Start: May 2011

End: January 2016

Funder: Robert Wood Johnson Foundation


The Affordable Care Act (ACA) offered the promise to expand health insurance coverage to as many as 32 million people nationwide – reducing the number of uninsured people in America by more than half. Through the State Health Reform Assistance Network (the State Network), the Robert Wood Johnson Foundation (RWJF) invested in technical assistance to maximize coverage gains made possible by the ACA.

As part of RWJF’s State Network, the Center for Health Care Strategies (CHCS) provided intensive technical assistance to numerous states including a core set of 11 — Alabama, Colorado, Illinois, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island, and Virginia — as they implemented the ACA’s coverage provisions. CHCS’ technical assistance helped these states pursue the below milestones to expand Medicaid to newly eligible populations:

  1. Establish Benefit Design – Compare current Medicaid benefits and delivery systems with benchmark options and essential health benefits to meet the new populations’ expected needs.
  2. Contract with Plans and Providers – Develop contracts with plans and providers, resolve procurement and rate-setting issues, and establish successful relationships between exchange qualified plans and Medicaid.
  3. Collaborate between the Exchange and Medicaid – Establish Medicaid’s role in the exchange structure, ensure smooth coverage transitions, and use combined purchasing leverage to ensure access to coordinated care.
  4. Secure Federal and State Authority  Identify and develop necessary state regulatory authority and obtain federal authority (e.g., through a State Plan Amendment or Medicaid waiver).
  5. Build a Bridge to Expanded Coverage  Assess the opportunities associated with strengthening current Medicaid programs, including benefit package redesign, cost sharing and rate-setting options, and efforts to integrate care; and early expansion.

Technical assistance activities included: (1) needs assessment/policy analysis; (2) direct technical assistance and connection to expert resources; (3) stakeholder engagement; and (4) assistance in applying for federal implementation grants.