Creating Seamless Coverage Transitions between Medicaid and the Exchanges
Center for Health Care Strategies - Carolyn Ingram, Shannon M. McMahon, and Veronica Guerra
Under health reform, Medicaid will expand in 2014 to cover an additional 16 to 20 million beneficiaries. This population will include a significant percentage of childless adults with urgent and complex health care needs, who are likely to shift between subsidy programs over time. This brief, prepared by the Center for Health Care Strategies, draws from current state programs that have dealt with this challenge successfully. The experiences described herein can help states develop policies and procedures that foster seamless coordination of care during coverage transitions between Medicaid managed care organizations and qualified health plans in the exchanges. A companion matrix includes excerpts of sample contract language related to coverage transitions in existing programs.
In February, Galen Benshoof underscored the importance of agents and brokers in ensuring robust enrollment and exchange sustainability. Recognizing this, the State Network funded programs in Illinois and Minnesota, led by Wakely Consulting Group (Wakely), to enhance in-person agent and broker engagement while expanding their capability to assist anyone who walks through their doors, even if they are eligible for Medicaid or other state coverage programs. These Lead Broker Agency programs were a success, and the states are planning to continue or expand the programs next year!
A new issue brief, prepared by Kathie Mazza at Wakely and available here, describes the concept of these pilots and outlines how other states interested in partnering with insurance brokers can implement similar initiatives for future open enrollment periods.
Student health plans have long been a source of coverage for college students who do not have other options available. In 2012, the U.S. Department of Health and Human Services redefined student health plans under the Affordable Care Act (ACA), requiring that they be treated like individual health insurance. This means that students buying these plans through their college or university now have the same protections available to them as if they bought a plan in the individual market. It also means that states and the federal government have a new role in oversight of these plans.
The State Network team mourns the recent passing of our dear friend and colleague, Andy Hyman. Andy was the father of the State Network, seeing the value in connecting states with the expertise they need to achieve the vision of coverage that drove him every day.