Improving the quality and cost-effectiveness of publicly financed health care
Coordinating Medicaid Expansion and Exchange Benefits
The Patient Protection and Affordable Care Act (ACA) expands Medicaid to cover all low-income individuals up to 133% FPL. State Medicaid agencies are charged with creating benchmark benefit packages for the 16-20 million projected new enrollees while coordinating eligibility and enrollment with the exchanges that will cover millions of Americans above 133% FPL. This meeting brought together a small group of experts to consider the issues around: 1) defining the benefit packages for the Medicaid expansion population; 2) the impact of benefit design on rates, risk adjustment and actuarial soundness; and. 3) how Medicaid benefits should be aligned with other subsidized insurance offerings in the exchange to minimize the impact on enrollees churning between the two programs.
For a brief overview of the meeting, visit the National Academy for State Health Policy's Refor(u)m blog (see Attending to Benefit Design post, 12/10/10).
I. Setting the Stage - Aligning Benefits Across Medicaid and the Exchange
Allison Hamblin, MSPH - Director, Complex Populations, Center for Health Care Strategies
Anticipating the Health Needs of the Expansion Population
Julia Paradise - Associate Director, Kaiser Commission on Medicaid and the Uninsured
Explaining Health Reform: Benefits and Cost-Sharing for Adult Medicaid Beneficiaries
Issues Discussed:
- What are the health needs of the expansion population, especially those that may churn between programs around 133% FPL and how should that impact benefit design and alignment across Medicaid and the exchange?
- What types of physical health, mental health and substance abuse benefits must/should be offered in the expansion population and exchange?
II. Essential Health Benefits and Benchmarks
Darin Gordon - Medicaid Director, Tennessee
John Kaelin - Senior Vice President, Health Reform, United Healthcare
Issues Discussed:
- From the state perspective, what is the ideal benchmark benefits package for the expansion population, e.g. full Medicaid, commercial-like?
- How will expansion benefits differ from existing Medicaid benefits, commercial employer-based plans, and silver tier exchange plans?
III. Coordinating Expansion and Exchange Delivery Systems
Andy Allison, PhD - Director, Kansas Health Policy Authority
John Bertko, FSA, MAAA - Senior Fellow, LMI Center for Health Reform
Issues Discussed:
- What are the tools available for aligning benefits?
- How will benefits coordination differ in Medicaid FFS/PCCM models?
- How will care be coordinated for individuals churning between programs (e.g., network alignment, role of safety-net providers, etc.)?
- How can Medicaid expansion enrollees be appropriately placed in plans/systems of care that best meet their health needs?