Managed Care & Health Insurance - Kaiser State Health Facts

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} </style> <div id="container"> <div id="leftcol"> <br/> <img src="/web/20090720052009im_/http://www.statehealthfacts.org/images/comparearrow2.png" style="position: absolute; left: 259px; top: 155px"/> <b>     Choose a different category...</b>  <select onchange="ChangeCategory(this.options[this.selectedIndex].value,0);" name="newcategory" class="dropdowns"> <option value="cat=1">Demographics and the Economy</option> <option value="cat=2">Health Status</option> <option value="cat=3">Health Coverage & Uninsured</option> <option value="cat=4">Medicaid & CHIP</option> <option value="cat=5">Health Costs & Budgets</option> <option value="cat=6">Medicare</option> <option selected="selected" value="cat=7">Managed Care & Health Insurance</option> <option value="cat=8">Providers & Service Use</option> <option value="cat=9">Minority Health</option> <option value="cat=10">Women's Health</option> <option value="cat=11">HIV/AIDS</option> <option value="/children.jsp"> -- Featured Topics -- </option><option value="/children.jsp">Children's Health</option> </select> <br/><br/> <span class="leftnavhead"> Managed Care & Health Insurance <a href="#" id="catImgA" onclick="expandAllSubCats(10); return false;"><img align="top" id="catImg" src="/web/20090720052009im_/http://www.statehealthfacts.org/images/minus_big.png" border="none"></a></span><div style="display: none;"><form id="thisCategory" type="hidden" name="7"></form></div> <div style="padding-left: 33px; text-indent: -18px"><a href="#" onclick="navToggle(0); return false;"><img id="subCatImg_0" border="none" src="/web/20090720052009im_/http://www.statehealthfacts.org/images/minus.png"/></a><span class="leftnavsub">HMOs</span></div> <div style="display: block;" class="subCatDiv" id="subCatNav_0"> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparemaptable.jsp?ind=347&cat=7">Number of HMOs</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparemaptable.jsp?ind=348&cat=7">Total HMO Enrollment</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparemaptable.jsp?ind=349&cat=7">HMO Penetration Rate</a></div> </div> <div style="padding-left: 33px; text-indent: -18px"><a href="#" onclick="navToggle(1); return false;"><img id="subCatImg_1" border="none" src="/web/20090720052009im_/http://www.statehealthfacts.org/images/minus.png"/></a><span class="leftnavsub">Protections in Small Group Markets</span></div> <div style="display: block;" class="subCatDiv" id="subCatNav_1"> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=350&cat=7">Small Group Guaranteed Issue</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=351&cat=7">Small Group Rate Restrictions</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=352&cat=7">Small Gr. Pre-Ex Condition Exclusion</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparereport.jsp?rep=7&cat=7">Standardized Plans Small Group Market</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparereport.jsp?rep=4&cat=7">Health Insurance Subsidies Small Group</a></div> </div> <div style="padding-left: 33px; text-indent: -18px"><a href="#" onclick="navToggle(2); return false;"><img id="subCatImg_2" border="none" src="/web/20090720052009im_/http://www.statehealthfacts.org/images/minus.png"/></a><span class="leftnavsub">Protections in Individual Insurance Markets</span></div> <div style="display: block;" class="subCatDiv" id="subCatNav_2"> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=353&cat=7">Individual Market Guaranteed Issue</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=354&cat=7">Individual Market Rate Restrictions</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=355&cat=7">Individual Market Portability Rules</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=356&cat=7">HIPAA Rules</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparereport.jsp?rep=6&cat=7">Standardized Plans Individual Market</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparereport.jsp?rep=3&cat=7">Health Insurance Subsidies Individual Market</a></div> </div> <div style="padding-left: 33px; text-indent: -18px"><a href="#" onclick="navToggle(3); return false;"><img id="subCatImg_3" border="none" src="/web/20090720052009im_/http://www.statehealthfacts.org/images/minus.png"/></a><span class="leftnavsub">Other State Protections</span></div> <div style="display: block;" class="subCatDiv" id="subCatNav_3"> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=357&cat=7">Expanded COBRA Continuation Coverage</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=358&cat=7">State Conversion Coverage</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=601&cat=7">Dependent Coverage </a></div> </div> <div style="padding-left: 33px; text-indent: -18px"><a href="#" onclick="navToggle(4); return false;"><img id="subCatImg_4" border="none" src="/web/20090720052009im_/http://www.statehealthfacts.org/images/minus.png"/></a><span class="leftnavsub">Mental Health Coverage</span></div> <div style="display: block;" class="subCatDiv" id="subCatNav_4"> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparereport.jsp?rep=2&cat=7">Mental Health Coverage Small Group Market</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparereport.jsp?rep=1&cat=7">Mental Health Coverage Individual Market</a></div> </div> <div style="padding-left: 33px; text-indent: -18px"><a href="#" onclick="navToggle(5); return false;"><img id="subCatImg_5" border="none" src="/web/20090720052009im_/http://www.statehealthfacts.org/images/minus.png"/></a><span class="leftnavsub">High Risk Pools</span></div> <div style="display: block;" class="subCatDiv" id="subCatNav_5"> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=602&cat=7">High Risk Pool Enrollment</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=603&cat=7">High Risk Pool Eligibility</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=604&cat=7">High Risk Pool Portability Rules</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=605&cat=7">High Risk Pool Plan Options and Premiums</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=606&cat=7">Pool