Global Budgets, Payment Reform and Single Payer: Understanding Vemont\u27s Health Reform

The Muskie School of Public Service hosted two health policy colloquia this April to promote informed discussion throughout the state regarding MaineCare coverage options under the ACA and the implications of Vermont’s move toward a single-payer system.The series, sponsored by the Muskie School Board of Visitors, offers community conversations in which experts from various disciplines and perspectives inform and engage the broader public to explore and debate critical policy issues. On April 22, community and sector leaders joined for Global Budgets, Payment Reform, and Single Payer: Understanding Vermont\u27s Health Reform. Participants discussed Vermont\u27s recent movie toward single payer health care and how the state is cutting costs and improving how health care is delivered, as well as the implications for Maine

Lessons from Health Reform

Maine’s Dirigo Health reform is a microcosm in the current sea of health reform, but a full decade after its enactment the similarities to the Affordable Care Act (ACA) are striking. Both reforms created subsidized, private health insurance, negotiated by an independent entity; both expanded Medicaid and included strategies to improve quality and lower cost; and both met with strong, well-organized conservative opposition. This essay briefly explains the politics surrounding the Dirigo reform and the compromises that allowed Dirigo to continue under two governors and serve over 41,000 people and nearly 1,000 small businesses which can transition to the ACA January 1, 2014. It suggests why Massachusetts met with less resistance in their reform and concludes with lessons learned from Maine

The Affordable Care Act: What\u27s next for Maine?

On January 1, 2014 major provisions of the Affordable Care Act (ACA) take effect - including requirements that everyone has health insurance coverage and the availability of new subsidies and insurance reforms that are designed to make that coverage affordable. Most Americans will continue to get their health insurance through their workplaces. Individuals and small businesses (those with fewer than fifty employees)1 will be able to shop for coverage through a new, online Marketplace, also called an Exchange. The Marketplace will provide one-stop shopping for health insurance with simplified information available to help compare the costs and benefits of available plans and, for individuals, assistance in qualifying for premium tax credits that will discount the cost of coverage for those eligible. Navigators and others will be trained and in place to help consumers and small businesses understand their choices. Beginning October 1, 2013 the Marketplaces will open so consumers can begin to shop for coverage. Open enrollment – the time period allotted to attain coverage – lasts through March 20142. Implementing the new law challenges governments at all levels and the private sector. Much needs to be done to be ready for the changes envisioned in the ACA. The rollout of this complex law will not be without problems. As part of its on-going Health Policy Colloquium series, the Muskie School will provide information and convene leaders to explore in detail how the ACA will affect Mainers, what preparations are in place to transition to the new law and to raise and respond to questions as the law is implemented. This policy brief provides background information and lays out some of those questions. We hope to provide an on-going forum for interested parties to work together with the Muskie School to address these and other issues in a timely and accurate way

Building a Relationship between Medicaid, the Exchange and the Individual Insurance Market

The alignment of Medicaid and State Health Insurance Exchange (Exchange) policy and practice is a basic tenet of the Patient Protection and Affordable Care Act (ACA). Through both legislative provisions and implementing regulations, the ACA addresses this relationship. At the same time, the federal framework provides states with considerable discretion to flesh out the fuller dimensions of system interaction

Multi-State Plans Under the Affordable Care Act

New state health insurance exchanges that are developing under The Patient Protection and Affordable Care Act (ACA) will offer consumers a choice of private health plans known as qualified health plans (QHPs). Under the law, in every state, two of those must be multi-state plans or MSPs. These plans will be administered by the federal Office of Personnel Management (OPM). The MSPs must meet the same requirements as other QHPs. As with other QHPs, people enrolled in the plans will be eligible for premium tax credits and cost sharing assistance if their income is less than 400 percent of poverty or $92,200 for a family of four. OPM, which also administers the Federal Employee Health Benefits Plan, must administer MSPs separately and must contract with both a non-profit insurer and one that does not provide abortion coverage. OPM will negotiate premiums, set rates, establish medical loss ratios and profit margins as well as certify and de-certify plans and make sure they have adequate networks of providers. OPM is expected to release its proposed rule on the MSPs this spring. This paper, based on interviews with federal and state policy makers and others, examines key implementation issues

Building a Relationship between Medicaid, the Exchange and the Individual Insurance Market

The alignment of Medicaid and State Health Insurance Exchange (Exchange) policy and practice is a basic tenet of the Patient Protection and Affordable Care Act (ACA). Through both legislative provisions and implementing regulations, the ACA addresses this relationship. At the same time, the federal framework provides states with considerable discretion to flesh out the fuller dimensions of system interaction

