Policy & Practice June 2015

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Š Š Must not increase the federal deficit

Š Š How should eligibility and enroll- ment processes be streamlined and made more attractive to consumers? The 2017 State Innovation Waiver is an invitation for state leaders to think boldly about how they want to help their citizens with accessing afford- able health insurance and it will be both a journey and a learning process. As states venture down this path, MAXIMUS is doing its part to help facilitate the creative thinking about the waiver with a published white paper (http://www.maximus.com/ sites/default/files/MAXIMUS_2017%20 State%20Waiver_White-Paper.pdf), a live event that created a dialogue among key health policy experts, and a webinar (http://www.maximus.com/ webinars) that continued the dialogue with additional leaders of innovation. As a partner to many states, we see many possibilities for leveraging the 2017 State Innovation Waiver and we look forward to helping them capitalize on this new opportunity to reinvent and improve their health insurance programs.

Š Š Complex rules and guidance that can prevent or inhibit states from pursuing program policies they find attractive, such as greater benefi- ciary financial participation and incentives for healthy behavior The spectrum of options permitted in the provision has the potential to waive a number of ACA requirements that states can consider: Š Š Establishment of Qualified Health Plans (QHP) Š Š Individual requirement to maintain minimum essential coverage Š Š Delivery of QHP benefits through a health insurance exchange Š Š Premium tax credits to subsidize insurance coverage Š Š Reduced cost sharing for qualified individuals Š Š Small business tax credits Š Š Employer mandate However, the ability to waive one or more of these requirements is con- strained by four conditions: Š Š Must provide at least as much coverage as before Š Š Must not make individuals pay more than before Š Š At least as many people are covered as before

State Considerations State leaders should begin their deliberations on whether to propose a waiver. Given the number and nature of the requirements that can be waived, there is a very broad continuum on what a state might do, from limited changes, such as eliminating the Small Business Health Options Program (SHOP) exchange, to dramatic, comprehensive changes that transform the state’s ability to manage and run the processes and technology that support health insur- ance coverage. A number of questions serve to illustrate the parameters that states might consider: Š Š Should a waiver encompass each of the three primary insurance afford- ability programs—Medicaid, CHIP, and the exchange—or be more limited in scope? Š Š To what extent should the private market, including job-based benefits, be leveraged? Š Š How can the eligibility breakpoints be re-configured to better protect continuity of care, reduce churn, and increase consumer engagement and loyalty?

Jan Ruff is the senior vice president of MAXIMUS.

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A FINALWORD The journey that APHSA members and their partners have embarked upon to improve the outcomes for health and human service program participants by increased collaboration and integration of health and human services has been both a satisfying and successful one. Our efforts are evolving to meet the complexity of horizontal integration. We encourage you to join your colleagues and us on this exciting new, transformational journey.

effectiveness, together with other key factors such as financing arrange- ments, business process re-engineering steps, and useful workforce support measures. Address Needed Policy and Practice Changes Through an Ongoing Dialogue with Federal Legislative and Executive Branch Decision-Makers Because success requires multiple partners at all levels of government, the NC will identify both barriers and successful policies and practices at the

federal level that either encourage or discourage state and local horizontal integration efforts. Share Best Practices Globally The NC will initiate global commu- nications on best practices by sharing the products and tools developed within the project with human service orga- nizations worldwide . We initiated these discussions in July 2014 at the European Social Network conference and will leverage the relationships established there to expand our shared learning to and from other countries.

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