As part of the Health Reform Toolkit Series, the Blue Cross Blue Shield of Massachusetts Foundation, the Robert Wood Johnson Foundation, and the Commonwealth Health Insurance Connector Authority have published Effective Education, Outreach, and Enrollment Approaches for Populations Newly Eligible for Health Coverage. The series offers resources for health...
A new report outlines the key principles and various options for funding the operating costs of Health Insurance Exchanges mandated under the Affordable Care Act. Nevada’s Silver State Health Insurance Exchange describes methods other states are using or may use to finance day-to-day operations of a Health Insurance Exchange...
Health insurance plans are required to report their administrative expenses. For health plans in the for the large group, small group, and individual insured markets, an new report from Milliman details insurers’ administrative expenses in five categories:
Expenses for improving healthcare quality
Claims adjustment expenses
Agents and brokers fees and commissions
Direct sales...
The Affordable Care Act (ACA) requires that most Americans have health insurance that meets minimum federal requirements. Under the controversial mandate, starting in 2014, most individuals under 65 must purchase minimum essential health insurance coverage or pay a penalty to the IRS. One practical concern is that healthy individuals...
Under the Affordable Care Act (ACA), states are responsible for implementing a complex array of health reforms, most notably Health Insurance Exchanges, Medicaid expansion, and health insurance market regulations. ACA presents states, particularly state Medicaid agencies and insurance departments, with unprecedented policy, fiscal, programmatic, operational, and systems challenges.
A helpful new...
New federal guidance outlines what States must do to demonstrate they are ready to operate a Health Insurance Exchange (HIX) or share HIX functions with the Centers for Medicare and Medicaid Services (CMS). While CMS guidance on HIX implementation and operation remains very general and many questions remain, the new guidance...
Under the Affordable Care Act, Health Insurance Exchanges, whether state or federally operated, must manage several core functions starting in 2014. The functions include pre-screening for Medicaid or CHIP coverage, federal subsidy eligibility determination, consumer assistance, management and oversight of qualified health plans (QHPs), financial management, and enrollment of individuals or small...
States that expand Medicaid and establish Health Insurance Exchanges - both part of the Affordable Care Act (ACA) - should start planning early, should take advantage of time-limited federal funding to improve enrollment systems, and should emphasize online enrollment methods, says a brief from the Robert Wood Johnson Foundation’s Maximizing...
The rise of uninsurance in the South and West over the past decade means those regions have the most to gain from the Affordable Care Act’s (ACA) coverage expansions, says a brief by the Urban Institute sponsored the Robert Wood Johnson Foundation. However, new taxpayer-financed health insurance coverage in the ACA...
States deciding whether to create a Basic Health Program (BHP) are worried it could undercut their health insurance exchanges, create a new entitlement program, and could carry financial risks if federal funds don’t cover the costs, according to a series of briefings on state progress in implementing the Affordable...
