beneficiaries.

Health Reform Resources

The Cost of Not Expanding Medicaid – This new report, prepared by Urban Institute researchers for the Kaiser Commission on Medicaid and the Uninsured, provides updated estimates of states’ costs under the ACA with and without the Medicaid expansion. Currently there are 21 states not going forward with the expansion and 6 that are still debating the matter. Over the next ten years, states in the former category would forgo $345.9 billion in federal funding, the figure is $151 billion for states in the latter category. The state-by-state estimates take into account federal spending and reductions in uncompensated care, but not other state-specific savings, which may produce greater cost-savings. The decisions of these 27 states will have large consequences when it comes to reducing the nation’s number of uninsured, as almost two-thirds of individuals originally expected to be covered by Medicaid reside there. You can read Martha Heberlein’s blog post for more insight into the report.

State Medicaid Decisions May Create Greater Disparities -This brief, also from the Kaiser Commission on Medicaid and the Uninsured, highlights five ways that state decisions will shape the outcome of the Medicaid expansion. States that do not expand Medicaid are likely to experience increased inequality, as there will be large gaps in coverage; significant implications for health care for the uninsured; consequences for certain regions and for people of color; coverage and fiscal implications for states; and implications for uncompensated care and hospitals.

New Animated Video Explains Obamacare – The Kaiser Family Foundation (KFF) released a new animated video, “The YouToons Get Ready for Obamacare,” to help people understand the imminent health care system changes to take place under the Affordable Care Act. The approximately 7 minute video provides an overview of how the ACA will impact health insurance coverage and costs, whether coverage is through an employer, Medicaid, Medicare, or the new marketplaces. The video also discusses the individual mandate and the private health insurance reforms that are working to strengthen and stabilize insurance coverage. KFF welcomes organizations to embed the video on their websites or blogs.

State Health Reform Survey Questions – SHADAC’s State Reform Survey Workgroup compiled this matrix of survey questions and metrics from the 19 states (which include most of the Finish Line States) that regularly conduct household surveys related to health care access and cost. The matrix also includes items from two federal surveys, the CPS and the NHIS, as well as a Commonwealth Fund survey. Advocates who are interested in monitoring the impact of health reform in their state can use the matrix to see what metrics are already being collected and reported and to inform decisions about what to include in future surveys.

2013 Base Premiums to Help in Assessing 2014 – Using January 2013 data available on the Healthcare.gov Plan Finder, the Government Accountability Office compiled the range of insurers’ base premiums prior to underwriting for health plans in each state and the District of Columbia. The analysis provides costs for the plan with the minimum, median, and maximum premium for six consumer scenarios. Although there are some caveats to the data, including that roughly 20 percent of insurance companies did not submit premiums, the report may prove useful for a comparison of premiums as the ACA continues to be implemented.


Children’s Dental Care Utilization Increased Over the Last Decade – A new study that appeared in the Medicare and Medicaid Research Reviewfinds that from 2000-2010 the number of children receiving at least one preventive dental care visit increased 2.5 times and the number of kids receiving a dental treatment doubled. It also provides state specific data on the percentage of children that received dental services, including preventive dental care, dental treatments, and dental sealants, in 2010.

July 10, 2013

In this edition of the Finish Line Flash, we bring you news of recently awarded Connecting Kids to Coverage Outreach and Enrollment Grants and Enroll America’s newly launched Get Covered America Campaign. Next, we highlight two health reform resources. The first is a series of colorful MAGI lessons provided by Louisiana’s Medicaid agency. The second is a toolbox from NASHP that focuses on how to maintain and advance children’s coverage during implementation of the ACA. Lastly, we include a new State Refor(u)m map that tracks premium rates in the marketplace as they are released.

Outreach and Enrollment

Connecting Kids to Coverage Announces $32 Million in Grant Awards – Last week, Secretary Sebelius announced the award of 41 grants to state agencies and community organizations in 22 states under Cycle III of the Connecting Kids to Coverage Outreach and Enrollment Grants. The grantees designed proposals to target one of five key focus areas that have been recognized to effectively reduce the number of uninsured children. In addition, CMS noted that it ensured grantees are representative of the states that have a large number of eligible but unenrolled children. The Cycle III grant awards range from $190,000 to $1 million with an average award of $775,000.  You can view the full list of grantees and awards here.

Enroll America Announces Its Get Covered America Campaign – This national campaign, recently launched by Enroll America, is focused on raising public awareness and educating consumers with regard to the health insurance benefits and options that will be made available under the ACA. The campaign is hosting a number of in person events, ranging from community wide events to trainings and neighborhood canvasses. If you are interested in learning about events in your state or getting involved you can view their calendar.

Health Reform Resources 

Mondays are More Fun with MAGI – In an effort to make the concept of MAGI more digestible for eligibility workers, Russell Connor of Louisiana’s Medicaid Agency created a weekly email series entitled MAGI Monday.  Using vignettes that feature the Kardashians and other reality T.V. stars to illustrate the complexities of MAGI, the series is both informative and entertaining, which has likely contributed to its popularity on State Refor(u)m’s MAGI discussion board.  The emails have been compiled into several different word documents that are available via State Refor(u)m.

Toolbox for Advancing Children’s Coverage through Health Reform Implementation – This new website complements the similarly titled June 2013 report (also previously highlighted by the Flash), both of which feature ideas learned through NASHP’s Children in the Vanguard initiative. The toolbox functions as a centralized source of information that is focused on two main topics: pathways to coverage and key implementation issues. It can be helpful for states as they try to think through some of the challenges in maintaining and advancing children’s coverage while also implementing the ACA.


Preliminary Premium Rates in the Marketplaces  – This map from NASHP’s State Refor(u)m is tracking the premium rates filed by insurance carriers that have expressed interest in participating in the individual and small group markets. As of July 2013, the map indicates that eleven states have released at least preliminary premium rates for exchanges (CA, CO, CT, DC, MD, OH, OR, RI, VA, VT, WA). The map also notes which states have finalized rates. Until this afternoon when Oregon announced that its rates are final, Vermont was the only other state to have done so.

