State efforts to promote continuity of coverage and care under the Affordable Care Act.

Many states have worked tirelessly over the past two years to develop health insurance exchanges and prepare for the expansion of their Medicaid programs in order to meet the requirements of the Patient Protection and Affordable Care Act. Programs to expand coverage, however, do not necessarily ensure seamlessness for many individuals who are likely to experience shifts in program eligibility due to changing circumstances (e.g., income fluctuations, family composition changes, etc.). A number of states are actively working to limit the impact of changes in program eligibility by developing policies that limit either the incidence of program eligibility changes and/or the impact those changes have on individual consumers. Various emerging state approaches take into account program history, the desire for state flexibility, and the political and operational challenges states face in developing coverage expansions that work for consumers, stakeholders, and policy makers.

Maximizing quality and value in Medicaid: using return on investment forecasting to support effective policymaking.

In order to serve increasing numbers of Medicaid beneficiaries, particularly during an economic recession, states must find ways to maximize the impact of available funds. Some states are identifying new ways of organizing, financing, and delivering health care in order to lower costs without sacrificing quality of care or enrollment capacity. An important tool for helping policymakers design such "value-added" strategies is return-on-investment (ROI) analysis. ROI forecasting has long been used to inform the allocation of limited resources in the private sector. This brief outlines what ROI can do, and in a few cases has already done, in the public sector, to improve quality and control costs in Medicaid.