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Publications by Brigette Courtot for Health Policy Center

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More about Brigette Courtot's areas of expertise can be found on this Urban Institute expert's page.


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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: March 05, 2014Availability: HTML | PDF

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: March 05, 2014Availability: HTML | PDF

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: March 05, 2014Availability: HTML | PDF

Medicaid and CHIP Managed Care Payment Methods and Spending in 20 States (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: October 17, 2013Availability: HTML | PDF

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: October 09, 2013Availability: HTML | PDF

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: May 29, 2013Availability: HTML | PDF

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: November 19, 2012Availability: HTML | PDF

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: July 18, 2012Availability: HTML | PDF

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: May 23, 2012Availability: HTML | PDF

SHAP Enrollment and Eligibility Activities: Implications for Process and System Modernization under National Health Reform (Research Report)
Teresa A. Coughlin, Brigette Courtot

The Affordable Care Act (ACA) requires that most Americans have health insurance by January 1, 2014. To help achieve this coverage goal, the ACA includes several provisions calling for major changes in state eligibility and enrollment processes currently used in public health insurance programs. To a large extent much of the responsibility for creating these eligibility and enrollment systems resides with the states. In this brief we draw on the experiences of five states—Colorado, Kansas, Minnesota, New York and Oregon—that had begun modernizing their eligibility and enrollment systems and processes prior to the ACA. We describe the best practices that these states have employed with regard to these activities, and consider the implications of these practices for implementing the ACA.

Posted: May 18, 2012Availability: HTML | PDF

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