Kip Piper's Health Care Blog
Medicare, Medicaid, Health Reform

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...
In February 2012, The Hospital Community Benefit Program, established by the Hilltop Institute at the University of Maryland, Baltimore County (UMBC), published the third issue brief in a series, Hospital Community Benefits after the ACA: Partnerships for Community Health Improvement. The series, published across a three-year span, is funded...
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...
The $350 billion Medicare-Medicaid dual eligible market is an extraordinary new business opportunity for health insurers, as well as a way for state Medicaid programs to generate significant budget savings and improve access and quality of care for frail seniors and persons with severe disabilities.  A dozen states are now looking...
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...
So far, federal guidance has fallen short of what states need to implement the Affordable Care Act’s Medicaid expansion, according to a recent report by the Government Accountability Office (GAO). State officials questioned for the report said delays of meaningful direction from the Centers for Medicare and Medicaid Services (CMS),...

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