- ACA Implementation & State Health Reform
- Coverage and Access
- Federal/State Issues
- Medicaid and CHIP
- Population and Public Health
- Providers and Services
- Acute Care
- Assisted Living
- Behavioral Health
- Case Management
- Child Development Services
- Chronic Care Management
- Community Health Centers
- Developmental Screening
- Early Childhood Services
- Emergency Care
- EPSDT
- Family Planning
- Federally Qualified Health Centers
- Home & Community Based Services
- Hospitals
- Long Term Services & Supports
- Medical Homes & Health Homes
- Mental Health
- Nursing Homes
- Oral Health
- Preventive Care
- Primary Care
- Safety Net Providers
- Quality, Cost, and Health System Performance
- ACOs
- Adverse Event Reporting
- Care Transitions
- Comparative Effectiveness
- Cost Sharing
- Delivery System Reform
- Fraud and Abuse
- Health Care Workforce
- Health Information Technology
- Managed Care
- Medical Homes & Health Homes
- Medical Malpractice
- Patient Safety
- Payment Reform
- Performance Measurement
- Provider Payment Policy
- Quality Oversight
- Specific Populations
- Adolescents
- Childless Adults
- Children
- Children with Special Health Care Needs
- Dual Eligibles
- Elders
- Families
- Low Income People
- Parents
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- Transitional Youth
- Vulnerable Populations
- Young Adults
- Youth
- Youth in Foster Care System
- Youth in Juvenile Justice System
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Paving an Enrollment Superhighway: Bridging State Gaps Between 2014 and Today
The Affordable Care Act (ACA) provides a transformative vision for eligibility and enrollment in public and publicly subsidized health coverage: an enrollment superhighway that is streamlined, modern, seamless, integrated, easy for consumers to use, and connects Medicaid, CHIP and Exchange coverage. This vision contrasts sharply with most states’ welfare-era, paper-based systems that rely on complex eligibility rules and outdated technologies. This paper frames ACA’s vision and discusses gaps between 2014 and today and opportunities to close these gaps in four key areas: 1) Consumer Experience; 2) Eligibility and Enrollment Policy; 3) Technology and Systems Infrastructure; and 4) Governance and Administration.
Supported by the California HealthCare Foundation, based in Oakland, California.
March 2011» -
Electronic Enrollment of Newborns into Medicaid: Insights from Oklahoma
This issue brief highlights the state of Oklahoma, which recently implemented an electronic enrollment system for newborn children in its hospitals. By replacing a paper-based enrollment process with an electronic system, Oklahoma has been able to improve efficiency and program analysis, streamline billing, facilitate the establishment of medical homes, and reduce administrative costs.June 2010» -
Maximizing Enrollment for Kids: Results from a Diagnostic Assessment of Enrollment and Retention in Eight States
Maximizing Enrollment for Kids, a $15 million initiative of the Robert Wood Johnson Foundation (RWJF) launched in June 2008 and directed by the National Academy for State Health Policy (NASHP), aims to increase enrollment and retention of eligible children into Medicaid and CHIP programs and to establish and promote best practices among states. In this first year of the Maximizing Enrollment for Kids program NASHP collaborated with Health Management Associates (HMA) to conduct a baseline assessment of each grantee states’ policies and processes for enrolling and retaining children in coverage. The findings of these assessments provide a foundation for the work of these states over the next three years to improve enrollment of eligible children.
February 2010 -
Directory of Risk-Based Medicaid Managed Care Programs Enrolling Elderly Persons or Persons with Disabilities
This directory provides a snapshot of states enrolling elderly persons and/or persons with disabilities into risk-based Medicaid managed care programs as of January 1, 1997. For each state, it focuses on such issues as:
- Waivers
- Eligibility
- Specialty/generic program
- Voluntary/mandatory enrollment
- Service package
- Contractors
- Risk limitation mechanisms
- Case management
- Linkage with the long-term care system
January 1997» -
Protecting Low Income Beneficiaries of Medicare and Medicaid in Managed Care
Volume I: Contracting Arrangements, Beneficiary Choice, Enrollment and Disenrollment, and Tracking
These papers were prepared prior to the passage of the Balanced Budget Act of 1997. The Act makes significant changes that will affect managed care programs for dually eligible beneficiaries. However, the specific impact cannot be fully determined until regulations are drafted by HCFA.
