Health care “exchanges” are critical to fulfilling the promise of
the Affordable Care Act and how states decide to meet their responsibility
to establish them will have an enormous impact on children and families. Today, the Department of Health and
Human Services is hosting a stakeholder conference to discuss exchanges. To coincide with the
conference, my colleagues, Dawn Horner and Sabrina Corlette, released an issue brief that takes a deeper
look at exchanges and what’s at stake for children and families.
HHS’s day-long conference is intended to engage
stakeholders on the important policy decisions surrounding the establishment
and operation of exchanges. CCF’s
Jocelyn Guyer will take part in a panel discussion and Dawn Horner will attend
the conference. (You can view the conference via be webcast here.)
We’ll hear more from them about the conference tomorrow,
so let’s get back to the issue brief.
“Health Exchanges: New Coverage Options for Children and
Families” provides a comprehensive overview of exchanges and key
questions policymakers must consider when establishing exchanges. It outlines the funding and design
decisions the states will have to make fairly quickly and points out the broad
responsibilities exchanges will have in ensuring that consumers can make
informed health care coverage choices.
For example, the Affordable Care Act requires plans to
offer child-only policies (reflecting the importance policymakers placed on the
need to ensure that children could secure coverage even if their parents were
ineligible for an exchange plan).
Beyond the essential benefits packages, exchange plans must provide
children with a comprehensive package of preventive care services (referred to
as Bright Futures), including immunizations, well-child visits, vision and
hearing tests, health and behavioral assessments, and developmental screenings,
with no cost-sharing. These
federal standards are only a floor and states can require plans to cover
services for adults and children that are not in the minimum package. In fact, a number of states already
have policies mandating that plans cover specific services, some of them
critical to children. (Sixteen states and the District of Columbia mandate that
insurers offer at least some level of services for autism.)
Another issue that could impact many families is how well
states meet the “no wrong door” policy established by the new law. It is vital that exchanges coordinate
closely with Medicaid and CHIP because many people will move back and forth between
subsidized exchange coverage and public program eligibility as their income
fluctuates. The brief points out
that states should consider ensuring that some plans offered in the exchange
also serve Medicaid and CHIP beneficiaries, creating overlapping provider
networks and requiring plans to help facilitate transitions for those in the
middle of treatment.
The brief also covers the importance of dynamic
technology applications to the success of the exchanges. The exchange procedures envisioned
under the ACA rely heavily on the application of smart technology systems.
States should consider setting up a working group now to begin to build these
systems. As a first step, a state can pave the way toward electronic interfaces
by implementing the proven Medicaid and CHIP automated linkage with the Social
Security Administration allowed under CHIPRA to verify citizenship status.
These are but a few of the insights included in the issue
brief. I hope you’ll take the time
to read it for yourself and share it with others in your state. We would also love to hear from you on
how your state is approaching the establishment of its exchange.