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Brigette Courtot

Senior researh associate
Health Policy Center

Brigette Courtot is a Research Associate in the Urban Institute's Health Policy Center. Her current work focuses on Medicaid and Children's Health Insurance Program (CHIP) policies relating to eligibility and enrollment, managed care delivery systems, and health care quality measurement. Prior to joining the Urban Institute, she was Senior Policy Analyst for Health and Reproductive Rights at the National Women's Law Center, where she examined women's access to health coverage, implementation of the federal health reform law, and how various public policies affect women's health outcomes. In her previous tenure at the Urban Institute (2003-2007) she conducted maternal and child health services research with an emphasis on access to care for underserved populations, including work on both the San Mateo County and Los Angeles County Healthy Kids program evaluations and the national Covering Kids and Families program evaluation. She holds a bachelor's degree from Northwestern University and a Master in Public Health degree from the Johns Hopkins University Bloomberg School of Public Health.


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The Launch of Health Reform in Eight States: State Flexibility Is Leading to Very Different Outcomes (Research Report)
John Holahan, Linda J. Blumberg, Teresa A. Coughlin, Brigette Courtot, Ian Hill, Rebecca Peters, Shanna Rifkin, Margaret Wilkinson, Sabrina Corlette, Kevin Lucia

This paper provides a review of a series of papers that examine early implementation of the Affordable Care Act in 8 states. These states – Alabama, Colorado, Maryland, Michigan, Minnesota, New York, Oregon, and Virginia – have made very different design choices in implementing the law. We examine coverage expansion; financial impacts; the development of information technology systems; outreach, education and enrollment assistance; insurer participation, competition and premiums in marketplaces; insurance market reforms; development of SHOP marketplaces; and issues of provider capacity. We conclude that different design choices made by states will lead to different results. The law will work very differently for residents in different states around the country and there will be different outcomes both in terms of coverage and economic impacts.

Posted to Web: March 05, 2014Publication Date: March 05, 2014

The Launch of the Affordable Care Act in Selected States: Building ACA-Compliant Eligibility and Enrollment Systems (Research Report)
Brigette Courtot, Teresa A. Coughlin, Divvy Upadhyay

Arguably among the biggest tasks facing the health insurance marketplaces established by the Affordable Care Act (ACA) has been the creation of an information technology (IT) system (including a self-service enrollment web site) that determines eligibility for and facilitates enrollment into health coverage. This paper examines the development and performance of ACA-compliant eligibility and enrollment systems for health insurance marketplaces in eight states. Some of these states’ IT systems are operating smoothly while others have struggled to overcome technical glitches for months. These early successes and stumbles are reflected in marketplace-based enrollment numbers during the ACA’s first months of open enrollment.

Posted to Web: March 05, 2014Publication Date: March 05, 2014

The Launch of the Affordable Care Act in Eight States: Outreach, Education, and Enrollment Assistance (Research Report)
Ian Hill, Margaret Wilkinson, Brigette Courtot

The Affordable Care Act's success depends on whether eligible, uninsured persons can enroll in health coverage. Meeting enrollment goals partially hinges on the effectiveness of marketing campaigns to raise public awareness, and application assistance programs that help consumers enroll. This brief examines ACA-related marketing, outreach, and application assistance efforts in eight states: five that have aggressively participated in ACA implementation and three states that have taken a limited approach. Differences in the intensity of efforts across states are stark—with some launching multi-pronged marketing campaigns and funding community-based organizations and providers to lend hands-on assistance with enrollment, and others investing much less energy and resources in such efforts. These differences may ultimately contribute to noticeably different enrollment experiences during early ACA implementation.

Posted to Web: March 05, 2014Publication Date: March 05, 2014

Medicaid and CHIP Managed Care Payment Methods and Spending in 20 States: Final Report to the Office of the Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services (Research Report)
Brigette Courtot, Teresa A. Coughlin, Emily Lawton

This study of Medicaid and CHIP managed care programs in 20 states indicates that capitation rate-setting became more data-driven and transparent during the time period 2001-2010. Benefit packages were fairly consistent over time and among states, with carve outs in every state for a least one acute service. Total spending on managed care services for Medicaid enrollees varied considerably across states and subgroups; nondisabled children had the lowest average monthly spending and adults with disabilities had the highest.

