State Information
Three states have recently implemented comprehensive reforms: Maine, Massachusetts, and Vermont, while other states are focusing on universal coverage for kids, and many are utilizing incremental reforms. Some states have particular interest in employer-based reforms.
By sector, recently-implemented reforms include:
Public Sector Initiatives
- SCHIP eligibility expansions (from the low of 150% in MT to 315% in NJ)
- SCHIP target population expansions through HIFA 1115 waivers (AZ, CA, ID, IL, MN, NJ, OR, and RI cover parents of SCHIP children; AZ, ID, IL, MI, and OR cover childless adults)
- SCHIP and Medicaid premium subsidies to purchase private coverage (MT, OK)
- HIFA 1115 waivers that provide an expansion of limited benefit coverage (UT, WV, AK)
- Medicaid target population expansion to include childless adults using DSH funds (ME)
Insurance Market Initiatives
- Rating reform including community rating (NY) and modified community rating for B&E plans (NJ)
- Reinsurance in the individual market (MA) or high risk pools (ID)
- Exemptions from offering all, some or none of the state mandated coverage to consumers (AR, MT)
- Limited-benefit plans in the individual market (MT, ND, NJ, UT)
- Insurance Exchanges (CT, MA)
Employer-Based Initiatives
- Small group purchasing pools (NM, CA-soon to be inactive, CT, NY, OH, TX)
- Small group purchasing pools with reinsurance (public reinsurance in AZ, MN, NY; private reinsurance in NM)
- Small group pool that use public program negotiated payment rates (CT, NM, WA,WV)
- Employer mandate (HI)
- Refundable tax credits for currently insured employers (ID, MT)
- Premium incentives and premium assistance payments for new/uninsured employers (ID, MT)
- Premium discounts, lowered deductibles and out-of-pocket for employees of small businesses (ME)
- State continuation coverage or Mini-COBRA (SD, UT)
Mixed Approaches
Medicaid buy-in to high risk pools (MT)
Public premium subsidy for qualifying employers and employees of small businesses (NM, OK)
HIFA 1115 waivers to buy-in to small employer pools or private market for low-wage workers (OK, NJ, RI, UT, IL)
High risk pools and subsidy of premiums to buy-in to high risk pools (MT)
Framework of Reform Reform Process Public Sector Reforms
Employer-Based Reforms Insurance Market Reforms
Financing Strategies
|
