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State Children's Health Insurance Program

 

 
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Using Behavioral Economics to Inform the Integration of Human Services and Health Programs under the Affordable Care Act (Research Report)
Fredric Blavin, Stan Dorn, Jay Dev

Behavioral economics, which analyzes how behavior sometimes departs from the rational calculation of self-interest, can help Medicaid programs use targeted enrollment strategies more effectively by eliminating apparently modest procedural requirements, which can greatly reduce participation levels. It can also help health coverage applicants receive SNAP, even though demonstrating eligibility for health subsidies and choosing a health plan can tax many consumers' cognitive resources, making it hard to process information about SNAP. For example, health applicants could be given the option to have the state's food agency contact them later to complete a SNAP application by phone.

Posted to Web: September 15, 2014Publication Date: July 21, 2014

Examples of Promising Practices for Integrating and Coordinating Eligibility, Enrollment and Retention: Human Services and Health Programs Under the Affordable Care Act (Research Report)
Stan Dorn, Sarah Minton, Erika Huber

States and non-profit organizations have used three approaches to successfully integrate enrollment and retention of health and human services programs: 1. Streamlining one program's eligibility determination based on data from other programs. This approach has helped uninsured children receive and retain health coverage, helped low-income seniors obtain SNAP, and produced state administrative savings. 2. Coordinated administration of multiple programs. Administrative savings resulted when multiple programs integrated their systems for case records, data matching, eligibility rules engines, on-line applications, and benefit payment. 3. Coordinating enrollment. Community colleges exemplify sites for enrolling consumers into multiple health and human services at once.

Posted to Web: September 15, 2014Publication Date: July 21, 2014

Opportunities under the Affordable Care Act for Human Services Programs to Modernize Eligibility Systems and Expedite Eligibility Determination (Research Report)
Stan Dorn, Rebecca Peters

Human services programs can benefit from 90 percent federal funding for information technology investments that are complete by the end of 2015 and that: 1) build a service that helps both Medicaid and human services; or 2) build an interface that helps Medicaid use human services records to verify eligibility or "fast track" enrollment. Once the Affordable Care Act is fully phased in, Medicaid will be the country's most widely-used need-based program. Human services programs can use Medicaid records to streamline eligibility determination, despite limits on information sharing and differences between Medicaid and human services program rules, including household definitions.

Posted to Web: September 15, 2014Publication Date: July 21, 2014

A First Look at Children's Health Insurance Coverage under the ACA in 2014 (Policy Briefs/Health Policy Briefs)
Genevieve M. Kenney, Joan Alker, Nathaniel Anderson, Stacey McMorrow, Sharon K. Long, Douglas A. Wissoker, Lisa Clemans-Cope, Lisa Dubay, Michael Karpman, Tricia Brooks

Beginning in June 2013, the Urban Institute's Health Reform Monitoring Survey (HRMS), which was designed to provide early feedback on implementation of the Affordable Care Act (ACA), has been tracking changes in health insurance coverage and other outcomes for children under the ACA. In contrast to adults, uninsured rates for children had been declining in the decade before the ACA's passage, largely because of the expansion of public coverage (Medicaid and the Children's Health Insurance Program) which is substantially generous and draws high participation among children. Estimates derived from HRMS children's supplement suggest that uninsured rates for children had not changed by June 2014 from their pre-ACA levels, though there are reasons to expect that children's coverage will grow in future years.

Posted to Web: September 09, 2014Publication Date: September 09, 2014

In Pursuit of Health Equity: Comparing U.S. and EU Approaches to Eliminating Disparities (Policy Briefs/Timely Analysis of Health Policy Issues)
Elizabeth Docteur, Robert A. Berenson

Researchers compare and contrast the U.S. public policy approach to tackling the problem of health disparities with the European approach in this paper. They begin by providing an overview of the ways in which the issue of health disparities has been framed in American and European policy discourse. They next compare how health disparities have been addressed in policy statements produced by the U.S. Department of Health and Human Services and by the European Commission, the executive body of the European Union, emphasizing the US emphasis and race and ethnicity and the European orientation to economic status.