The Role of State Attorneys General in Improving Prescription Drug Affordability

Impact litigation initiated by state attorneys general has played an important role in advancing public health goals in contexts as diverse as tobacco control, opioids, and healthcare antitrust. State attorneys general also play a critical role in helping governors and legislatures advance health policies by giving input into their drafting and defending them against legal challenges. State attorneys general have entered the prescription drug affordability arena in both these ways—for example, by initiating lawsuits relating to price fixing by generic drug manufacturers and defending state laws requiring disclosures of pharmaceutical prices. Yet the scope of their collective efforts is not well understood, and little is known about factors that facilitate and hinder them in their pursuit of policy objectives relating to drug affordability. In this article, we report findings from an empirical study of state attorney general activities relating to pharmaceutical pricing. Drawing from key informant interviews with attorneys working on drug pricing issues as well as a scoping review, we report on how state attorneys general are working to address the problem of drug affordability, how they make decisions about resource investments in this area, what positions them to be effective change agents in this space, and what challenges they confront in this work. We situate our results within the broader literature state attorneys general as policy actors, and we suggest measures that could extend their capacity to successfully tackle the complex issues that give rise to unaffordable drugs

Managing a High-Performance Medicaid Program

Today, the Medicaid program is evolving more rapidly than at any other time in its fifty-year history. States and the federal government are working to maximize the value and efficiency of Medicaid by reforming payment to reward value over volume, integrating effective care coordination across payers, and streamlining key processes like eligibility determinations across coverage programs. Underpinning a state’s ability to implement these reforms is its capacity to manage its Medicaid program effectively and efficiently. This paper discusses key responsibilities that the federal government and states hold for managing the Medicaid program and identifies the key issues and challenges states face as they transform the way they do business and achieve key national goals. The paper relies on an extensive review of federal and state responsibilities drawn from statute, regulation, and relevant literature, coupled with discussions with six current Medicaid directors, who graciously volunteered their time and observations on the opportunities and challenges they face in administering their state Medicaid programs

Managed Care, Medicaid & the Elderly, An Overview of Five State Case Studies

This publication contains a series of five state case studies of Medicaid managed care programs enrolling elderly care programs enrolling elderly Medicaid recipients. The case studies were prepared by University of Minnesota National Long Term Care Resource Center\u27s two partners: the National Academy for State Health Policy (NASHP) in Portland, Maine and the Institute for Health Services Research, School of Public Health at the University of Minnesota in Minneapolis, Minnesota. These case studies have been conducted under the leadership of Trish Riley and Robert Mollica at NASHP. The project was undertaken to examine the experience of elders in managed care, particularly managed care programs for low income, dually eligible elders, and the roles of aging network in relation to managed care. The site visits were conducted from November to early March and changes may have occurred since the reports were written

Improving health and education outcomes for children in remote communities: A cross-sector and developmental evaluation approach

Early childhood is one of the most influential developmental life stages. Attainments at this stage will have implications for the quality of life children experience as they transition to adulthood. Children residing in remote Australia are exposed to socioeconomic disadvantage that can contribute to developmental delays and resultant poorer education and health outcomes. Complex contributing factors in far west New South Wales have resulted in children with speech and fine motor skill delays experiencing no to limited access to allied health services for a number of decades. More recently, growing awareness that no single policy, government agency, or program could effectively respond to these complexities or ensure appropriate allied health service access for children in these communities has led to the development of the Allied Health in Outback Schools Program, which has been operational since 2009. The program is underpinned by cross-sector partnerships and a shared aspirational aim to improve the developmental outcomes of children to enhance their later life opportunities. It was identified early that the initiative had the potential to deliver mutually beneficial outcomes for communities and participating partner organisations.Over the last five years the program has been the catalyst for partnership consolidation, expansion and diversification. The developmental evaluation approach to continuous program adaptation and refinement has provided valuable insights that have informed health and education policy and enabled the program to be responsive to changing community needs, emerging policy and funding reforms.This article explores the evolution of the program partnerships, their contribution to program success and longevity, and their capacity to respond to an emergent and dynamic environment. The authors propose that a community-centred and developmental approach to program innovation and implementation in remote locations is required. This is based on the premise that contemporary linear, logic-based policy development and funding allocations, with predetermined program deliverables and outcomes, are no longer capable of responding appropriately to the complexities experienced by remote communities.Keywords: allied health, remote communities, cross-sectoral partnerships, service learnin