This is the tenth in an ongoing series of posts examining the Affordable Care Act, including previous posts on rate review and temporary high risk pools. For links to all previous posts and additional resources, please visit the health care reform page on our website.  If you have thoughts on health care reform, we encourage you to comment below or contribute a guest blog.

Earlier this year, we blogged about health insurance exchanges, a major provision of the federal health care reform law, the Affordable Care Act (ACA).  In a nutshell, states have been tasked with setting-up online insurance marketplaces, or “exchanges,” for selling private coverage and determining eligibility for premium subsidies or public health insurance programs.  The online exchanges envisioned by the Affordable Care Act institute robust consumer protections, simplify plan and premium comparisons, and facilitate competition.  The deadline for states to gain approval for their exchange plans from the federal government is January 2013, and the deadline for having their online insurance marketplace up and running is January 2014. Read the rest of this entry »

“Is there anyone here from Oklahoma?”

I was at a national conference of health care policy experts and advocates last month when the morning’s plenary speaker, Cindy Mann, Medicaid Director for the Centers for Medicare and Medicaid Services, posed that ominous question. “Uh-oh. What have we done this time?”, I wondered, as I tentatively lifted my hand.  But this time, Oklahoma was being singled out for major praise, not ridicule. What Oklahoma had done that had Mann and several others at the conference gushing was launch a new streamlined enrollment system for the Medicaid program that may be the most user-friendly in the nation – and that positions Oklahoma at the front of the pack as states face the challenges and opportunities of implementing health care reform in the coming years.

Until the launch of the new enrollment system, applicants for SoonerCare health insurance coverage, the state’s Medicaid program, submitted a paper application to the Oklahoma Department of Human Services (DHS) during regular office working hours. In most cases an eligibility determination would be made 20 to 30 days later after information was entered into the agency’s legacy mainframe computer and verified. Policies and procedures were handled at least slightly differently in each county office and by each caseworker, and the client numbering and tracking system was prone to errors. Read the rest of this entry »

This blog was authored by Tricia Brooks, a Senior Fellow at the  Center for Children and Families at Georgetown University. It originally appeared on November 4th on Say Ahhh! A Children’s Health Policy Blog and is cross-posted here with permission. For prior blog posts on health care reform and additional resources, click here

I’m not big on rules. When I ran New Hampshire’s Children’s Health Insurance Program  and had to talk with a family who was unhappy about some bureaucratic rule, I often diffused the conversation by saying “I don’t make the rules, if I did there wouldn’t be any.” I know, that was a cop-out but it worked. Now I take those words back. This is one rule I might love!

The Centers for Medicaid & Medicare Services (CMS) has published a proposed rule in the federal register that would broaden the definition of “claims” to include “claims of eligibility” in regard to Medicaid management information systems. What does this really mean? It means that eligibility systems may qualify (assuming the rule is adopted) for a 90 percent federal financial participation to support the design, development, testing and implementation of new or enhanced eligibility systems capacity through 2015. Systems could also qualify for an ongoing 75 percent federal match once they are operational.

Is this a big deal? Indeed it is. States have been severely encumbered by a lack of resources to make system innovations or replace decades old legacy systems that, quite frankly, have outlived their usefulness due to a lack of major overhauls. Moving forward on streamlining efficiencies and the use of data matching to verify eligibility helps both states and real people but requires the latest in systems architecture and performance to achieve the innovations that we know are possible. These kinds of system transformations, along with seamless integration with Exchange IT systems, require major investments and the enhanced federal funding will be welcome news to cash-strapped states. Read the rest of this entry »

According to the latest U.S. Census figures, 565,000 Oklahomans, or 15.8 percent of the total population, were without health insurance in 2007-2008. The uninsured rate is just under 10 percent for children but over 20 percent for adults ages 18-64.

The Oklahoma Legislature has made several efforts in recent years to chip away at the number of uninsured by expanding eligibility for Insure Oklahoma, a program that provides public subsidies towards the purchase of employer-sponsored coverage for employees of small businesses or a public product for those without access to employer coverage. Eligibility for Insure Oklahoma goes up to 200 percent of the federal poverty level ($44,000 for a family of four) and is available to employees of businesses with up to 250 employees. Read the rest of this entry »

From time to time we publish guest blog posts that help illuminate a policy issue or advance the discussion of public policy in Oklahoma (see our guest blog guidelines). This post was written by Laura Dempsey-Polan of Life Senior Services, a Tulsa senior service care provider. Laura may be reached at (918) 664-9000 X267 or LDPolan@LIFEseniorservices.org. The opinions stated below are not necessarily the opinions of OK Policy, its staff, or its board. This blog is a venue to help promote the discussion of ideas from a variety of different points of view.

Oklahomans and their families prefer in-home supports over institutionalization and we know these supports offer marked savings with much better outcomes. Over two decades, Oklahoma developed five in-home support Medicaid programs (i.e., 1915C Waivers) now serving 31,000 eligible citizens, and 2 more are in the works. Yet, in-home programs are increasingly squeezed by nearly eight years of stagnant reimbursement. Read the rest of this entry »

As we’ve discussed in various blog posts and issue briefs, most state agencies received basically flat funding or were dealt budget cuts of 5 to 7 percent for the new fiscal year beginning July 1st, even as inflation leads to increased operating expenditures and the cost of employee health care and retirement contributions continue to mount. The result is that most agencies are being underfunded for the basic functions and missions that they are expected to accomplish, whether that is operating schools or parks, regulating environmental quality or nursing homes, protecting at-risk children, or preserving  public safety.

But what does this situation mean for the agencies, departments, and school districts that operate public services? We usually don’t hear stories about the impact of underfunding unless and until there is a crisis. Yet the reality is that many public agencies at all levels of government, especially regulatory and administrative agencies, are perpetually underfunded.  Resources are always scarce, and even in good budgetary times, most legislators prefer to fund programs that provide direct benefits to their constituents than those that do the unglamorous work of  licensing, inspecting, investigating, and adjudicating. This is especially true here in Oklahoma, where we are among the bottom five states in the amount we spend per person on state and local government

Recently, the journal Health Affairs published an interview with Kerry Weems, who served as Interim Director of one of those unheralded but vital regulatory agencies, the Centers for Medicare and Medicaid Services (CMS), during the last 18 months of the Bush Administration. CMS is charged with overseeing expenditures of almost $700 billion annually in the two major public health care programs. In particular, it has the responsibility for preventing and investigating waste, fraud and abuse in these programs. But in Weems’ view, one that is shared by many others, CMS is not staffed at levels necessary for it to fulfill its mission. Here’s how he describes the impact that a shortage of resources has on his former agency: Read the rest of this entry »

Anyone who has worked over the years to support access to health care for low-income children and families will be heartened to learn that the Obama administration has appointed Cindy Mann to lead the Centers for Medicaid and State Operations, which is the division within the Centers for Medicare and Medicaid Services (CMS) that oversees the Medicaid and CHIP programs. Cindy is a highly passionate, intelligent, and experienced health care expert. Most recently, she was founder and Director of the Georgetown University Center for Children and Families; before that, she was  Deputy Director of CMS (back in the days when it was still HCFA) in the Clinton administration.  There are few, if any, people more highly respected in the health care policy and advocacy world. You can read Cindy’s thoughts on her new appointment and on her stellar replacements at the Center for Children and Families, Joan Alker and Jocelyn Guyer.

As health care reform heats up, it is clear that the Medicaid program will be one of the pillars upon which a new system providing health insurance coverage to all Americans will be built.  While Medicaid faces many significant challenges in the years ahead, it will without question benefit from Cindy Mann’s strong leadership.