Insurance & Marketplaces

Insurance & Marketplace expertise for the shifting terrain.

HMA Medicaid Market Solutions (HMA MMS), formerly SVC, is a recognized authority on the regulatory and operational requirements of all marketplace models for both states and insurers. Following passage of the Affordable Care Act (ACA), HMA MMS led the research of marketplace options for Indiana, identifying the ACA regulations that would impact current state policy and statutory authority. As part of the analysis, HMA MMS also worked with the state Medicaid agency and the Indiana Department of Insurance to develop the best approach for the state of Indiana in meeting the ACA requirements.

Some of the firm’s efforts included:

  • Development of a tool for identifying and comparing state plan options to meet the Essential Health Benefit (EHB) requirements
  • Assessment of the Marketplace for both the private and public healthcare sectors to identify the populations and existing regulations impacted by the ACA
  • Design and implementation of a Consumer Assistance program to assure that individuals receive accurate information regarding the Marketplace and their private and public healthcare options.

HMA MMS’ work on the Consumer Assistance program included assisting Indiana state agencies in addressing policy, technical, and operational requirements, bringing together the Medicaid agency and the Indiana Department of Insurance, and gathering input from internal and external stakeholders to develop the program. HMA MMS collected information regarding existing consumer programs, and interviewed key contacts to design a tool to identify key decision points, with possible state options. HMA MMS worked jointly with the state agencies to develop key program standards required for the certification of individuals or organizations applying to assist Hoosiers in understanding and making informed decisions regarding the Marketplace in Indiana.

The Indiana Consumer Assistance program is jointly managed by the Medicaid agency and the Indiana Department of Insurance. HMA MMS was instrumental in accomplishing this joint effort by:

  • Identifying funding for the program
  • Drafting the Memorandum of Understanding between the two state agencies
  • Writing the operational plan and the program’s rules and regulations
  • Developing an extensive training manual to provide a comprehensive explanation of ACA policies, the implications for the federal Marketplace in Indiana, and the Consumer Assistance program.

HMA MMS also created other tools used by stakeholders and state employees in implementing the Consumer Assistance program.

Additionally, HMA MMS worked with the Nebraska Department of Insurance to estimate enrollment in a state Marketplace, and to complete a Rate Review Grant proposal.

Aside from HMA MMS’ strength in the development of customized state-based programs, the firm is also proficient in analyzing complex insurance regulations, and meeting state and federal requirements across the private and public sectors. HMA MMS has studied the complexities of options for Alternative Benefit Plans (ABPs) required for Medicaid expansions, and is experienced in ABP analysis, design, development and completion of all required CMS ABP templates. HMA MMS continues to track and review state and federal requirements for offering unique plan options to provide health insurance coverage.