As Medicare Special Needs Plans Mark 10th Anniversary, ACAP Calls for their Reauthorization
Sunday, December 8 marked the tenth anniversary of the passage of the Medicare Modernization Act (MMA) of 2003. The law provided for the creation of Special Needs Plans, a distinct category of Medicare Advantage plans that tailor their services to people with specific diseases or characteristics.
Today,most Special Needs Plans (SNP) serve people who are dually eligible for Medicare and Medicaid. “Dual eligibles” number only about 9 million nationwide but are more likely to live with chronic conditions or mental illness. Since they tend to need continuous care, dual eligibles account for an outsized proportion of state and Federal health care spending.
In recent years, the SNP program has been reauthorized by Congress in a series of one-year patches in a manner similar to the Medicare Sustainable Growth Rate. “As we celebrate the tenth anniversary of their creation, it bears noting that Congress has an opportunity to bring needed stability to the SNP program through a long-term reauthorization,” said ACAP CEO Margaret A. Murray. Read more >
ACAP Analysis: 4 in 10 Issuers Participating in Marketplaces Also Offer Coverage Through a Medicaid Managed Care Plan
Note: Data updated November 26, 2013.
Issue Brief | List of Issuers (Excel)
A new ACAP analysis examines a comprehensive list of issuers offering Qualified Health Plans (QHP) in Marketplaces across the country and notes which issuers also offer health coverage through a Medicaid managed care plan in the same state. The analysis counts 287 separate QHP issuers in the 50 states and the District of Columbia, counting issuers once for each state in which they participate in a Marketplace.
Of those 287 issuers, more than 4 in 10—117 overall—also offer coverage through a Medicaid MCO in the same state. This suggests that there is significant overlap between Marketplace plan offerings and Medicaid managed care in many states, which would help to limit the impact of “churn.” “Churn” is a term used to describe enrollees entering and exiting Medicaid due to unforeseen loss of coverage; it can be caused by minor fluctuations in income, clerical errors, or failure to renew enrollment on a timely basis, among other factors. Studies have found churn to raise administrative costs to providers and governments, and to lead to negative health outcomes. Read more >
Meg Murray: Health Insurance Marketplaces Hold Promise For Low-Income Families and Workers
In a statement issued on the eve of the launch of open enrollment for Health Insurance Marketplaces, ACAP CEO Margaret A. Murray lauded the new coverage option. “October 1, 2013 has been circled on our calendars since March 23, 2010—the date the Affordable Care Act was signed... It brings affordable coverage options to millions of working Americans who were either priced out of the market for insurance, or shut out of the market entirely owing to a pre-existing condition." Read More >
Four of the 10 Top-Ranked Medicaid Health Plans in the U.S. Are ACAP-Member Safety Net Health Plans
New rankings of health insurance plans from the National Committee for Quality Assurance (NCQA) count four Safety Net Health Plans, all members of ACAP, among the top ten Medicaid insurance plans in the United States. The plans were ranked in NCQA’s Medicaid Health Insurance Plan Rankings 2013-2014 based upon their performance against metrics of clinical quality and member experience. Read More >
H.R. 1698 Would Bring Enrollment Stability to Medicaid, CHIP Programs
Representatives Gene Green (D-Texas) and Joe Barton (R-Texas) recently introduced H.R. 1698, the Stabilize Medicaid and CHIP Coverage Act of 2013, which would provide for 12-month continuous enrollment for Medicaid and CHIP. Every year millions of people enroll in the two programs, only to subsequently lose their coverage despite still being eligible. Many otherwise-eligible beneficiaries are continuously disenrolled and reenrolled in the program owing to bureaucratic and paperwork problems, or small and often temporary changes in income. These income changes can stem from items as simple as getting a few extra hours of overtime in a week. Such interruptions have an adverse effect on the continuity and quality of care.