June 27, 2013

In this edition of the Finish Line Flash, we have plenty of resources covering health reform, outreach, and eligibility and enrollment that could keep you busy reading during the holiday.  The health reform section links you to three resources. The first is a brief from the Georgetown University Center on Health Insurance Reforms that notes how the lessons learned during implementation of Medicare Part D can inform ACA implementation. It is followed by a brief from the University of California that cites evidence on the benefits of expanding access to health care coverage and then a study featured in the Journal of the American Medical Association that compares the health needs of newly eligible versus currently eligible Medicaid beneficiaries. Our picks for eligibility and enrollment resources include a new checklist from Enroll America designed to help states streamline enrollment and two briefs from SHADAC that offer suggestions for states as they iron out some of the intricacies of MAGI determinations.  Finally, we bring you news of a webinar hosted by CMS to discuss back-to-school strategies for connecting kids to coverage.

Health Reform Resources

Lessons for Health Reform from Medicare Part D – This new report, authored by researchers at the Georgetown University Health Policy Institute and funded by the Robert Wood Johnson Foundation, likens the implementation of the ACA’s health insurance exchanges to another large national health coverage program born amidst partisan controversy, Medicare Part D. The ability for Medicare’s prescription drug coverage to overcome initial skepticism was due in part to the ability of those implementing the program to successfully address many of the challenges as they arose.  The authors of the report suggest that officials in charge of exchange implementation should look to the lessons learned from Medicare Part D, specifically in the areas of program readiness, eligibility assessment, education and outreach, and consumer assistance.

Recent Studies Affirm the Benefits of Health Care Coverage and the Safety Net – This brief funded by the California Endowment is a collaboration between research centers at the University of California in Berkeley and Los Angeles. The brief helpfully collects evidence from several recent studies documenting the benefits of expanding access to coverage for children and adults as well as the adverse effects of being uninsured. The evidence cited in the brief comes from national and state specific studies.

How Do Potential New Medicaid Enrollees Compare to Current Enrollees? – A key question for both states that will be expanding Medicaid and those still considering the question is how the health needs of the newly eligible will compare to those already enrolled. Findings from a study recently published in the Journal of the American Medical Association suggest that the prevalence of chronic diseases such as diabetes, hypertension, and hypercholesterolemia is lower among the population of adults potentially eligible for new Medicaid coverage than among those currently enrolled. Yet, the currently uninsured who do have one of these chronic conditions are less likely to be diagnosed or to have good disease control. The researchers estimate that nationally, among the uninsured individuals who are potentially eligible for Medicaid, as many as 1.6 million may have at least one undiagnosed condition and 3.5 million may have at least one uncontrolled condition.

Eligibility and Enrollment 

Strategies to Accelerate State Enrollment Efforts – Enroll America created a checklist of six strategies that can be used by all states, regardless of the type of exchange that will be operated or if it will expand Medicaid, to significantly reduce the number of uninsured. Using the suggested strategies, which fall under the umbrellas of automatically enrolling people known to be eligible or streamlining the enrollment process, will not only reduce the number of uninsured, but perhaps also allow more efficient use of the resources being invested in outreach and in-person assistance.

Getting MAGI Right – In these two related briefs funded by the State Health Access Reform Evaluation program at SHADAC, John Czajka of Mathematica Policy Research discusses issues that may arise when using MAGI for eligibility determinations under the ACA. The first briefcontrasts what types of income count under current Medicaid rules versus those that will apply under MAGI. In addition, Dr. Czajka discusses problems that may arise when using MAGI to measure income on a monthly basis for Medicaid determinations and how states can begin to address those issues. The second brief explains how the requirement to base Medicaid eligibility on monthly income and exchange subsidies on annual income will lead to churn among those with income instability. For instance, Dr. Czajka’s analysis of monthly income volatility for the population likely to be newly eligible for Medicaid found that more than twenty percent of beneficiaries will potentially experience enough variation in monthly income to cause them to lose eligibility for Medicaid, yet remain ineligible for exchange subsidies. You can also read Tricia Brooks’ discussion of these two briefs on our Say Ahhh! blog!

Upcoming Events

Back-to-School Outreach Strategies – This webinar, hosted by CMS as part of its Connecting Kids to Coverage National Campaign, will highlight effective strategies that can be used during the back to school season to aid enrollment of eligible children and teens in Medicaid and the Children’s Health Insurance Program. During the webinar, partners from the campaign who have prior outreach experience will provide tips on hosting enrollment events, engaging corporate and organizational partners, and conducting school outreach. Additionally, webinar attendees will learn about Campaign materials available for the back-to-school season. The webinar will be take place on Tuesday, July 9, from 3:00 to 4:15 p.m. Eastern.

June 12, 2013

In this edition of the Finish Line Flash, we bring you four new resources on health reform topics. The first, a paper from the National Academy for State Health Policy, discusses how to make the ACA work for children.  The second, a brief from the Kaiser Commission on Medicaid and the Uninsured, discusses outreach and enrollment strategies for the ACA. It is followed by a fact sheet from CMS that breaks down the different consumer assistance models and the training needed for each. Lastly, we include a brief co-authored by Georgetown Center on Health Insurance Reforms researchers that considers the effects on entrepreneurship of the ACA’s health insurance market reforms and estimates for each state the number of newly self-employed due to the law.

Health Reform Resources

Making the Affordable Care Act Work for Children and Youth – As the ACA is implemented, its emphasis on expanding adult coverage presents some challenges for children’s coverage. This paper from the National Academy for State Health Policy explains some policy concerns in regard to outreach and consumer assistance, eligibility and enrollment, affordability, and access to appropriate providers and benefits. It also discusses the opportunities that await – lessons learned from state Medicaid and CHIP programs, federal policy, and relevant research findings – in order to make health care reform work for children.

