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

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),...
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...
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...
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 (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...
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...
A new federally mandated tax on health insurers will increase costs for state Medicaid programs and Medicaid health plans. In an excellent new report, PPACA Health Insurer Fee Estimated Impact on State Medicaid Programs and Medicaid Health Plans, Milliman, retained by the Medicaid Health Plans of America (MHPA), conducted an independent...
The Patient Protection and Affordable Care Act (ACA) requires benefit plans offer a minimum set of essential health benefits. Those include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitation and habilitative services and devices, and laboratory services. The...
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 previous research, Milliman, one of the nation's top actuarial firms, provided an overview of the impact made by guaranteed issue and community rating reforms on the health insurance markets within eight states in the 1990s. Retained by America’s Health Insurance Plans (AHIP), Milliman has published an update to this...

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