Medicaid's Role in the Health Benefit Exchange: A Road Map for States

Prepared for the National Academy for State Health Policy (NASHP)

The National Academy for State Health Policy (NASHP), in a report authored by Manatt Health Solutions, identifies the new opportunities under the Affordable Care Act (ACA) for states to consolidate and rationalize the oversight of public and private insurers, and the decision points for states as they consider how to most effectively integrate Medicaid into the administration and operation of the Health Benefit Exchange and into the continuum of coverage in the Exchange.

Under federal health reform, 32 million Americans are expected to gain coverage through an expansion of Medicaid to 133 percent of the Federal Poverty Level (FPL); premium subsidies for individuals with incomes between 134 percent and 400 percent of the FPL; new insurance markets – Health Benefit Exchanges – through which individuals and small businesses may compare coverage options and purchase insurance; and reforms of private health insurance. "Medicaid's Role in the Health Benefit Exchange: A Road Map for States" examines the issues states will want to consider in building, operating and financing their exchanges and effectively integrating Medicaid in the following areas:

Eligibility, enrollment and outreach for state health subsidy programs;

Health plan contracting, standards and requirements;

Benefits; and

Governing, operating and financing the Exchange.



pursuant to New York DR 2-101(f)

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