This article provides an overview of the purpose of the Health Insurance Exchanges, a central component of the Affordable Care Act (ACA). The Exchanges are online marketplaces where individuals, families, and small businesses, using the Small Business Health Options Program (SHOP) in the Exchange, will shop for health insurance. Consumers will be able to access user-friendly information that will make it easy to compare and enroll in a health insurance plan. Note: Individuals and families with income less than 400% of the federal poverty level ($92,000 a year for a family of four) who do not have employer-sponsored health insurance, or who cannot afford their employer's plan are eligible to use their state Exchange. Just how small is a small business? Between 2014 and 2016, states may define the small group market as up to 50 employees or up to 100 employees. After 2016, all businesses with fewer than 100 employees will be "small" and may purchase health insurance through the SHOP. (See the fact sheet Affordable Insurance Exchanges for details.)

States that set up state-run Exchanges will be responsible for:

• Certifying health plans to participate in the Exchange,
• Designing a system to identify consumers who are either eligible for Medicaid or for subsidies to purchase health insurance, and
• Providing Navigators to help consumers understand their options and make decisions. 

Listen to the podcast or read the transcript.  

For 12 years, the Kaiser Commission on Medicaid and the Uninsured (KCMU) and Health Management Associates has surveyed Medicaid officials in all 50 states and the District of Columbia (D.C.). The top five findings for fiscal years (FY) 2012 and 2013, which are detailed in the Executive Summary include:  

1. The improving economy accounts, in part, for slowed spending and enrollment in Medicaid during FY 2012. There was only a 2% increase in Medicaid spending, and the rate of enrollment slowed to 3.2%.  
2. States used various methods to control Medicaid costs, including cutting provider reimbursement rates, limiting optional services for adults, creating preferred drug lists, and using home- and community-based services waivers to support individuals in community-based settings rather than in institutional care.   
3. The Maintenance of Eligibility (MOE) provision of the Affordable Care Act (ACA) requires states to maintain current eligibility for adults through 2014. Children's eligibility for Medicaid and the Children's Health Insurance Program (CHIP) is protected until 2019. In an effort to control costs, some states that currently extend Medicaid to optional populations of adults have cut eligibility by allowing waivers to expire or certifying that they have a budget deficit. Other states have requested waivers to expand Medicaid eligibility for childless adults in advance of the Medicaid expansion provision of the ACA, which will go into effect in January 2014.    
4. States are expanding managed care to new geographic areas and to additional populations and linking payment to performance in an effort to improve delivery of care to individuals dually eligible for Medicare and Medicaid. Forty-four states are implementing care coordination activities. Some of the care coordination will occur through the Medicaid health home state plan option (section 2703 of the ACA), for individuals with chronic conditions.    
5. States have to decide how they will proceed with ACA implementation, including whether they will adopt the Medicaid expansion and whether to set up a state-run health benefits Exchange or have the federal government operate it. 

Read the complete analysis, review the survey, methodology, and case studies from Massachusetts, Ohio, Oregon, and Texas in the full report.    

• Disproportionate numbers of children in foster care and in the juvenile justice system have disabilities compared to other groups of children; Note: Learn more about Financing the Special Health Care Needs of Children and Youth in Foster Care.
• More children with disabilities live in poverty than all children (31% vs 20%);
• Most children with disabilities (94%) have either private or public health insurance.  

This research brief includes a table with data for each state, which may be used to help plan for needed services for this vulnerable population of children.  

• When children (younger than 19), including children with special health care needs, can be added to a parent's private health insurance (hint: know when your open enrollment period occurs);
• Special circumstances for adding a dependent to a parent's coverage outside of the open enrollment period due to the termination of other health coverage;
• Whether an insurer can refuse or limit coverage for a child with a pre-existing condition (hint: as of September 2010, the Affordable Care Act (ACA) prohibits private insurance companies from denying or limiting coverage to children under age 19 with pre-existing conditions. Starting in January 2014, the ACA will also prohibit insurers from denying coverage to adults with pre-existing conditions).
• If an insurer can increase the premiums for a child with a known medical condition (yes). 

As part of their work as a Lucile Packard Foundation for Children's Health grantee, the Center for Medical Home Improvement (CMHI) has established a development team and an advisory committee to inform and endorse/promote consensus standards for Planned Coordinated Care. The development team is framing a Planned Care document that will include:

1. Why planned care, care coordination, and care plans are so important,
2. How care planning/care plans and related care coordination are effectively achieved in practice, and,
3. What core elements or dimensions should be evident at each step of care planning and its subsequent plan of care.  

The intent is to offer clear standards, which can be flexibly applied in practice. An ultimate aim is to create a clear path for professional/national endorsement and/or promotion of these standards using the guidance set forth by the organizations represented on its advisory. 

Correction: In the November 13th issue of Catalyst Center Coverage, we incorrectly referred to the Center for Medical Home Improvement as the National Center for Medical Home Improvement. We apologize to our valued partners at both the Center for Medical Home Improvement and the American Academy of Pediatrics' National Center for Medical Home Implementation, as well as to our readers for any confusion this may have caused.   

Developing a Psychometrically Sound Parent Measure of Family-Centered Care
Family-centered care occurs when patients, families, and health providers work together. Often, family-centered care leads to improved quality of care and health outcomes. The Family Voices National Center for FamilyProfessional Partnerships is testing a Family-Centered Care Assessment Tool. Families raising children with special health care needs are invited to complete a 15 - 20 minute questionnaire as part of this online research project. The Western Institutional Review Board has approved this survey. Learn more about the Family-Centered Care Tool Validation project. Read the invitation and participate in this research.