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Outreach, Marketing, Entrollment and Disenrollment Policies in Medicaid Managed Care: A Summary of a 1996 Survey of Medicaid Agencies
The focus of this paper is on enrollment and disenrollment policy and practice in Medicaid managed care. Specifically, this paper examines policies and practices in risk-based programs with attention to Primary Care Case Management (PCCM) program policies only as they specifically interact with risk-based enrollment policies. In risk-based managed care, a Medicaid agency contracts with an entity (the contractor) to provide or arrange for the provision of an agreed upon set of services in exchange for a set fee per person enrolled per month where the prepaid fee does no vary month to month based on services used by the individual enrollee. In other words, in risk-based managed care the contractor assumes some level of financial risk for providing care to enrollees. A PCCM program in this discussion refers to a fee-for-service system where Medicaid pays a nominal amount per PCCM enrollee per month to the provider/care manager in addition to per service fees.
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Medicaid Eligibility, Enrollment, and Retention Policies: Findings from a Survey of Juvenile Justice and Medicaid Policies Affecting Children in the Juvenile Justice System
NASHP, with the support of the John D. and Catherine T. MacArthur Foundation, is working with Models for Change grantee organizations and state policymakers to address the health needs of youth in the juvenile justice system. This new issue brief from NASHP is the second in a series that highlights findings from surveys of juvenile justice and Medicaid agencies in order to determine policies around health care and Medicaid for youth involved in the juvenile justice system. The paper focuses on findings related to Medicaid enrollment and retention policies for juvenile justice-involved youth.December 2009» -
Express Lane Eligibility and Beyond: How Automated Enrollment Can Help Eligible Children Receive Medicaid and CHIP
As states work to insure more children in challenging economic times, a new report funded by the Robert Wood Johnson Foundation (RWJF) explores how states can identify and enroll eligible but uninsured children by borrowing automated strategies that have proven effective in helping eligible people receive other public and private benefits. Authored by Urban Institute researcher Stan Dorn in collaboration with the National Academy for State Health Policy (NASHP), the report details how auto-enrollment strategies have the potential to identify, enroll and retain large numbers of eligible children while reducing state administrative costs. The report explains how the recently enacted Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) makes these strategies substantially easier for states to implement while establishing powerful new financial incentives for states to reach the greatest possible number of eligible children.April 2009 -
Maximizing Kids’ Enrollment in Medicaid and SCHIP: What Works in Reaching, Enrolling and Retaining Eligible Children
This report published in February 2009, with the support of the Robert Wood Johnson Foundation (RWJF), was developed to help states improve their CHIP recruitment and retention efforts. Revisiting ideas summarized in a previous NASHP publication entitled Seven Steps Toward State Success in Covering All Children Continuously, this brief provides more concrete information for states seeking to take the next steps in enrolling more eligible, uninsured children. According to the authors, many states have successfully improved SCHIP enrollment and retention through implementing some of the key themes identified in the report. In addition, the report suggests that states can increase enrollment in Medicaid and the State Children’s Health Insurance Program (SCHIP) without massive changes in policy – providing ideas on how to build on existing administrative and public outreach efforts.
February 2009 -
Maximizing Kids’ Enrollment in Medicaid and SCHIP: What Works in Reaching, Enrolling and Retaining Eligible Children
Nearly two thirds of the nation's 8.9 million uninsured children are eligible but not enrolled in Medicaid and SCHIP. This new report from the National Academy for State Health Policy, the National Program Office for the Maximizing Enrollment for Kids program of the Robert Wood Johnson Foundation, examines strategies states can use to increase enrollment in these two programs.
Building on a 2006 NASHP report, the new paper reviews literature and expert opinions to elaborate on seven strategies states can implement to maximize enrollment for uninsured children eligible for public coverage. From simplifying the enrollment process to implementing the latest technology and urging political leaders to make enrollment a priority, the report lays out key steps that states may consider when tackling the difficult issues of making sure the pathways for enrollment and renewal for all eligible children are as efficient as possible.
February 2009