Applying Lessons Learned from Outreach and Enrollment in Medicaid and CHIP to the ACA – Part of the Kaiser Commission on Medicaid and the Uninsured’s “Getting into Gear for 2014,” this brief presents five lessons learned about outreach and enrollment and discusses how they can better equip states to handle the task of enrolling millions of uninsured beginning this October. These valuable strategies range from the need to have both a broad and targeted outreach strategies, to simplified applications, and one-on-one enrollment assistance.  These and other strategies presented in the brief will be pivotal in realizing the long-term outreach efforts that are needed to ensure the successful implementation of the ACA.

Helping Consumers Apply and Enroll through the Marketplace – This concise, two-page fact sheet from CMS differentiates the roles to be played by each of the four consumer assistance categories: navigators, in-person assistance personnel, certified application counselors, and agents and brokers. In addition, a matrix details what kind of training will be necessary for each model of consumer assistance, depending on whether the marketplace is state-based, partnership, or Federally-facilitated.

Will the Health Care Law Spawn New Entrepreneurs? – A new analysis, co-authored by researchers at the Urban Institute and the Georgetown Center on Health Insurance Reforms says yes; nationwide, an increase of 1.5 million more self-employed individuals is expected. Using findings from recent empirical analyses, this brief also estimates the number of new entrepreneurs that will blossom in each state once the ACA is fully implemented, that is, when guaranteed, affordable, comprehensive health insurance will no longer depend so heavily on participation in an employer’s group coverage.  The increase expected for each state varies, and is dependent in part on the policy steps that states have already taken to facilitate purchase of coverage in the non-group market. Thus, no increases are expected in Massachusetts and Vermont as a result of the ACA. However, California and Arkansas are estimated to add a quarter of a million and 13,000 new entrepreneurs, respectively; both of which are above the national increase of 11 percent.

May 29, 2013

This edition of the Finish Line Flash brings you several resources related to Medicaid and Health Insurance Marketplaces. Among the featured Medicaid materials are a Medicaid expansion tracker from State Refor(u)m, new state estimates on continuity of coverage in Medicaid commissioned by the Association for Community Affiliated Plans, and a recorded webinar from the Kaiser Commission on Medicaid and the Uninsured on retention strategies in Medicaid and CHIP. They are followed by several webinars related to exchanges. First, NASHP discusses how CHIP can help inform marketplace design; next, a CMS webinar series will present an overview and a more detailed look at how exchanges will operate.


Medicaid Expansion Tracker – State Refor(u)m’s newest table tracks the status of state legislative activity and governors’ statements surrounding Medicaid expansion, including whether there are proposals related to cost-sharing, premium assistance, state-specific financing of the expansion, or severability clauses to discontinue participation if the FMAP is reduced below a certain level. In addition, the table tracks analyses of the Medicaid expansion, both those conducted or commissioned by the state as well as those produced by other independent institutions.

Opportunities to Reduce Churn in Medicaid – This report, sponsored by the Association for Community Affiliated Plans, provides an update of a 2009 report on continuity of coverage in Medicaid as well as considerations for continued improvement. Nationally, the continuity ratio of Medicaid coverage, that is, the average proportion of a fiscal year that beneficiaries are enrolled, improved from an average of 78.5 percent in 2006 to 81.2 percent in 2010-2011. Still, large differences exist across the states, ranging from a low of 68.8 percent in Utah to a high of 88.6 in Illinois. Continuity ratios are also available by child, adult, disabled, and aged populations.

Successful State Medicaid Renewal Initiatives – The Kaiser Commission on Medicaid and the Uninsured recently hosted a webinar that highlights successful retention efforts in Medicaid and CHIP. A panel of administrators from Louisiana, Michigan, and California discuss the lessons learned from their initiatives and suggest how they are applicable to enrollment and retention under health reform. The link above includes a podcast, transcript, and slides from the webinar.


Ensuring Exchanges Meet Children’s Needs – NASHP recently hosted a state official only webinar, How CHIP Can Help Meet Child Specific Requirements and Needs in the Exchange. This webinar includes a discussion of ways in which CHIP could be used to inform the design of exchanges, including Essential Health Benefits and provider networks, so that they are prepared to serve the needs of children. Though geared toward state exchange/marketplace officials, advocates working on health reform issues in states with all types of marketplaces may find it informative. You can also read the guest blog post from NASHP’s Maureen Hensley-Quinn on Say Ahhh! that highlights a companion brief and compendium on the issue.

Upcoming Events

Health Insurance Marketplace Training with Two Levels – CMS will soon host a series of webinars on health insurance marketplaces. The first level will provide a basic hour-long introduction to marketplaces, including who will be eligible and how the marketplace will work, while the second level will be a more in-depth two-hour presentation to focus on eligibility, enrollment, plan structure, Medicaid expansion, and the streamlined application. These webinars may be useful for advocates as well as other stakeholders who are interested in learning more about exchanges. The webinars are scheduled to take place on multiple occasions throughout June and July.

May 16, 2013

This edition of the Finish Line Flash brings you new estimates on uninsurance and other indicators, info on the impact of Medicaid expansion, and several materials related to consumer assistance and outreach. Enroll America compiled Census data into an interactive map of the uninsured while estimates from the 2011-2012 National Survey of Children’s Health provide info on more than 100 indicators of child well being. Next, a series of briefs from the Kaiser Commission on Medicaid and the Uninsured provide state-level estimates on the potential impact that Medicaid expansion could have for people of color. Then we link you to a brief from the Kaiser Family Foundation that looks at key decisions around Navigator and In-Person Assistance programs in 11 states as well as a report from Consumers Union on premium tax credits.

Recent Research

New Data on the Uninsured – Enroll America’s new interactive map allows you to zero in on the number and percent of non-elderly uninsured in different regions of your state. It also provides a breakdown of the uninsured by income, age, and race/ethnicity. The map combines data from the U.S. Census Bureau and CMS. It allows for a closer comparison of the distribution of the uninsured than other geographic level estimates.

