Health Insurance Exchanges: Progress in Iowa, Minnesota, Nevada, New York, Oregon, Rhode Island, and DCKip Piper -
Much about the Health Insurance Exchanges is uncertain, even as the October 1 deadline to make them operational approaches. Many states running their own or partnership exchanges have yet to decide on key elements of plan management, consumer outreach, and other important functions. Exchanges are a genuine game changer...
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 beneficiaries that meet specific criteria. Institutional SNPs (I-SNP) serve beneficiaries who, for 90 days...
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 that take into account differences among states in health costs, demand for services,...
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 decide how to allow for disparate state and federal requirements for exchange-based plans,...
Kip Piper -
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 subsidies, softening the sting of so-called premium shock and attracting healthier people to...
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 federal Medicaid expansion money to give premium subsidies for Medicaid beneficiaries to enroll...
Impact of ACA on Health Premiums and Enrollment: Society of Actuaries Estimates of Health Reform LawKip Piper -
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 analytical perspective, the ACA is a simultaneous, non-linear equation from hell. A number of...
Kip Piper -
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 switch from private insurance, which pays much higher provider rates than Medicaid does....
Kip Piper -
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 plans or Medicaid fee-for-service, depending on the state), the new enrollees would be...
Strategic Approach to Qualified Health Plans in Health Insurance Exchanges: Selecting and Managing QHPsKip Piper -
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 Care Act's most complex and ambitious features - will require comprehensive, well-structured strategies,...
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