Expanding Health Care Coverage

By

United Hospital Fund

Funding Area

Expanding Health Care Coverage

Date

May 1, 2011

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This United Hospital Fund report, supported by NYHealth, examines the organizational improvements necessary to successfully integrate the State’s Medicaid program into the health insurance exchange.

In order to achieve seamlessness between Medicaid and the exchange, five key areas need to be coordinated: eligibility and enrollment; renewals and transitions; information systems; consumer communications; and challenges associated with aligning the plans, networks, and benefits offered.

This report is the second in a series of reports focused on New York’s health insurance exchanges. The first report examined the initial set of governance and organizational choices for states in designing their exchanges.The third report focused on two discretionary decisions for New York involving the Exchange: merging the exchanges for individuals and small businesses and merging the individual and small group markets. The fourth report explored the roles the Exchange should play, ranging from a passive market organizer model to an active purchaser. The fifth report examined the various plan options that will serve as a benchmark plan for implementing the essential health benefits rule required for all individual and small group policies. The sixth report looked at the extent of public and private health insurance plans’ provider networks and current State standards and processes for determining the adequacy of these networks.