The Affordable Care Act's impacts on individuals and providers will be influenced by states' policy choices, such as decisions about Medicaid benefit levels, outreach strategies, and provider reimbursement rates. Table 13 presents a list of key policy choices that will be important to track in order to understand how states' decisions are influencing the Affordable Care Act's impacts on individuals and providers. The table also includes ongoing data sources that track the relevant information, to the degree that they currently exist.
In some cases, the variables of interest relate to specific policy decisions that states must make to implement the Affordable Care Act. For example, states will need to decide what benefits are covered in Medicaid benchmark plans and whether to establish a Basic Health Plan. Because these decisions will be made in the future, no existing data source describes them. This information could be obtained by modifying existing data sources (see below) or through new data collection. Much of this information will be available to CMS through states' amendments to their Medicaid state plans; in addition, the Affordable Care Act specifically requires states to report to the Secretary of Health and Human Services (HHS) each year on their outreach activities. It would be helpful if this information were reported in a standardized way that can be easily accessed by the evaluation team.
For the policy variables where data are currently available, the data come from several sources. The first of these sources is existing HHS public reporting. For example, data about Medicaid managed care is currently available through CMS Medicaid Managed Care Enrollment Reports, and HHS already publishes information about Federal Medical Assistance Percentagesand Disproportionate Share Hospital Allotments. A second major source of existing data about state policy decisions is the annual 50-state survey conducted by the Kaiser Commission on Medicaid and the Uninsured and the Georgetown University Center for Children and Families.12 This survey collects detailed information about Medicaid eligibility rules, enrollment and renewal procedures, and cost-sharing practices. Finally, information about the numbers of health care providers by type is available from various sources, including the AHA annual survey and AMA Physician Masterfile described earlier in this report; these provider data are also available aggregated to the county level through the Area Resource File (ARF) made available by HRSA, although the ARF data are not available in as timely a way as the source data. Similar to the ARF, CMS's Environmental Scanning and Program Characteristics (ESPC) Database aggregates state-level information from a variety of sources on the characteristics of state Medicaid programs and a variety of other factors from existing publicly available data sources. An advantage of the ESPC database is that it aggregates relevant information into a single database; a disadvantage, however, is that it lags behind the availability of the source data.
|TABLE 13. State Policy Control Variables|
|Indicator||Existing Data Sources|
|Policy variables for evaluating individual impacts|
|Funding for outreach|
|Outreach through other programs (e.g., SNAP)|
|Outreach to parents of children in Medicaid|
|State efforts to simplify enrollment and renewal processes||Kaiser/Georgetown survey*|
|State commitment to enrolling new population and keeping them enrolled|
|Benefits covered in benchmark plans||N/A--future policy decision|
|State choice to establish Basic Health Plan||N/A--future policy decision|
|Integration of Medicaid with health insurance exchanges|
|Ease of transitions between Medicaid and exchange||N/A--future policy decision|
|Purchasing and provider policies|
|Reimbursement rates and policies|
|Safety net investments|
|Managed care||CMS Medicaid Managed Care Enrollment Reports|
|Disproportionate Share Hospital|
|Policy variables for evaluating provider impacts|
|Medicaid matching rates||Federal Medical Assistance Percentages published annually by HHS|
|Medicaid disproportionate share allotments||Fiscal Year Disproportionate Share Hospital Allotments published annually by HHS|
|Medicaid enrollment||Medicaid Statistical Information System (MSIS); CMS-64 reports|
|Medicaid managed care enrollment||CMS Medicaid Managed Care Enrollment Reports|
|Number of Medicaid managed care plans||CMS Medicaid Managed Care Enrollment Reports|
|Number of each provider type in state||Area Resource File (source data from AHA, AMA, etc.)|
|Medicaid eligibility before the Affordable Care Act||Kaiser/Georgetown survey*|
|AHA = American Hospital Association; AMA = American Medical Association; CMS = Centers for Medicare and Medicaid Services; HHS = Department of Health and Human Services; N/A = not applicable; SNAP = Supplemental Nutrition Assistance Program.
*Annual 50-state survey of Medicaid eligibility, enrollment and renewal procedures, and cost-sharing practices in Medicaid and the Children's Health Insurance Program. The survey is conducted jointly by the Kaiser Commission on Medicaid and the Uninsured and the Georgetown University Center for Children and Families.