I believe I am in good company when I read Merrill, Charles, and you. Your detail is exemplary.
When you end up repeating yourself time after time, I find myself wondering if I really need to say it again. But as you have said, when the numbers enrolled in free or almost free healthcare insurance do not improve . . . what can be done differently? Perhaps and just a thought, enroll them automatically when they show up at a hospital or doctor when they need care. Especially those at the 200% or less level when it is free. Hospitals and doctors will collect zilch if they are that low in income, so why not?
Thanks, Bill -- much appreciated. Hospitals and federally qualified health centers actually do enroll many uninsured in Medicaid. FQHCs have a dedicated funding stream for enrollment assistance. I don't know how consistent hospitals are, but I think safety net hospitals at least will enroll anyone they can.
I wonder if CSR take up would improve if we change the subsidy structure for them to make ALL (not just benchmark) Silver plans premium free below 200% poverty (in other words for CSR 87 and CSR 94). Make them more like Basic Health Plans in NY and MN.
If they were all free, they'd have to be much more standardized - -including in payment rates paid to providers, I'd think. In other words, a BHP within the marketplace framework -- which is pretty much what Massachusetts' ConnectorCare is, now extended up to 500% FPL. I do think that that makes sense -- in other words, acknowledging that the marketplace should have been structured more like a BHP, while avoiding the BHP framework, which cuts off the under-200% FPL program from the marketplace risk pool.
The alternative to that being including BHPs on risk-adjustment like Minnesota does, but yea that could more directly keep similar networks and reimbursement rates for CSR eligibles and other people on the ACA marketplace. Instead of potentially having one for Medicaid MCOs, one for BHPs, and one for ACA plans.
MinnesotaCare shares a risk pool with the marketplace? Are you sure? I see that a state-based RA system was proposed in 2016, and one rec was to combine BHP and QHP risk pools, but I can't find anything on its having been done. https://www.health.state.mn.us/data/apcd/docs/raLegislativeRpt2016.pdf
Last I checked when I saw a CMS presentation on BHPs, it described MinnesotaCare as seeing inclusion of it in risk adjustment as a key part of sustainability. I'll try to find it again for you. The link should be in my BHP article.
Andrew:
I believe I am in good company when I read Merrill, Charles, and you. Your detail is exemplary.
When you end up repeating yourself time after time, I find myself wondering if I really need to say it again. But as you have said, when the numbers enrolled in free or almost free healthcare insurance do not improve . . . what can be done differently? Perhaps and just a thought, enroll them automatically when they show up at a hospital or doctor when they need care. Especially those at the 200% or less level when it is free. Hospitals and doctors will collect zilch if they are that low in income, so why not?
Just a thought here in AZ.
Thanks, Bill -- much appreciated. Hospitals and federally qualified health centers actually do enroll many uninsured in Medicaid. FQHCs have a dedicated funding stream for enrollment assistance. I don't know how consistent hospitals are, but I think safety net hospitals at least will enroll anyone they can.
I wonder if CSR take up would improve if we change the subsidy structure for them to make ALL (not just benchmark) Silver plans premium free below 200% poverty (in other words for CSR 87 and CSR 94). Make them more like Basic Health Plans in NY and MN.
If they were all free, they'd have to be much more standardized - -including in payment rates paid to providers, I'd think. In other words, a BHP within the marketplace framework -- which is pretty much what Massachusetts' ConnectorCare is, now extended up to 500% FPL. I do think that that makes sense -- in other words, acknowledging that the marketplace should have been structured more like a BHP, while avoiding the BHP framework, which cuts off the under-200% FPL program from the marketplace risk pool.
The alternative to that being including BHPs on risk-adjustment like Minnesota does, but yea that could more directly keep similar networks and reimbursement rates for CSR eligibles and other people on the ACA marketplace. Instead of potentially having one for Medicaid MCOs, one for BHPs, and one for ACA plans.
MinnesotaCare shares a risk pool with the marketplace? Are you sure? I see that a state-based RA system was proposed in 2016, and one rec was to combine BHP and QHP risk pools, but I can't find anything on its having been done. https://www.health.state.mn.us/data/apcd/docs/raLegislativeRpt2016.pdf
Last I checked when I saw a CMS presentation on BHPs, it described MinnesotaCare as seeing inclusion of it in risk adjustment as a key part of sustainability. I'll try to find it again for you. The link should be in my BHP article.
Thanks, I'll take a look. If the risk pools are combined, you'd think that might pave the way to extending MinnesotaCare eligibility upward.
Yea, I think it could at least. And I the rules exist to add them to risk adjustment. But I'm sure others would know more.