Friday, December 21, 2012

Health Insurance Exchanges Come into Focus Amidst the Holiday Fog

The Affordable Care Act (ACA) provided for the creation of health insurance exchanges designed to allow consumers and small businesses to visit an online marketplace to compare and purchase insurance plans. Under the law, states can choose to operate their own exchange or, if they are unable or unwilling, a federal exchange will be available for patients to compare plans.

Following last week’s deadline for states to declare their intent to participate, the Obama Administration has now approved 11 state exchanges and one state/federal partnership exchange (Delaware). These exchanges are expected to be operational in time to enroll customers beginning in fall of 2013. Although states can choose to establish exchanges at a later date, it is unlikely they will be able to open in time to meet the January 2014 deadline—any states not meeting the deadline will be served by the federal exchange until their exchange is operational.

INTERACTIVE: For a great overview of which states are planning to participate in the exchanges, visit the Commonwealth Fund’s interactive exchange map.

For health centers, patients with income levels between 133% and 400% FPL eligible to be insured via the exchanges will no doubt become a substantial portion of the new payer mix.  Fortunately, the ACA requires insurers participating in the exchanges to pay health centers their Medicaid PPS rate.  This should help health centers continue to provide the quality, comprehensive care for which they have come to be known.

Tuesday, December 18, 2012

Medicaid Update: CMS declares “all or nothing” opportunity, and other resources

By Joe McKelvey, Project Consultant

Last week, the Centers for Medicare and Medicaid Services (CMS) issued an extensive memo offering additional guidance on Medicaid, State Exchanges and additional ACA-related issues.  The memo indicated that CMS does not believe the ACA authorizes them to approve partial expansions.  As a result, the ACA Medicaid expansion is now an all or nothing proposition. 

Although the ultimate outcome in each state is uncertain, recently revised national estimates from the Congressional Budget Office indicate that Medicaid will cover 6 million fewer individuals.  Unfortunately, only one-third of this group will have incomes high enough to qualify for the newly-created health insurance exchanges which are designed to create a competitive marketplace for consumers to purchase commercial insurance plans.  The remaining 4 million will either have incomes too low to qualify or will opt not to purchase insurance via an exchange plan, many falling into the “donut hole” of individuals who don’t qualify for Medicaid but earn less than 100% of FPL and will be required to purchase insurance, but are not eligible for the subsidies to cover it.  Community Health Centers (CHCs) are one of the few providers available to meet this group’s medical needs.

We’ve also rounded up a few links to newly available resources on the Medicaid expansion:

National Medicaid Expansion Map: Based largely on Urban Institute data, this handy map by the Texas Tribune includes state by state data on possible Medicaid expansion costs and benefits. 

NACHC Medicaid Guide: Comprehensive listing of Medicaid-related data and information.

Urban Institute Reports and Estimates:  Urban Institute’s Health Policy Center has completed a great deal of research on the national and state by state implications of the ACA and Medicaid expansion.

For states looking to better understand the implications of Medicaid expansion, Capital Link has developed a wide variety of tools to assist Primary Care Associations, health centers, and policymakers including:
·         Economic Impact Reports with and without Medicaid expansion, including tax implications
·         Patient and payer mix projections

For more information, contact Joe McKelvey at or 202-331-4602.