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Reports and Technical Papers

2011

  • Modified Adjusted Gross Income: Implications for Medicaid Eligibility Systems under the ACA
    This ACA Note discusses the implementation of the new income definition--Modified Adjusted Gross Income or "MAGI"--that will be used to determine Medicaid income eligibility across the country in 2014 when the Affordable Care Act (ACA) takes full effect.  The implementation of MAGI is complicated by the requirement that each state distinguish between two different eligibility groups that will garner different federal medical assistance percentages (FMAPs)--the "newly-eligible" expansion population and the "previously-eligible" population that would have met the state's pre-ACA income thresholds.  This report discusses the complexities that this scenario will raise for state Medicaid eligibility systems and how these issues might be addressed.

2010

  • Achieving Universal Coverage through Comprehensive Health Reform: The Vermont Experience - Evaluation Results (Final Report)

    This report from SHARE grantee Ron Deprez and his research team at the Center for Health Policy, Planning, and Research at the University of New England presents the findings of a two-year comprehensive evaluation examining the impact of health care reform in Vermont initiated by the state's 2006 Health Care Affordability Acts (HCAA).  The evaluation addresses coverage affordability and access, along with the sustainability of Vermont's reforms.

  • Medicaid Policy Changes in Kentucky under the Deficit Reduction Act of 2005: Implementation Issues and Remaining Challenges
    In this report, SHARE grantee Genevieve Kenney, with co-authors Jennifer Pelletier and Julia Costich, details policy changes in Kentucky's Medicaid program that were implemented under authority granted by the Deficit Reduction Act of 2005 (DRA).  This authority allowed the state greater flexibility in benefit design, cost-sharing, care coordination, health promotion, and chronic disease management.  The authors evaluate the impacts of Kentucky's Medicaid policy changes, along with the political, regulatory, and institutional environment that influenced these impacts.

  • Medicaid Policy Changes in Idaho under the Deficit Reduction Act of 2005: Implementation Issues and Remaining Challenges
    In this report, SHARE grantee Genevieve Kenney and co-author Jennifer Pelletier detail policy changes in Idaho's Medicaid program that were implemented under authority granted by the Deficit Reduction Act of 2005 (DRA).  This authority allowed the state greater flexibility in benefit design, cost-sharing, care coordination, health promotion, and chronic disease management.  The authors evaluate the impacts of Idaho's Medicaid policy changes, along with the political, regulatory, and institutional environment that influenced these impacts.
     
  • Small-Group Health Insurance Reform in the States: Lessons from Rhode Island's HEALTHpact Plan (In-Depth Report)
    In this report, Edward Miller and the SHARE research team led by Vincent Mor (Brown University) present findings from their qualitative evaluation of Rhode Island's HEALTHpact initiative, which aimed to encourage take-up of health insurance coverage in the state's small-group market.  The program has seen only minimal take-up, and Miller and his co-authors explore the reasons why through an analysis of in-depth key informant interviews, enrollment data, and archival documents.  They conclude with a set of recommendations for future small-group reform efforts based on lessons learned from the Rhode Island experience, pointing to the importance of subsidies, broker and insurer support, well-resourced government outreach and oversight, and carefully-designed wellness incentives.

2009

  • The Secrets of Massachusetts' Success: Why 97 Percent of State Residents Have Health Coverage (Full Report)
    In this report, SHARE grantee Stan Dorn and his research team present preliminary findings from their evaluation of auto-enrollment procedures in Massachusetts.  The researchers use data from interviews with policymakers, stakeholders, advocates, and others, along with a review of published reports, to identify the factors that were important in encouraging, in particular, the enrollment of eligible, low-income uninsured.  Factors identified include: the use of state data rather than traditional application forms to determine eligibility for subsidies; the use of a single application form and eligibility determination system for multiple subsidy programs; and the completion of applications by community-based organizations and health care providers on behalf of consumers.
     
  • Achieving Universal Health Coverage through Comprehensive Health Reform: The Vermont Experience (Year 1 Interim Report)
    This detailed report presents preliminary findings from the SHARE research team at the University of New England.  Led by Investigator Ron Deprez, Ph.D., the team is midway through a two-year comprehensive evaluation examining the impact of health care reform in Vermont as initiated by the 2006 Health Care Affordability Acts.

2008

2006

  • Options for Small Employer Health Insurance in Missouri
    This report addresses small employer health insurance options for the state of Missouri. It outlines the key attributes, respective benefits and challenges of both purchasing pools and reinsurance, provides examples of state initiatives that combine purchasing pools and reinsurance to better meet the needs of uninsured employees of small firms, and describes selected states’ experiences with state employee pool buy-ins. March 2006.
     
  • Universal Coverage: The Role of Government in Health Care Reform
    A report on the findings of the Midwest States Health Reform Summit, which was hosted by the National Institute of Health Policy and SHADAC and held in November of 2006. December 2006.