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maxenroll Bachrach 033011.pdf - National Academy for State Health ...

maxenroll Bachrach 033011.pdf - National Academy for State Health ...

health subsidy

health subsidy eligibility systems – or “vertical integration” – with a longer-term goal of bridging thesesystems to other appropriate social services.Beyond eligibility and enrollment, states must consider how and if other Medicaid administrativefunctions might be consolidated into the Exchange, and staff responsibilities integrated. Notably, theACA specifically authorizes Exchanges to outsource certain functions to state Medicaid agencies,including the determination of eligibility for tax-credit subsidies and exemptions from the individualmandate. 46 Moreover, many of the required functions of an Exchange beyond subsidy determinationsare ones with which the Medicaid agency has substantial experience, including hot line operation,certification of health plans (in states with robust Medicaid managed care programs), electroniccalculators, consumer assistance and stakeholder consultation.The Medicaid Agencyʼs Role in the Exchange: Planning, Governance and OperationsSummaryThe ACA and implementing guidance require collaboration andcoordination between Exchanges and Medicaid but do not dictateMedicaidʼs role in governance or administration of HBEs.IssuesDecision Points for StatesStates will need to determine how best to leverage existingrelevant expertise, resources, assets in the Medicaid/CHIPagency and how to represent Medicaid in HBE governance.To what extent can the current Medicaid eligibility and enrollmentsystem be upgraded to include the Exchange functions withrespect to subsidy determination and enrollment into coverage?Would it be more cost-effective to build an entirely new system?How can the state best ensure that the data collected fordetermination of subsidy determination for Exchange populationsis equally usable for determination of coverage for the non-MAGIpopulations and for determination of eligibility for social servicesprograms? Should these decisions be delayed until after 2014 toensure a functioning Exchange by that date?What functions and staff of the stateʼs Medicaid agency can andshould be integrated into Exchange operations?46 ACA, Sec. 1413. Medicaid’s Role in Exchanges -29

Financing the ExchangeHHS has announced multiple funding opportunities targeted to planning and implementation of stateExchanges, with a particular focus on funding for systems and emphasis on integration of eligibilityand enrollment functionality.Funding for Health Insurance Exchange Planning and Implementation. Three waves offunding to states will support Exchange planning and implementation efforts that are compatible withMedicaid and CHIP. The first Exchange grants were awarded September 30, 2010, with eachapplicant state receiving approximately $1 million to support planning efforts. Forty-eight states (allbut Minnesota and Alaska) and the District of Columbia received grants to conduct the research andplanning needed to determine how their Exchanges will be operated and governed. 47 Permissibleplanning activities include assessing information technology (IT) needs, identifying necessarychanges to state law and regulations, determining staffing needs, planning the coordination ofeligibility and enrollment systems across Medicaid, CHIP, and the Exchanges, and developingperformance metrics and milestones. 48Second, recognizing that states will need significant technical assistance to develop modernized ITsystems, HHS is making funding available to support the development of model informationtechnology systems upon which other states can build. On February 16, 2011, two-year grants totaling$241 million were awarded to 13 “early innovator” states, representing seven coalitions of states, tobuild IT systems for Exchanges. 49Finally, on January 20, 2011, HHS announced a third round of Exchange grants to enable states toestablish Exchanges. 50 These grants will fund states, the District of Columbia and consortia of statesfor implementation activities and functionalities that are integral to Exchange operations and meetHHS requirements for Exchanges. 51 The award amount will vary according to the demonstratedneeds of each state. States may choose their application level, which is distinguished by stateprogress in Exchange planning, and timing of application as multiple funding opportunities areavailable.Level One of the Exchange implementation grants, designed for states that have made someprogress in planning, provide funding for a maximum of two years (an initial application for one year47 Minnesota and Alaska did not submit applications for the Exchange planning grant in 2010. On January 19, 2011, HHS released a limited competition funding opportunity announcement for Exchange planning grants available to these two states. Minnesota applied for a planning grant but no award announcement has been made to date. 48 Health Insurance Exchanges: State Planning and Establishment Grants. July 29, 2010. http://www.healthcare.gov/news/factsheets/esthealthinsurexch.html. 49 U.S. Department of Health and Human Services, Office of Consumer Information and Insurance Oversight, "Cooperative Agreements to Support Innovative Exchange Information Technology Systems," October 29, 2010. 49 "States Leading the Way on Implementation: HHS Awards 'Early Innovator' Grants to Seven States," HHS Press Release, February 16, 2011. 50 U.S. Department of Health and Human Services, Office of Consumer Information and Insurance Oversight, "Cooperative Agreement to Support Establishment of State-­‐Operated Health Insurance Exchanges," January 20, 2011. 51 A separate funding opportunity announcement was released for the territories. Medicaid’s Role in Exchanges -30

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