“ACAP applauds Representatives Green and Barton for their leadership in seeking to provide Medicaid and CHIP beneficiaries with a source of coverage they can count on,stabilizing health care services for those who need it most," said ACAP CEO Margaret A. Murray in a statement. “Providing 12 months of continuous enrollment in Medicaid and CHIP brings these critical programs in line with private health plans, Medicare and other health care programs.We call upon other Members of Congress to join Reps. Barton and Green and promptly pass the Stabilize Medicaid and CHIP Coverage Act."
ACAP has developed a Web site that provides a wide range of resources on "churn" and its ill effects, including maps detailing the variance in enrollment continuity rates among various subgroups and from state to state. For more details, visit coverageyoucancounton.org.
Research Update: Higher Continuity of Coverage in Medicaid Leads to Lower Monthly Costs
A new update on research released by the Association for Community Affiliated Plans makes the connection between higher continuity of coverage in the Medicaid program and lower average monthly costs. The report, authored by health policy researchers Leighton Ku, Ph.D., M.P.H. and Erika Steinmetz, M.B.A. of George Washington University, used new data to calculate the average monthly costs for persons enrolled in the Medicaid program. It found that the average monthly cost to the Medicaid program is $345 for adults enrolled in Medicaid for 12 months of the year,compared with $597 for those who are enrolled for just one month—a difference of more than 40 percent. This report also finds significantly lower costs for children who are continuously enrolled, with an average monthly cost of $110 for children enrolled in Medicaid for 12 months of the year, versus monthly costs of $151 for those enrolled for just one month, a difference of more than 25 percent.
Report: Medicaid Managed Care Plan Members Report Higher Satisfaction With Their Plan than Members of Private Plans
ACAP recently issued a fact sheet that shows that member satisfaction among enrollees of public-sector health plans in general, and members of Medicaid managed care plans in particular, report higher levels of satisfaction with their health plan than those enrolled in commercial health plans. The report comes shortly before millions of Americans are set to gain coverage on January 1, 2014, through expansions of the Medicaid program under the Affordable Care Act. Most who gain coverage will do so through a Medicaid managed care plan. The report examines publicly-reported results of the Consumer Assessment of Healthcare Providers and Systems (CAHPS), a regular, systematic survey of patient experience published by the Agency for Healthcare Research and Quality (AHRQ).
Fact sheet | Press release
ACAP to Convene Substance Abuse Collaborative with Support from Open Society Foundations
ACAP recently announced that it would convene a collaborative of ACAP-member plans to provide support for strategies to address substance abuse. The collaborative is supported by a $363,000 grant from the Open Society Foundations (OSF), a group with wide-ranging policy initiatives aimed at building vibrant and tolerant democracies whose governments are accountable to their citizens. OSF’s work in health policy focuses on establishing health policies and practices that are based on evidence and promote social inclusion, human rights, and justice.
The collaborative will focus its efforts on prescription drug abuse, which has increased in recent years: the number of drug overdoses grew every year between 1999 and 2010. Of the more than 38,000 overdoses reported in 2010; nearly 60 percent involved prescription or over-the-counter drugs, 3 in 4 of which involved opioids such as hydrocodone, oxycodone or methadone. In 2010, more than 16,500 deaths from opioid overdoses were reported—more than a fourfold increase from 1999. The collaborative’s efforts and results will also be summarized in an ACAP publication in 2015 for review by all interested parties.
Read more >
ACAP Report Proposes Improvements to Risk Adjustment in Health Insurance Exchanges
A report issued by ACAP examines efforts by the Federal government to promote stability in the new Health Insurance Exchange markets created by the Affordable Care Act. The report, written by Tony Dreyfus and Ellen Breslin Davidson of BD Group, outlines challenges to effective risk adjustment and payment accuracy for plans that focus on serving low-income individuals who will access health coverage through the Exchanges.
Risk adjustment is a mechanism widely used that improves the accuracy of payments to health plans and provides health plans that take on sicker populations with higher levels of revenue. Risk adjustment encourages health plans to serve members with high health care needs, such as those with a chronic illness or disability. The paper, Improving Risk Adjustment in the Health Exchanges to Ensure Fair Payment, makes several proposals to strengthen risk adjustment to reflect more accurately the risk taken on by plans focused on serving vulnerable populations.