Medicaid's Role in the Health Benefits Exchange

A Road Map for States

This report from the Maximizing Enrollment program, administered by the National Academy for State Health Policy, offers a road map on many of the issues state officials face in effectively integrating Medicaid as they build, operate and finance their new health benefit exchanges. With the Affordable Care Act’s enactment, Medicaid has completed its transition from a specialized program linked to welfare recipients, to a major health insurer that will be a lynchpin in ensuring functional exchanges in very state.

Lead author Deborah Bachrach, J.D., of Manatt Health Solutions, highlights four key areas where state officials can support and expand Medicaid’s role in planning exchanges:

  • Eligibility, enrollment and outreach;
  • Health plan standards and requirements;
  • Benefit package design; and
  • Infrastructure—governance, operations and finance.

Study authors conclude that a thorough evaluation of Medicaid’s role in planning and operating any state’s exchange is a pivotal early step.