Posted to Web: October 17, 2013Publication Date: December 01, 2012

Reaching and Enrolling the Uninsured: Early Efforts to Implement the Affordable Care Act (Research Report)
Ian Hill, Brigette Courtot, Margaret Wilkinson

The Affordable Care Act's success depends on whether eligible, uninsured persons can enroll in health coverage. Meeting enrollment goals partially hinges on the effectiveness of marketing campaigns to raise public awareness, and application assistance programs that help consumers enroll. This brief describes early state efforts, and finds that government officials have taken many positive steps including launching multi-pronged campaigns that combine broad marketing with grass-roots outreach, and funding community-based organizations and providers to provide hands-on assistance. Differences in the intensity of these efforts across states are stark, however, and may contribute to noticeably different enrollment experiences during early ACA implementation.

Posted to Web: October 09, 2013Publication Date: October 09, 2013

Are State Medicaid Managed Care Programs Ready for 2014? A Review of Eight States (Research Report)
Teresa A. Coughlin, Brigette Courtot, Rebecca Peters

The Medicaid expansion authorized by the Affordable Care Act (ACA) will result in significant enrollment increases for state Medicaid programs. A majority of these new enrollees will receive care through a Medicaid managed care plan. This brief describes how eight states are preparing to provide Medicaid coverage to these new enrollees and, more generally, altering their managed care programs. While some challenges were noted, state officials in each of the eight states felt their Medicaid managed care programs were well positioned to handle ACA-related Medicaid enrollees. Moreover, health plan capacity was described as sufficient, although there was some concern about provider capacity.

Posted to Web: May 29, 2013Publication Date: May 29, 2013

Early Lessons from the Work Support Strategies Initiative: South Carolina (Research Report)
Brigette Courtot

Work Support Strategies (WSS) is a multiyear, multi-state initiative to implement reforms that help eligible low-income families get and keep a full package of work support benefits, including Medicaid, nutrition assistance (SNAP), and child care assistance. This report describes South Carolina's accomplishments and lessons learned during the initiative's first year. During this year, the two primary agencies involved in delivering work support program benefits in the state began breaking down the barriers between them to create a more efficient, coordinated approach. The state undertook activities to improve the business and technological processes used within each agency while also identifying areas for cross-program alignment.

Posted to Web: April 03, 2013Publication Date: April 03, 2013

Progress in Implementing Selected Medicaid Provisions of the Affordable Care Act: A Ten-State Analysis (Research Report)
Brigette Courtot, Teresa A. Coughlin

Even in the wake of the Supreme Court ruling that made the Affordable Care Act's (ACA) Medicaid expansion voluntary for states, Medicaid remains a centerpiece in the law’s effort to expand coverage and reform the nation’s health care system. In addition to the now-optional eligibility expansion, the ACA includes many other Medicaid-related provisions, such as the option to expand Medicaid early (before 2014), the requirement to modernize eligibility and enrollment systems, and testing of new delivery systems. A related provision gives states the option to create a Basic Health Program that could resemble Medicaid. This brief describes ten states’ experiences with and decisions about implementing these selected major Medicaid provisions. At this juncture in ACA implementation, the states are assiduously working on many different fronts to prepare for the 2014 coverage expansions while also taking advantage of various ACA-related opportunities to save costs and improve their programs.

Posted to Web: November 19, 2012Publication Date: November 19, 2012

ACA Implementation-Monitoring and Tracking: Minnesota Site Visit Report (Research Report)
Brigette Courtot, Stan Dorn, Vicki Chen

A longstanding leader in private- and public-sector health reform, Minnesota is making remarkable progress implementing the Patient Protection and Affordable Care Act (ACA), despite a challenging political environment. The state’s ability to accomplish as much as it has including the creation of two task forces, securing multiple grants to support different pieces of ACA implementation, adopting the early Medicaid expansion, implementing early insurance reforms, and taking vigorous steps toward building an effective Exchange in time to meet challenging federal deadlines testifies to remarkable collaboration between multiple state agencies and stakeholders in transforming the state’s health system.

Posted to Web: July 18, 2012Publication Date: July 18, 2012

Best Practices in SHAP Outreach, Eligibility, and Enrollment Activities (Research Report)
Brigette Courtot, Teresa A. Coughlin

This brief draws on the experiences of five states-Colorado, Kansas, Minnesota, New York and Oregon—that received federal State Health Access Program (SHAP) grant funding to expand health coverage using approaches that included community-based outreach and improvements to Medicaid/CHIP eligibility and enrollment processes. We describe the best practices that these states shared with regards to activities related to outreach, streamlining application and enrollment processes, and modernizing eligibility determination systems, and consider the implications of these practices for implementing the Affordable Care Act (ACA).

Posted to Web: May 23, 2012Publication Date: May 23, 2012

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