Posted to Web: June 30, 2014Publication Date: June 24, 2014

Increase in Medicaid under the ACA Reduces Uninsurance, According to Early Estimates (Policy Briefs/Health Policy Briefs)
Lisa Clemans-Cope, Michael Karpman, Adam Weiss, Nathaniel Anderson

An important strategy for increasing health insurance coverage under the Affordable Care Act (ACA) is expanded enrollment in Medicaid, which provides free or very low cost health insurance to low-income people. Over 6 million individuals enrolled in Medicaid or the Children’s Health Insurance Program between October 2013 and April 2014 despite the fact that only about half of the states have expanded Medicaid and the early problems with the federal health insurance website. This brief takes advantage of new data from the Health Reform Monitoring Survey to examine how much of the increase in Medicaid coverage is a net gain in insurance coverage rather than a shift to Medicaid from other coverage, as well as whether there are differences in the patterns of Medicaid changes across states and among different population subgroups.

Posted to Web: June 26, 2014Publication Date: June 26, 2014

Measuring Medicaid/CHIP Enrollment Progress Under the Affordable Care Act (Research Report)
Lisa Dubay, Genevieve M. Kenney, Matthew Buettgens, Jay Dev, Erik Wengle, Nathaniel Anderson

Since the beginning of the first open enrollment period under the Affordable Care Act (ACA) on October 2013 and April 2014, Medicaid/CHIP enrollment increased by 6.0 million. This accounts for almost half of enrollment increase projected by the Urban Institute's Health Insurance Policy Simulation Model to occur by the end of 2016 when the full ACA coverage effects are expected. Progress is greater in states that expanded Medicaid but there is variation even among these states. This variation is likely due in part to differences in outreach and application assistance efforts by states and whether they used fast-track enrollment strategies.

Posted to Web: June 13, 2014Publication Date: June 13, 2014

Uncompensated Care for the Uninsured in 2013: A Detailed Examination (Research Report)
Teresa A. Coughlin, John Holahan, Kyle Caswell, Megan McGrath

Millions of uninsured people use health care services every year. We estimated providers’ uncompensated care costs in 2013 to be between $74.9 billion and $84.9 billion. We calculated that in the aggregate, at least 65 percent of providers’ uncompensated care costs were offset by government payments designated to cover the costs. Medicaid and Medicare were the largest sources of such government payments, providing $13.5 billion and $8.0 billion, respectively. Anticipating fewer uninsured people and lower levels of uncompensated care, the Affordable Care Act reduces certain Medicare and Medicaid payments. Such cuts in government funding of uncompensated care could pose challenges to some providers, particularly in states that have not adopted the Medicaid expansion or where implementation of health care reform is proceeding slowly.

Posted to Web: May 30, 2014Publication Date: May 30, 2014

The Effects of Express Lane Eligibility on Medicaid and CHIP Enrollment among Children (Article)
Fredric Blavin, Genevieve M. Kenney, Michael Huntress

We estimate the impact of Express Lane Eligibility (ELE) implementation on Medicaid/CHIP enrollment in eight states using 2007-2011 data from the Statistical Enrollment Data System. We use fixed effects difference-in-differences models to allow the experience of non-ELE states to serve as a counterfactual to assess the changes in the ELE states. Across specifications, ELE effects on Medicaid enrollment among children were consistently positive, ranging between 4.0 and 7.3 percent, with most estimates statistically significant at the 5 percent level. Our results imply ELE has been an effective way for states to increase enrollment and retention among children eligible for Medicaid/CHIP.

Posted to Web: May 19, 2014Publication Date: January 31, 2014

Coverage For Low-Income Immigrant Children Increased 24.5 Percent In States That Expanded CHIPRA Eligibility (Article)
Brendan Saloner, Neel Koyawala, Genevieve M. Kenney

By 2011, twenty states and the District of Columbia had expanded eligibility for federally funded public insurance to low-income immigrant children within their first five years of legal residence in the United States under the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009. Data from the National Survey of Children's Health shows that compared to immigrant children in states that did not expand eligibility, children in states expanding eligibility experienced a 24.5 percent increase in insurance coverage, largely due to greater enrollment in public insurance. These immigrant children also experienced significant reductions in unmet health care needs, compared to their counterparts in non-expansion states. Disparities relative to children in nonimmigrant families were substantially reduced in states that expanded eligibility, compared to states that did not. Expanding eligibility for federally funded public insurance to immigrant children within their first five years of legal residence in other states could improve coverage for immigrant children and might also increase access to care.

Posted to Web: May 06, 2014Publication Date: May 01, 2014

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