Updated Estimates from the National Survey of Children’s Health – National and state level estimates from the 2011-2012 survey, which is conducted by the CDC’s National Center for Health Statistics, are now available at the Data Resource Center for Child and Adolescent Health (DRC). The survey contains over 100 indicators of child health and well being, including health insurance, health care access and quality, and physical and dental health, among others. Indicators related to health insurance coverage include health insurance status and type, as well as consistency and adequacy of coverage. Once you have chosen your indicator of interest, you can modify the results to account for subgroups, such as, age, sex, race/ethnicity, household income, type of insurance, and special health care need status. You can then compare your data to another geographic region, such as a neighboring state. The DRC also provides information on how to effectively use and communicate the data as well as state snapshots.


The Impact of the Medicaid Expansion for Low-Income Communities of Color – The Kaiser Family Foundation prepared this series of briefs to illustrate the disproportionate impact that the ACA Medicaid expansion will have for people of color, who are often more likely than whites to be uninsured and have low-income. The first of four briefs is an overview of the combined impact of the expansion for all non-elderly uninsured communities of color as well as the specific impact for low-income uninsured Hispanics, blacks, and Asians and Pacific Islanders. Three individual briefs follow it, one for each community of color. Each brief provides state-specific estimates, using data from the 2011 American Community Survey.

Consumer Assistance

Snapshot of State Navigator and In-Person Assistance Programs – This brief from the Kaiser Family Foundation provides a sample of some key decisions that have been made regarding Navigator and IPA programs in 11 states: Arkansas, California, Colorado, Connecticut, Delaware, Maryland, Minnesota, Nevada, New York, Oregon, and Washington. Analyzing state documents and requests for proposals (RFP), the brief outlines the program model, the role of each kind of assister, entities eligible to serve, certification and training needed, as well as compensation and funding for each of the states.

Research Findings To Inform Consumer Outreach for Premium Tax Credits – In response to the concern that consumers may not be aware of or understand how premium tax credits work, a new report from Consumers Union examined consumer responses to a brochure on premium tax credits. Consumer focus groups in Maryland, Oklahoma, and Utah found that the brochure and its supplemental material were successful in helping consumers understand the design and eligibility requirements for premium tax credits. The brochures are available for use in the public domain. Consumers Union will host two webinars on the research findings and the brochure. While each has reached its registration capacity, you can use the link to indicate your interest in another session.

May 1, 2013

This edition of the Finish Line Flash highlights resources on Medicaid, private insurance, health reform, as well as outreach and enrollment.  The Medicaid resource links you to a report from the Congressional Research Service on Disproportionate Share Hospital payments that includes a handy map indicating state DSH expenditures as a percentage of Medicaid spending. It is followed by a new SHADAC report on trends in employer-sponsored insurance and associated state fact sheets that help to underscore the erosion of ESI coverage over the past decade. Our pick for a health reform resource is State Refor(u)m‘s table outlining state exchange plan certification standards. And under upcoming events, you’ll find a webinar hosted by CMS on using social media as part of the Connecting Kids to Coverage initiative.


State DSH Allotments and Spending – This map illustrates total state disproportionate share hospital (DSH) expenditures as a percentage of total Medicaid medical assistance expenditures.  It’s a great way to gauge the potential impact in your state of coming changes to DSH payments under the ACA.  The map shows the contribution to Medicaid expenditures in 2011 ranged from a low of 0% in Wisconsin to a high of 12.1% in New Jersey.  The map is contained in a longer report on DSH payments from the Congressional Research Service. In addition to providing background on DSH, the report also discusses DSH allotments, payments, and expenditures.

Private Insurance

State-level Trends in ESI Over the Past Decade – Although most Americans still receive their health insurance through an employer–sponsored insurance (ESI) plan, this SHADAC report details how ESI coverage has eroded over the last decade.  The report examines national and state-level trends in ESI coverage and serves as a baseline against which the impact of the ACA can be monitored. It also includes convenient state-specific summary tables that break down ESI coverage trends by income and age, access to and take-up of ESI, average annual premiums and employee contributions, among a few others.

Health Reform Resources

States’ Standards for Qualified Health Plan – State-based health insurance exchanges are taking a variety of approaches in deciding how they will certify health plans. This table from State Refor(u)m outlines states’ approaches to health plan certification, including: whether the exchange has authority to actively purchase,  if the exchange will use active purchasing in 2014, the QHP certification date and length, if there are any additional network adequacy requirements, what rating factors are allowed, and if the exchange has developed standard plan designs.  The table is a great way to check on other state’s decisions on topics like network adequacy or geographic rating areas that may be helpful for your own state discussions.

Upcoming Events

Using Social Media to Connect Kids to Coverage – This is the second in a two-part series of webinars hosted by CMS as part of its Connecting Kids to Coverage initiative. Join CMS representatives for a discussion of how social media can assist efforts to engage and build a network of organizational partners and community members. Attendees will be given hands-on, practical advice, in addition to hearing how other organizations use social media in their outreach strategies. The webinar will take place next Wednesday, May 8, at 3:00 PM Eastern.

April 18, 2013

This edition of the Finish Line Flash highlights a number of briefs and reports and three upcoming webinars, all of which will be helpful to advocates’ work on health reform. The first is a checklist to help ensure that all states are in compliance with Medicaid provisions required under the ACA. The second is a brief that refutes erroneous claims made about early Medicaid expansions in Arizona and Maine. Next is a two-page brief that highlights the importance of Medicaid expansion for continuous coverage for women. Then, a report from the Urban Institute examines the burden of medical spending with state-by-state data focused on those who would benefit from Medicaid expansion. Two of the featured webinars are scheduled for today; the first will be hosted by Enroll America and will discuss the recently released grant opportunity for Navigators in federally facilitated exchanges and the second will be hosted by the Center on Budget and Policy Priorities and will focus on alternative benefit plans and premium assistance options in Medicaid. The final webinar will explore how to use media to help enroll children in Medicaid and CHIP. CMS will host the webinar next Wednesday as part of the Connecting Kids to Coverage initiative.


State Medicaid Checklist for 2014 – Written by the National Academy for State Health Policy and supported by the State Health Reform Assistance Network, this checklist highlights changes that the ACA requires all states to make to their Medicaid programs by January 1, 2014. Additionally, it delineates the provisions that are necessary only for those states expanding Medicaid, and a few optional provisions that states may want to consider as they modernize their eligibility systems. The checklist groups requirements into five domains: eligibility and enrollment, operations, financing, benefits, and consumer assistance. Also, each requirement cites the timeframe for completion and links to relevant resources.

