All Articles In 'State Health Reform'
Medicare Special Needs Plans: MedPAC Recommendations on Future of Special Needs Plans
Special Needs Plans (SNP) are part of the Medicare Advantage program and were created by the Medicare Modernization Act of 2003 (MMA). There are three types of SNPs, each intended to provide coordinated care for Medicare [...]
Medicaid Federal Match Rates: Reforming the FMAP Formula
The Government Accountability Office (GAO) says it has found a more fair way to set federal matching rates for state spending on social programs such as Medicaid and the Children’s Health Insurance Program (CHIP). Match rates [...]
Multi-State Health Plans in Health Insurance Exchanges: OPM Final Rules
The federal Office of Personnel Management (OPM) had a tricky job in setting rules for multi-state health plans (MSP), which eventually will be offered in all states through Health Insurance Exchanges (HIX). The OPM had to take [...]
Health Insurance Exchange Premiums: Adverse Selection Possibly Mitigated with Taxpayer Subsidies
Fears abound that health insurance premium increases because of the Affordable Care Act (ACA) will discourage young, healthy people from participating in the Health Insurance Exchanges. But most young people are likely to be eligible for exchange [...]
Medicaid Expansion Through Health Insurance Marketplaces: Unresolved Questions
The Centers for Medicare and Medicaid Services (CMS) has answered some questions about how Arkansas’s creative plan to expand Medicaid under the Affordable Care Act (ACA). The plan, which Gov. Mike Beebe put forward, would use [...]
Impact of ACA on Health Premiums and Enrollment: Society of Actuaries Estimates of Health Reform Law
Love it or hate it, the Affordable Care Act is unprecedented in size, scope, complexity, and uncertainty. To project its impact, numerous policy, economic, competitive, and behavioral factors must be considered and assumptions made. From an [...]
Medicaid Expansion and Hospitals: Hospital Medicaid Revenue to Outpace Crowd-Out Losses
The Affordable Care Act (ACA) created a trade-off for providers, particularly hospitals: On the one hand, Medicare fee-for-service hospital payments will be cut by $260 billion over 10 years. Some people newly eligible for Medicaid will [...]
Medicaid Expansion Via Health Insurance Exchanges: CMS Answers on Premium Assistance and Waivers
Some states have expressed interest in using premium assistance to expand Medicaid eligibility under the Affordable Care Act (ACA). Instead of serving the new ACA Medicaid expansion population through the Medicaid delivery system (through Medicaid health [...]
Strategic Approach to Qualified Health Plans in Health Insurance Exchanges: Selecting and Managing QHPs
The qualified health plan contracting process in Health Insurance Exchanges present many opportunities and challenges for states and the Centers for Medicare and Medicaid Services (CMS). Success in implementing the Exchanges – one of the Affordable [...]
Physician Payment Reform: Preparing for Value-Based Reimbursement
Primary care is shifting to payment based on providing higher quality, lower cost health care. New payment models – such as patient-centered medical homes (PCMH) – replace or supplement traditional fee-for-service payments with per-member per-month payments, [...]
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