A Closer Look At One State’s Implementation Planning Efforts

The past few months have been busy ones for Maryland’s Health Care Reform Coordinating Council. We wanted to provide an update both on Maryland’s process for health reform implementation and some of the substantive recommendations made so far.

The Council was created in March 2010 by Governor Martin O’Malley through an executive order. In an interim report issued in July, the Council identified the need for six issues workgroups:

• Exchange and Insurance Markets
• Entry to Coverage
• Education and Outreach
• Public Health, Safety Net and Special Populations
• Delivery System
• Health Care Workforce

Each of the six workgroups used a similar process of holding meetings, receiving public input, and developing options and recommendations that are outlined in white papers/reports to the Council. Each workgroup was charged with listening to public comments and identifying short-term (within 12 months) and long-term implementation decisions. For some workgroups, the issues they were focused on are optional within ACA or do not hinge on immediate decisions, so the options presented in these reports are not tied to a specified timeframe. Soon, the Council will meet to develop its initial recommendations based on these reports, and finally, issue a final report in December, which will chart a path for Maryland’s implementation efforts.

Maryland’s recommendations for moving forward with implementation may be helpful for other states to consider in their planning efforts. Some key workgroup recommendations are listed below.

Exchange and Insurance Markets – Final Report to Council

• Decisions to be made in the short-term: the exchange governance structure and whether to phase in changes to the insurance market, including benefit requirements and small group or individual market rating rules.
• Recommended for long-term decision-making: whether the exchange should take on greater functions than set forth in ACA, the role of the exchange in the broader marketplace, whether the exchange and Medicaid coordinate their contracting, defining “small employer”, the role of the navigator and its location, and financing the exchange after federal funds go away.

Entry to Coverage – Final Report to Council

The Entry to Coverage workgroup developed a number of overall goals, but their report did not separate them into short-term and long-term priorities.

• Two issues that must be decided in 2011: the goals and functions of information systems and structural decisions related to eligibility determination and plan enrollment.
• Overall goals: integrated and seamless eligibility determinations; income-based eligibility should be simplified compared to the current system; eligibility policy and process should reflect a culture of insurance; a “no wrong door” approach for applying for coverage; and, eligibility and enrollment into health plans should be continuous rather than distinct systems.

Education and Outreach – Final Report to Council

The Education and Outreach workgroup focused on work related to engaging stakeholders in the implementation process and educating consumers about how health reform affects them.

• Recommendations for short-term priorities: continue to coordinate state government outreach; develop an asset inventory, including tracking community-based organizations; formalize a public/private coalition for health reform; develop template outreach materials; leverage existing federal resources, like the healthcare.gov website; establish partnerships to communicate immediate health reform changes, such as dependent coverage; and promote existing coverage programs, like Medicaid and CHIP.
• Recommendations for long-term decision-making: Obtain and fund communications expertise; coordinate work with other Council workgroups since messaging hinges on the decisions made by the other workgroups; centralize the outreach strategy; and, seek private funding.

The other three workgroup reports to the Health Care Reform Coordinating Council coveringpublic health, safety net and special populations, delivery system and workforce are also available on State Refor(u)m.

Every state’s approach to implementation is different – and instructive to other states! Please send your state’s implementation resources to statereforum@oldsite.nashp.org.