The Truth About Medicaid in Early Expansion States – This brief from Finish Liner Anne Dunkelberg at the Center for Public Policy Priorities in Texas debunks claims made about existing Medicaid expansions in Arizona and Maine by a Florida think-tank, the Foundation for Government Accountability. The brief explains the claims are problematic in that they “ . . . inappropriately hold adult Medicaid expansion responsible for growth and cost trends that actually occurred in most states – or even all states—over the period analyzed.” This brief will be particularly useful to advocates in states that are facing similar opposition to the expansion of Medicaid.

CBPP Highlights Benefits for Maternal and Child Health of Medicaid Expansion—While the ACA’s Medicaid expansion is often classified as one for childless adults, a quick brief from the Center on Budget and Policy Priorities points out the clear benefits that more continuous coverage would offer for women before and between pregnancies.  It notes the value of continuous coverage for both women and children and suggests savings state can achieve by supporting healthier births with a Medicaid eligibility threshold that does not depend on pregnancy.

Medical Out-of-Pocket Spending and the Potential Impact of Medicaid Expansion – This report, authored by researchers at the Urban Institute and supported by the Robert Wood Johnson Foundation, is one of the first to provide a state and income level-specific analysis on the burden of medical spending.  As expected, it finds that those with lower income devote a greater share of their spending to medical costs.  Further, it specifies how many of those who would be eligible under a Medicaid expansion face a high burden of medical spending.  Table 2 reports the 75th percentile of burden for individuals above and below 138% FPL. It shows, for instance, that in Arkansas, a quarter of the population below 138% FPL spend 20% or more of their income on medical expenses.  In Wisconsin, one in four low-income residents spend at least 16.4% of their income on health care.

Upcoming Events   (Note: the schedules for the first two webinars overlap) Best Practices for Navigator Applicants   –  Enroll America will host this webinar for organizations that plan to pursue the new federal navigator grant opportunity. The webinar will provide an overview of the funding opportunity and identify potential resources for applicants. In addition, community leaders from Arizona, Ohio, and Tennessee, three states with federally-facilitated marketplaces, will join the discussion to offer insight on their past experiences using federal grants for enrollment assistance or their plans to pursue the Navigator grant opportunity.  The webinar will take place on today, Thursday, April 18, at 2:00 PM Eastern.

Medicaid Alternative Benefit Plans and Premium Assistance Options – The Center on Budget and Policy Priorities will host a webinar on Medicaid alternative benefit plans, the plans that must be provided to most newly eligible beneficiaries in states that decide to expand Medicaid. During the first hour, the discussion will focus on the populations that must be covered by alternative benefit plans, how plans will be structured, what flexibility states have in designing plans, and the role that advocates can play in designing benefit packages. The last half-hour of the webinar will turn to the issue of using premium assistance to enroll Medicaid beneficiaries in QHPs and thus will be particularly relevant to advocates in states that are considering this option. The webinar will take place today, Thursday, April 18, at 2:30 PM Eastern.  

Using Media to Enroll Children in Medicaid and CHIP  – CMS will host this webinar as part of its Connecting Kids to Coverage initiative. Join CMS representatives for a discussion of the various types of media outreach: paid, earned, social, and owned media, and how each can aid in  outreach and enrollment efforts. Attendees will learn how to engage local media and prepare for media interviews. In addition, partners from the initiative will share their experiences of working with media and using social media to boost outreach. The webinar will take place next Wednesday, April 24, at 3:00 PM Eastern.

April 4, 2013

In this edition of the Finish Line Flash, we bring you a number of resources related to Exchange implementation. The first brief, from a variety of national child-focused organizations (and authored by Finish Liner Lincoln Nehring of Utah), examines how to ensure that Exchanges work for children. It is followed by two resources that focus on consumer assistance: a brief from the Pacific Business Group on Health that looks at how to create user-friendly experiences in web portals and a blog post from State Refor(u)m that examines the different approaches states are taking in their Navigator and Assister program designs. We also include information on upcoming CMS calls for state stakeholders on federally facilitated and partnership Exchanges.

Consumer Assistance

Top Five Rules for Consumer Decision Support in Exchanges – The Pacific Business Group on Health (PBGH) presents their top five principles for ensuring user-friendly decision supports in Exchange web portals. Based on PBGH’s research, the principles highlighted in the three-page brief address how Exchanges can present cost information; organize plans; employ short-cuts to improve user experience; focus on the issues that matter most to consumers; and use a consolidated provider directory to allow for easy searching of provider participation in plans. For Exchanges that are not able to implement these approaches before open enrollment begins, the brief also outlines strategies to bridge any gaps.

Details Begin to Emerge on State Navigator and In-Person Assistance Programs – In this blog post, State Refor(u)m’s Rachel Dolan reviews five states’ approaches to implementing three key features of state Navigator and In-Person Assister programs: contract design, performance metrics, and certification.  Examination of applications and RFPs from Colorado, Delaware, Maryland, New York, and Nevada reveal that states are using a variety of strategies in designing their programs.

Health Reform Resources
Ensuring Exchanges Address the Needs of Children – This brief, authored by Lincoln Nehring of Voices for Utah Children for several national child advocacy organizations, outlines seven key components of Exchange design and implementation that will positively affect children and their access to care. The necessary elements include: pediatric representation in Exchange governance; effective consumer assistance; comprehensive child-specific Essential Health Benefits; seamless coverage and care through strong coordination with Medicaid and CHIP; access to the health care providers that kids need; appropriate pediatric-focused quality measurement and improvement; and transparent exchange planning and operation.  In addition, the brief includes a list of other resources focused on making Exchanges work for children.

Upcoming Events
CMS to Hold Regional Stakeholder Calls – Starting in the last week of April, CMS will hold stakeholder consultation calls for Federally-facilitated and State Partnership Marketplace states.  The CMS regional offices will host a separate call for each state with an FFM or state partnership.  A tentative schedule can be found by clicking the link above.

