Financing shared administrative functions between state-based marketplaces and state Medicaid programs: cost allocation methodologies
- Collection:
- Health Policy and Services Research
- Series Title(s):
- State Health Reform Assistance Network issue brief
- Author(s):
- Leddy, Tricia, author Larson, Mark, author Heiss, Christian, author
- Contributor(s):
- Center for Health Care Strategies, Inc., issuing body Robert Wood Johnson Foundation, issuing body State Health Reform Assistance Network, issuing body
- Publication:
- [Princeton, NJ] : Robert Wood Johnson Foundation, September 2015
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Health Insurance Exchanges -- organization & administration Medicaid -- organization & administration State Government United States
- Genre(s):
- Technical Report
- Abstract:
- The Affordable Care Act (ACA) advanced opportunities to expand access to health coverage for low-income Americans, including the expansion of Medicaid and the establishment of health insurance marketplaces. As pathways to public and private health coverage, state-based marketplaces (SBMs) perform many cross-program functions that support access to both marketplace Qualified Health Plans (QHPs) and Medicaid. For example, an individual cannot be found eligible for marketplace tax credits and cost-sharing reductions until they are determined ineligible for Medicaid. These shared functions represent an opportunity for achieving savings through efficiencies, but in doing so, states are required to properly attribute funding between programs through a process known as cost allocation. In exploring cost allocation, it is to a state's advantage to take a broad view of Medicaid and SBM operations, focusing on statewide impacts rather than viewing the operations in silos. States must offer residents access to a public and private continuum of affordable health insurance coverage options, with one streamlined online application process. In addition, federal Medicaid matching funds could offset costs for services shared by Medicaid that would otherwise be paid from state general revenue funds or marketplace assessments or fees. As marketplaces have moved to become self-sustaining, it is in a state's best interest to allocate the costs of Medicaid-related operations performed by the marketplace to the Medicaid program. This brief builds on a prior State Health Reform Assistance Network report from January 2013, providing an in-depth view of the mechanics of implementing cost allocation between Medicaid and marketplace programs. Targeted to state policy leaders interested in financing options for state-based marketplaces, it outlines: (1) potential shared administrative services between Medicaid and SBMs that may be cost allocated; (2) cost allocation methods between Medicaid and the marketplace; and (3) available federal Medicaid match funding to support shared administrative tasks. It also provides a step-by-step process for states to develop and submit for federal approval a state-specific cost allocation methodology.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (9 pages)).
- NLM Unique ID:
- 101672959 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101672959