Coverage Expansion

The Patient Protection and Affordable Care Act (ACA) reshapes the nation’s health system to make it easier for millions of Americans to obtain, afford, and keep healthcare coverage.

This section is designed to provide information pertaining to the federal, state, and local rules and regulations surrounding insurance coverage expansion in both the private and public arenas.

The following links are just a sampling of the materials relating to insurance coverage expansion. ADP has identified the following as particularly helpful resources, but this does not represent an exhaustive list of the quality reports available. As new material is made available, ADP will update the contents of this page periodically so that it remains current and relevant.

Medi-Cal and Medicaid

Californians Newly Eligible for Medi-Cal under Health Care Reform
ABSTRACT: This brief from the UCLA Center For Health Policy Research (May 2011) provides detailed demographic information on the Medicaid expansion populations that became newly eligible for benefits under the Patient Protection and Affordable Care Act. The analysis includes factors ranging from income, to the general health of the expansion population. This information is designed to help public health professionals better meet the distinct needs of those gaining access to Medi-Cal- the Medicaid program administered by the State of California.

Medicaid Expansion and Reform: Hopes and Lessons From California
ABSTRACT: For a July 2011 blog post, Health Affairs interviewed 26 healthcare stakeholders in California including policy makers, industry leaders and organizations for their perspective on California’s Medicaid Expansion. The blog summarizes the stakeholders’ areas of general consensus and concern, and provides a broad overview of the design of California Section 1115 Medicaid Waiver.

Low-Income Patients in California: Experiences and Expectations
ABSTRACT: This article summarizes the results of a survey conducted between March and April 2011 by the Blue Shield of California Foundation. The survey documented how low-income Californians currently use the healthcare system, and gauged their interest in changing healthcare providers if they had a choice.

Explaining Health Reform: Benefits and Cost-Sharing for Adult Medicaid Beneficiaries
Abstract: Published in August 2010, the article examines the populations that may benefit from the expansion of Medicaid under the ACA, as well as the cost-sharing standards for participants based on their percentage above the Federal Poverty Level (FPL).

Understanding the Baseline: Publicly Funded Substance Abuse Providers and Medicaid
ABSTRACT: The National Association of State Alcohol/Drug Abuse Directors (NASADAD) provides technical assistance and research to both national and state policymakers, researchers, and industry professionals. A wide range of topical reports can be found on its website http://nasadad.org/nasadad-reports. This May 2011 report provides a national comparison of state-by-state availability of Medicaid-financed substance use disorder treatment.

ESSENTIAL HEALTH BENEFITS

Perspectives on Essential Health Benefits Workshop Report
ABSTRACT: The Affordable Care Act will require health plans to meet a minimum benefit level that contains essential health benefits (EHBs). EHBs include a general category for mental health and substance use disorder treatment services, including behavioral health treatment. Currently, the EHBs remain undetermined. The U.S. Department of Health and Human Services has requested that the Institute of Medicine (IOM) recommend criteria and methods for determining and updating the EHBs. The Perspectives on Essential Health Benefits: Workshop Report summarizes the work done by IOM so far. The committee's recommendations will be released in a subsequent report.

Health and Human Services (HHS) Informational Bulletin - Essential Health Benefits Fact Sheet (December 16, 2011)
This informational bulletin and fact sheet from the U.S. Department of Health and Human Services outlines proposed policies pertaining to the definition and implementation of “essential health benefits” required by the Affordable Care Act. Under the Department’s intended approach, states will have the flexibility to select a benchmark plan that reflects the scope of services offered by a “typical employer plan” that best meet the needs of their citizens.

HHS Secretary's Letter to Governors (December 16, 2011)
This letter to state governors from U.S. Department of Health and Human Services Secretary Kathleen Sebelius explains the Department’s Essential Health Benefits Bulletin and invites comments and suggestions from the governors.

Health Benefit Exchange

Four Visions for the California Health Benefit Exchange
ABSTRACT: The California Healthcare Foundation generated a series of six articles describing four potential approaches (visions) to how California’s Health Benefit Exchange (Exchange) may be designed. Each of the four visions places an emphasis on one of several competing goals including affordability; consumers’ access to the greatest quantity of care possible, reform care delivery and payment, and aligning the Exchange with the existing Medicaid program administered by the State of California, named Medi-Cal. This introductory paper sets the work in context, followed by an examination of the four visions, and a sixth paper that examines the core operational requirements needed. The Exchange will be required to operate both as a public entity entrusted with implementing the Affordable Care Act’s provisions and as a private-sector marketer of health plans.

The Role of the Exchange in California’s Implementation of Health Reform
Abstract: This October 2010 briefing examines the central challenges facing California as it works to establish an operational insurance exchange by 2014.

Federal Guidance on Exchanges

Eligibility and Enrollment

Eligibility for Medi-Cal and the Health Insurance Exchange in California under the Affordable Care Act
Abstract: This August 2010 update describes how the ACA will expand Medi-Cal access and the creation of health insurance exchanges. The report includes some quantifying information in regard to the number of new enrollees and percentages of the insurance markets.

Experiences from Other States

Covering Low-income Childless Adults in Medicaid: Experiences from Selected States
Abstract: This August 2010 article examines various population subsets and how these populations enrollment will drive Medicaid cost. The article examines several states as they (1) design appropriate benefit packages and delivery systems; (2) allocate sufficient resources and set adequate rates; and (3) develop effective outreach and enrollment strategies.

The Effects of Health Care Reform on Access to, and Funding of, Substance Abuse Services in Maine, Massachusetts, and Vermont
Abstract: This March 2010 article documents case studies form Maine, Massachusetts and Vermont to highlight the importance of effective state advocacy for substance abuse treatment and prevention systems under the ACA. The article also outlines the importance of SAPT Block Grant funding.

Bending the Health Care Cost Curve by Expanding Alcohol/Drug Treatment
Abstract: This September 2010 article documents how investments in AOD treatment results in a significant relative reduction in rates of growth in medical and nursing facility costs for disabled Medicaid clients with substance use problems.

Health Care Reform, Medicaid Expansion and Access to Alcohol/Drug Treatment: Opportunities for Disability Prevention
Abstract: Drafted in October 2010 this article discusses the anticipated prevalence of those with substance use problems in the newly eligible Medicaid enrollee population.