March 20, 2013,

This edition of the Finish Line Flash, which coincides with the first day of spring, is blooming with resources to aid advocates.  We highlight new county data on uninsured rates and access to care, two briefs on designing consumer assistance programs, and a case study of a successful Medicaid enrollment initiative in Utah.  Resources related to health reform include a brief on the barriers to employer-sponsored health insurance access for low-income adults and one on states’ decisions and decision-making approaches when choosing an essential health benefits benchmark plan.

New Data

Annual County Health Rankings  –– Today, the Robert Wood Johnson Foundation released its annual report on county health rankings, complete with interactive maps. Advocates will be particularly interested in the data on uninsured rates and the ratio of residents to primary care physicians and to dentists.

Consumer Assistance

Considerations for Consumer Assistance Policy and Program Design ––  This brief, prepared by the State Health Reform Assistance Network, summarizes the basic information and guidance released to date on Navigator and In-Person Assistor (IPA) programs.  It also outlines policy decisions that states will have to make when designing their Navigator programs, such as how Navigators will interact with Medicaid and the private market, how Navigators will be funded, which payment mechanisms to use, and how to evaluate their performance, among other things.  A list of related resources and materials from states that have begun to make policy and operational decisions is provided at the end of the brief.

Resources to Aid Design of Consumer Assistance Programs – A second brief from the State Health Reform Assistance Network summarizes a list of consumer assistance resources to help state officials make decisions about how to design consumer assistance strategies.  The resources cover four major topic areas that states need to consider as they develop consumer assistance strategies: outreach and engagement through marketing and advertising; enrollment assistance through Navigators and in-person assistors; engagement of insurance producers (agents and brokers); and individualized support through call centers and other communications.

Outreach and Enrollment

Case Study of Outreach and Enrollment Strategies in Utah –– What does a successful outreach and enrollment strategy look like?  This brief, which focuses specifically on an initiative among health centers in Utah, provides one example. From developing a strategy to conducting an evaluation, the lessons learned in Utah can inform the enrollment efforts of other states. This brief is part of the “Getting Into Gear for 2014” series that examines key implementation issues as states prepare for the ACA coverage expansions.

Health Reform Resources

Working Adults’ Need for Medicaid Expansion –– This brief from the Center on Budget and Policy Priorities addresses the myth that adults who will be newly eligible for Medicaid under the ACA already have access to coverage, or that they would have access if they were employed. In addition, the brief discusses how expanding Medicaid to more adults will improve their health and economic stability.

State Decisions on Essential Health Benefits  –– This issue brief, authored by researchers at the Georgetown University Center for Health Insurance Reforms and supported by the Commonwealth Fund, examines state action to select an essential health benefits benchmark plan. Twenty-four states and the District of Columbia have formally selected a plan, of which all but five states will have a small-group plan as their benchmark. Studying the benchmark selection process of 10 selected states, the brief also describes the varying approaches taken by states, including intergovernmental collaboration, stakeholder engagement, and research on benchmark options.

March 6, 2013

In this edition of the Finish Line Flash, we link you to several Medicaid resources, including a brief from the Kaiser Commission on Medicaid and the Uninsured on premiums and cost sharing and a new Georgetown CCF brief on access to care for Medicaid beneficiaries. We also feature resources from InsuringOurFuture.org, a partnership of advocacy organizations in Colorado. Under enrollment and eligibility, we highlight a blog post from Gene Lewit, who discusses an evaluation of California’s on-line application system. We also include news of a webinar that will be hosted by StateRefor(u)m next week, focused on reforms in Medicaid other than the expansion to childless adults.


Advocacy and Outreach Materials from Colorado – Finish Liners in Colorado are part of Insuring Our Future, a partnership of individuals and organizations across the health care spectrum that are working together to protect and strengthen Medicaid for the people of Colorado. The resource section of the website is stocked with a plethora of materials on Medicaid, including briefs on the basics of the program and reports that explain the significance of the expansion for Colorado. Also, a story bank provides a glimpse into the lives of Coloradans from a variety of life circumstances that have benefitted from Medicaid and CHP+.

Premiums and Cost-Sharing, Past, Present and Future – This brief from the Kaiser Commission on Medicaid and the Uninsured provides an overview of cost-sharing and premiums in Medicaid. It covers what is currently allowed by federal law, by type of service and percent of the poverty level, the number of states that currently impose premiums and cost-sharing, and the updated rules for premiums and cost-sharing recently proposed by HHS.

Access to Care in Medicaid -– Georgetown CCF’s latest brief surveys research on access to care for children and adults in Medicaid. It finds that children and adults in Medicaid are much more likely to access the care they need than the uninsured. In addition, access to care in Medicaid is comparable for many measures to access for the privately insured. While there is some room for improvement in areas such as access to specialty care, overall Medicaid provides needed access to care. On Say Ahhh!, Joan Alker blogged about the new brief and Tara Mancini reports on how primary care access needs will vary in the years ahead.

Eligibility and Enrollment

Knowing Your Audience is Key to Enrollment Success –– Gene Lewit of the David and Lucille Packard Foundation guest blogs for Say Ahhh! about the latest findings from Mathematica’s evaluation of Health-E-App, California’s web-based application system. The brief details the characteristics and experiences of those who completed on-line applications through the self-service tool. The blog post notes that the findings underscore the significance of knowing your audience. The fact that not all enrollees will be able to access on-line self-service tools or may not be comfortable using them highlights the need to “. . . [B]uild out the system of Navigators and other in-person supports to enroll the large number of people who prefer paper applications and/or the help of a live person,” Gene writes.

Upcoming Events

Preparing for Complex Changes in Medicaid – State Refor(u)m will host a panel of health policy analysts and state officials for a webinar discussion on key Medicaid reforms required under the ACA other than expanding eligibility to childless adults. It will touch on eligibility and enrollment, financing and benefit design, and consumer assistance. A brief overview of these reforms will be provided before state officials speak to the status of these improvements in their states. State Officials will include: Beth Osthimer from New York, Linda Skinner from Arizona’s Governor’s Office, and John Supra from South Carolina. NASHP’s Alice Weiss and Kaitlin Sheedy will also join the panel, which will be moderated by Matt Salo of the National Association of Medicaid Directors.

