2013: Exchanges and More

By Neva Kaye
December 2013
 
The health policy community has been paying rapt attention to the challenges and successes of implementing the state and federal health insurance exchanges (aka marketplaces).  But states have a much broader agenda for improving coverage, promoting access to services, and improving the delivery of care.  In NASHP’s final blog of the year we draw attention to the many accomplishments that have occurred outside the spotlight.
 
There are many examples from which to choose! Using the resources offered by the ACA, states have streamlined Medicaid enrollment and renewals, implemented Health Homes for Medicaid Beneficiaries with Chronic Conditions and are developing and testing State Healthcare Innovation Plans in the State Innovations Models (SIM) initiative.  Many states chose to leverage other resources.  They partnered with the private sector, began licensing new types of health care workers to extend the supply of providers in critical areas, and changed the way they pay providers to foster more effective and coordinated delivery of services.  Below is just a small sample of state accomplishments.
 
Alabama simplified enrollment and improved retention for Medicaid coverage
In 2013, Alabama Medicaid initiated an automated Express Lane Eligibility process. Express Lane Eligibility allows a state to rely on either components of or entire eligibility determinations of other human service programs (such as SNAP) to determine eligibility for Medicaid and CHIP. Alabama is one of 12 states approved to use this approach to simplify enrollment and retention of children, and one of only two states using this strategy for an eligible adult population–low-income women 19-55 years of age who qualify for a package of benefits limited to family planning. (Alabama is one of eight states that participated in the Robert Wood Johnson Foundation’s Maximizing Enrollment program, which NASHP directs.)
 
Illinois improved services for young children with developmental delays
Between 2010 and 2013, Illinois changed both the Medicaid and Early Intervention programs to improve the rate of identification, assessment, and treatment services early in life for children at risk for developmental delay.  Illinois implemented new data systems to ease and speed communication between Medicaid and Early Intervention providers, clarified the process for referring children between the two types of providers, and incorporated these processes into the manuals used by both types of providers.  (Illinois was a member of NASHP’s third Assuring Better Child Health and Development learning collaborative, which was supported by The Commonwealth Fund.)
 
Iowa funded a new approach to coordinating care within communities
In April 2013, the Iowa Legislature passed legislation that provided funding for the Iowa Primary Care Association to pilot a new community care coordination strategy.  In January 2014, Iowa will launch two regional teams to provide care coordination for high-needs patients and support local primary care providers in providing medical home-caliber care. (Iowa was a member of NASHP’s Medicaid-Safety Net Learning Collaborative, which was convened under a National Organizations of State and Local Officials cooperative agreement with the Health Resources and Services Administration.)
 
Montana created a multi-payer medical home program
In April 2013, Montana passed legislation developed by the State’s Insurance Commissioner, with the support of private and public sector stakeholders, to create a framework that enables these sectors to work together to implement a medical home program.  Commercial payers and Medicaid have committed to using this framework to pay primary care practices that qualify as medical homes more than those that do not meet the medical home standards.  (Montana is a member of NASHP’s multi-payer medical home learning collaborative, which is supported by The Commonwealth Fund.  Montana also participated in NASHP’s IMPaCT Learning Community, which was supported by the Agency for Healthcare Research and Quality.)
 
State accomplishments in improving health policy and practice in 2013 are too many and varied to list.  These few examples illustrate the range and depth of state activity.  NASHP applauds all states’ success in advancing excellence in health policy and practice—and is honored to have contributed to these efforts.