Description: Medicare and Medicaid finance more than half of American health care. Medicare and Medicaid are at the forefront of nearly every major change in U.S. health care payments, from DRGs in the 1980s to today’s value-based care. Listen to a conversation with Bruce Pyenson, FSA, MAAA, who recently completed six years as a Medicare Payment Advisory Commission (MedPAC) commissioner and Stacey Lampkin, FSA, MAAA, who recently completed six years as a Medicaid and CHIP Payment and Access Commission (MACPAC) commissioner. Hear about programs’ current challenges, what changes the ex-Commissioners anticipate over the next few years, and how these changes might impact Medicare and Medicaid managed care plans, and spillover into employer-sponsored and individual commercial insurance. By attending this session, you will be able to appreciate the role of Medicare and Medicaid as health care payment change agents and foresee future health care payment changes.

Description: The SOA has been interested in financing of long term care for many years. As part of this interest, they approved a state-based research effort in the chosen location of Minnesota. Join authors of the research as they present their findings . The research effort looked at stakeholder responses in Minnesota to several designs that would create a state-based catastrophic long-term care insurance program. The conceptual work was based on efforts by Cohen, Feder and Favreault using the DYNASIM model created by the Urban Institute. Catastrophic coverage would be provided after a variable waiting period based on income. Private resources, including long-term care insurance, would be expected to cover the front end. (Persons on Medicaid would continue to have their gap coverage provided by that program).

Description: The U.S. health care system continues to have its problems. It costs too much and even with public policy developments we are not meeting the desired objectives. What's next? What else can we do? Discuss some of the emerging ideas that are being pursued and the likelihood of their success at solving our collective problem.

Description: 2021 ImpACT Conference - Session 1B: Mental Health Care in a Virtual World 10.25.21 Recording

Description: With there being over 11 million undocumented immigrants in the United States, some states are considering or have expanded Medicaid-like coverage to this population. Healthier Oregon launched in July 2022 to provide such benefits, and now covers more than 20,000 Oregonians. Hear about the structure of the program, along with its capitation rate build (which integrates federal participation for emergency and pregnancy-related services), risk corridor design, and related policy and implementation considerations. After attending this session, you will gain an understanding of the actuarial, regulatory and practical considerations for covering this population through managed care.

Description: Risk adjustment (RA) is a key component for CMS Medicare Advantage program and California Medicaid Managed Care program. While both RA programs follow generally accepted basic principles at a high level, their underlying methodologies and assumptions are also quite different. Due to recent events such as COVID-19 Public Health Emergency and Medicaid redetermination delay and restart, it adds complexity to Risk Adjustment. This is a hot topic in the industry and has significant impact to health plans. Keeping current with risk adjustment program changes and understanding the commonalities and differences of these two government risk adjustment programs is important to our health actuaries. Compare these two risk adjustment programs so you can learn key elements of a risk adjustment program, similarities and differences in methodology and assumptions , as well as special considerations due to serving different populations.

Description: Currently there are ten states in the U.S. —Rhode Island, California, New Jersey, New York, Washington, DC; Washington, Massachusetts, Connecticut, Oregon and Colorado —that have enacted Paid Family Leave. Paid Family leave is an employee funded state insurance program that provides wage replacement to eligible workers when they take time off of work to care for a seriously ill family member or to bond with a new child. Who pays the taxes? The employer or the employee? How will this effect short term disability benefit offerings in the work place? How does a Paid Family Leave plan get implemented? Is it up to the employee to file for the benefit through the unemployment office or does the employer file? At the state level, how is paid family leave reserved for? How is it administered? What job protections are there? How does this work with the Family Medical Leave Act? Get these and more questions answered. By attending this session, you should have an understanding of the state Paid Family Leave programs, what it means to future short term disability plans, and how the state accounts for this program.