“Beyond the Expansion Decision: Tackling the Other Medicaid Changes in the ACA” will take place on Wednesday, March 13th, from 1:00-2:00pm EST.

February 20, 2013

This edition of the Finish Line Flash passes along four useful resources. The first highlights a Health Affairs article on Oklahoma’s early work to streamline enrollment. It is followed by two briefs for state advocates from Families USA; the first is a to-do list for 2013 and the second discusses consumer-friendly qualified health plans (QHPs). The last item is a short piece from the Kaiser Family Foundation that discusses the impacts that private market reforms will have on premiums in the market for nongroup (individual) health insurance.

Eligibility And Enrollment

Lessons from the Sooner State in Streamlining Enrollment Systems –– In this Health Affairs article, NASHP’s Alice Weiss writes that Oklahoma’s early work to streamline its enrollment systems has helped the state save money and make real-time enrollment a reality.  The state’s success is linked to early implementation of the No Wrong Door concept, retooling staff to increase efficiency, and the use of metrics to monitor state performance. The Oklahoma experience can offer lessons to other states as they begin their final year of preparations to implement similar eligibility and enrollment system reforms under the Affordable Care Act.

Health Reform Resources

Key Issues for Advocates in 2013 –– Families USA created this to-do list to assist state advocates in what is sure to be a busy year. The list includes tasks for six key work areas, including the Medicaid expansion, exchanges, and eligibility and enrollment, among others. In addition, links are provided to some of Families USA’s more detailed resources.

Implementing Consumer-Friendly QHPs –– This brief provides examples from eight state-based exchanges and one partnership exchange of the consumer-friendly standards that must be met by QHPs sold in the new insurance exchanges. These cases will be helpful to advocates in states that are currently working to establish consumer protections, such as provider network adequacy, health plan standardization, quality reporting, and other key issues that will be central to establishing an exchange that meets the needs of consumers and small businesses.

Private Market Reform

Premium Changes in Nongroup Insurance –– Recently, much attention has been paid to how private health insurance premiums may change under the ACA, especially its provision to limit pricing variation due to age. The Kaiser Family Foundation explains in their Policy Insight that many of the ACA’s reforms will affect premiums in several ways, by raising, lowering, or redistributing them across groups.  Overall, Kaiser estimates that under health reform, premiums will be slightly higher for those with unsubsidized nongroup insurance as compared to current costs.  However, these increases will be accompanied by beneficial market reforms that include: the ability for more people to access coverage, less variability in premium rating, more comprehensive health insurance benefits and capped out-of-pocket expenses.  The piece concludes that delaying age rating rules may be unnecessary due to the federal subsidies young people will receive, the availability of catastrophic coverage plans, and the reinsurance payments the federal government will make to help stabilize premiums.

February 6, 2013

This week’s edition of the Finish Line Flash brings you two resources on Medicaid, one on health reform, as well as two upcoming webinars.  Included under the Medicaid resources is a brief from advocates in Pennsylvania on how an expansion will benefit the state’s families, and a presentation from the Center for Health Care Strategies on improving care coordination for children in foster care. A new brief from Health Affairs, the featured health reform resource, examines potential issues that will be encountered in federally facilitated exchanges. Enroll America hosts the first webinar featured below, in which they will share key findings from their research on messaging exchanges to the uninsured, and the State Health Reform Assistance Network will give a presentation on strategic plan management of qualified health plans selected for exchanges.


Covering Pennsylvania’s Parents Is Good for Kids –– Using state data published by Georgetown CCF, advocates in Pennsylvania make the case that expanding Medicaid in the state will strengthen its families. Connecting uninsured, low-income parents to coverage will contribute to children in these families also receiving the coverage and preventative health care that they need. In addition, the expansion provides families with economic security, as these parents will not have to worry about squeezing health care into their already tight budgets. The fact sheet also links to the Pennsylvania Health Law Project’s earlier analysis of the cost savings the expansion will have for the state.

Creating Environments to Help Youth Thrive –– This presentation was given at the Georgetown Public Policy InstituteLEAD Conference by Kamala Allen, Vice President and Director of Child Health Quality at the Center for Health Care Strategies. The presentation focuses on the health-related needs of children in foster care and how to improve health outcomes for this population. An overview of states’ activities in these areas, including those trying to improve the experience and care coordination of foster care children in Medicaid, is also provided.

Health Reform Resources 

Core Functions and Issues Related to Federally Facilitated Exchanges –– This Health Affairs policy brief provides a brief overview of the five core functions that must be implemented by a health insurance exchange, regardless of the model. The brief then discusses issues that may arise in federally facilitated exchanges (FFE), for instance, discrepancies between state and federal regulation of health care plans, the potential risk of adverse selection, the increased cost of federal insurance subsidies in states that do not expand Medicaid, and perhaps even the availability of federal subsidies in the FFE.

Upcoming Events  (NOTE: These Webinar Presentation Times Overlap)

Findings on Enroll America’s Messaging Research – Enroll America’s Martine Apodaca hosts this webinar with Michael Perry and Tresa Undem of Lake Research, as well as Alison Betty and David Smith of GMMB, in order to share findings from their research on the level of awareness among uninsured adults of the health insurance coverage options that will be available through the health insurance marketplaces slated to open for enrollment later this year.  Through a comprehensive national enrollment survey and 10 focus groups of uninsured adults who are likely to be eligible for free or reduced cost coverage through the new marketplaces, researchers found that the majority of these adults are unaware of the new options that will be available to them. To learn more, join the webinar next Thursday, February 14, 2013, from 2:00-3:15 p.m. Eastern.

Managing Qualified Health Plans in an Exchange – The State Health Reform Assistance Network will host this webinar to discuss the important and ongoing task of attracting, certifying, re-certifying, and de-certifying plans. This webinar will explore how exchanges can strategically solicit, certify, and manage their relationship with health plans over time. The webinar will take place next Thursday, February 14, 2013, from 2:00-3:00 p.m. Eastern.

January 23, 2013

This edition of the Finish Line Flash includes four helpful resources: a webpage that tracks Medicaid expansion developments across the states, 51 state-specific CHIP fact sheets from the National Academy of State Health Policy (NASHP), and an issue brief on state policy considerations for implementing Express Lane Eligibility that was developed by NASHP with assistance from the State Health Reform Assistance Network. In addition, we include a recent article from Health Affairs that examines some consumers’ experiences with the Massachusetts Health Connector and the lessons they hold for other states’ health insurance marketplaces.

Medicaid and CHIP

Medicaid Expansion Tracker – State Refor(u)m is keeping tabs on states’ Medicaid expansion decisions. The table includes web links to announcements made by governors or other executive branch members as well as state legislative activity and any fiscal and demographic analyses regarding the expansion.  The chart also includes helpful information, such as the percentage of uninsured poor adults and the history of subsidized coverage for parents and childless adults in each state.

CHIP Fact Sheets– NASHP created these fact sheets to reflect the status of states’ CHIP programs. The fact sheets report data on enrollment and participation rates, federal matching rates, eligibility and cost sharing requirements, and enrollment and renewal simplifications.  Information is also included for voluntary coverage elements, such as coverage for dependents of public employees, waiting periods for new enrollees and lawfully residing immigrant children, and the CHIP buy-in option. Data presented in the fact sheets were compiled from a variety of sources, including state reported data.

Policy Considerations for Express Lane Eligibility – Express Lane Eligibility allows states to simplify their eligibility and enrollment processes in Medicaid and CHIP.  Building on the experiences of states that have implemented Express Lane Eligibility (ELE), this issue brief from the State Health Reform Assistance Network and the National Academy for State Health Policy reviews key questions for states to examine when implementing ELE. Among the decisions for a state to consider are: which populations to target, which agencies will conduct eligibility determinations and at which point in the process, and whether states will auto-enroll based on ELE determinations.

Health Reform Resources

Massachusetts Experience Reveals Importance of Consumer Assistance  – This article, published in the latest issue of Health Affairs, discusses findings from a 2010 survey of enrollees of one plan offered through the Massachusetts unsubsidized health insurance exchange, “the program that most closely resembles the plan choice structure proposed in the Affordable Care Act.”  Over 40 percent of the respondents found the plan information difficult to understand, and while a third of respondents did receive help when selecting a plan, assistance most commonly came from friends or family.  A fifth of the survey respondents reported that they would have liked assistance when choosing their plan, and thus were more likely to report difficulty in understanding plan information, even after enrolling.  Moreover, almost a third of respondents reported income that would have made them eligible for a subsidized plan.  The results of this survey highlight the important role that consumer assistance can play, at least for a subset of consumers. Additionally, the article discusses some of the changes that the Massachusetts exchange implemented after the survey to facilitate a more consumer friendly experience.

January 9, 2013

Welcome to the first edition of the Finish Line Flash for 2013. We hope everyone’s year is off to a great start. Below we include HHS’s report on the quality of care for children covered by Medicaid and CHIP in 2011 as well as a useful summary of CMS’s final rule on Medicaid eligibility, enrollment simplification, and coordination.  Health reform resources include an infographic that visualizes the options and requirements for health coverage under the ACA. And between Enroll America’s webpage dedicated to information on in-person assisters and a brief from the California Health Care Foundation on engaging consumers to think about health insurance value, you’ll have a bevy of resources related to consumer assistance.

Medicaid and CHIP

Annual Report on Quality of Care for Children in Medicaid and CHIP  – In December, HHS released its 2011 review of the quality of care provided to children enrolled in Medicaid and CHIP. Mandated by CHIPRA, this annual progress report on national and state-specific data evaluates the completeness of reporting for the initial core of children’s health care quality measures. The collected data provide an opportunity to analyze the access to and quality of services received by child beneficiaries. Data on consumer experiences with health care and efforts by CMS and other stakeholders to improve the quality of care are also included.  Under CHIPRA’s voluntary reporting, states reported on a median of 12 measures and 33 states reported on at least one measure for both Medicaid and CHIP.  See Exhibit 6 on page xxii for a comparison of median state Medicaid and CHIP measures to the equivalents in commercial health plans.

New Rules for Medicaid Eligibility and Enrollment – The Kaiser Family Foundation provides a summary of CMS’s final rule on Medicaid eligibility, enrollment simplification, and coordination, which lays out procedures for states to implement the Medicaid expansion and the streamlined and integrated eligibility and enrollment system created under the Affordable Care Act. The brief presents a number of key issues that need to be taken into consideration in order to achieve these goals, including the close coordination between Medicaid, the new health insurance Exchanges, and other insurance affordability programs.

Health Reform Resources

Mapping Coverage under the ACA –  This single page infographic from Visualizing Health Policy, a joint effort from the Journal of the American Medical Association and the Kaiser Family Foundation, is a step-by-step guide to the options and requirements for health coverage under the Affordable Care Act beginning in 2014, including coverage provided through employers, health insurance exchanges, and Medicaid.  Note, though, that the infographic does not show that pediatric dental coverage may be offered by stand alone plans.

Enroll America In-Person Assister Resources – In an effort to help stakeholders develop and launch successful outreach and enrollment programs, Enroll America created a webpage to list useful resources. It includes federal government guidance and general and state specific information on state navigator and in-person assistance programs, as well as information on agents and brokers. Links are also provided to states that have developed outreach and assistance plans.

Engaging Consumers to Consider Health Insurance Value – When presented data on health coverage quality results and use, can consumers use that information to make decisions when purchasing health insurance? This brief from the California Health Care Foundation draws on focus group findings to determine if consumers understand data on health coverage value, information that will be presented to consumers through health insurance exchanges. Findings indicate that consumers, particularly the uninsured, are interested in having access to value data when purchasing insurance through the exchanges. However, these data must be accompanied by some education efforts to overcome the misperception that higher cost indicates higher quality.