Deductible Options and Enrollment</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=609&cat=7">High Risk Pool Costs</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=610&cat=7">High Risk Pool Financing Mechanisms</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=611&cat=7">High Risk Pool Governing Boards</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=673&cat=7">High Risk Pool Cost per Participant</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=674&cat=7">High Risk Pool Premium History</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=676&cat=7">High Risk Pool Rating Rules</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparereport.jsp?rep=11&cat=7">High Risk Pool Subsidies</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparereport.jsp?rep=12&cat=7">High Risk Pool Covered Benefits</a></div> </div> <div style="padding-left: 33px; text-indent: -18px"><a href="#" onclick="navToggle(6); return false;"><img id="subCatImg_6" border="none" src="/web/20090720052009im_/http://www.statehealthfacts.org/images/minus.png"/></a><span class="leftnavsub">Mandated Benefits in Private Insurance</span></div> <div style="display: block;" class="subCatDiv" id="subCatNav_6"> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparemaptable.jsp?ind=488&cat=7">Cancer Screening for Women</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparemaptable.jsp?ind=489&cat=7">Minimum IP Mastectomy Stay</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparemaptable.jsp?ind=490&cat=7">Reconstructive Surgery After Mastectomy</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparemaptable.jsp?ind=491&cat=7">Osteoporosis Screening</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparemaptable.jsp?ind=493&cat=7">Direct Access to OB/GYNs</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparemaptable.jsp?ind=494&cat=7">OB/GYNs as Primary Care Providers</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparemaptable.jsp?ind=496&cat=7">Eating Disorder Parity</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=686&cat=7">Infertility Coverage</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=687&cat=7">Maternity Care</a></div> </div> <div style="padding-left: 33px; text-indent: -18px"><a href="#" onclick="navToggle(7); return false;"><img id="subCatImg_7" border="none" src="/web/20090720052009im_/http://www.statehealthfacts.org/images/minus.png"/></a><span class="leftnavsub">Patients' Rights Requirements</span></div> <div style="display: block;" class="subCatDiv" id="subCatNav_7"> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=361&cat=7">External Review</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=362&cat=7">Health Plan Liability</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=363&cat=7">Financial Incentives to Providers</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=364&cat=7">Direct Provider Access</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=365&cat=7">Standing Referrals for Specialists</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=366&cat=7">Licensing of Medical Directors</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=367&cat=7">Drug Formulary Requirements</a></div> </div> <div style="padding-left: 33px; text-indent: -18px"><a href="#" onclick="navToggle(8); return false;"><img id="subCatImg_8" border="none" src="/web/20090720052009im_/http://www.statehealthfacts.org/images/minus.png"/></a><span class="leftnavsub">Health Insurance Reform</span></div> <div style="display: block;" class="subCatDiv" id="subCatNav_8"> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparemaptable.jsp?ind=378&cat=7">States That Allow HSA Deductions</a></div> </div> <div style="padding-left: 33px; text-indent: -18px"><a href="#" onclick="navToggle(9); return false;"><img id="subCatImg_9" border="none" src="/web/20090720052009im_/http://www.statehealthfacts.org/images/minus.png"/></a><span class="leftnavsub">Tax Incentives</span></div> <div style="display: block;" class="subCatDiv" id="subCatNav_9"> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=381&cat=7">Long-Term Care Insurance Tax Incentives</a></div> <div class="leftnav"><a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=683&cat=7">State Tax Credits for Private Insurance</a></div> </div> <script>initializeSubcategoryMenu('7');</script> <script>initializeCategoryMenu('7');</script> <div style="clear: both"></div> </div> <div id="rightcol"> <div id="strip"> <div align="right"><form id="email_form" action="/web/20090720052009/http://www.statehealthfacts.org/emailafriend.jsp" method="post" style="margin: 0px;"> <input id="email_form_title_new" type="hidden" name="page_title"/><input id="email_form_url_new" type="hidden" name="page_url" value=""/><span class="button"><a target="_blank" href="https://web.archive.org/web/20090720052009/http://www.statehealthfacts.org/comparecat.jsp?cat=7&print=1"><img border="0" 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id="category_summary" style="float: left"> <p class="bartext"> <span class="optionssub">Summary: </span> This category includes data on managed care enrollment, state consumer protection laws, and state benefit requirements.<br><br>For information about a state''s internal appeals procedure and external review process for disputes about medical coverage, see <a href="https://web.archive.org/web/20090720052009/http://www.kff.org/consumerguide/7350.cfm" target="_blank">A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan</a>, an updated consumer guide by the Kaiser Family Foundation and Consumer''s Union. </p> <p class="bartext" style="margin-bottom: 16px"> </p> </div> <div id="category_updates" style="float: left"> <table border="0" cellspacing="0" width="476"> <tbody> <tr> <td class="updatetablerow1" colspan="3"><strong>New or Updated Topics in this Category</strong></td> </tr> <tr> <td class="updatedividerrow" colspan="3"> </td> </tr> <tr> <td class="updatelabelrow" width="97">Revision Type</td> <td class="updatelabelrow" width="298">Topic/Comments</td> <td class="updatelabelrowend" width="77">Date</td> </tr> <tr> <td class="updatedividerrow" colspan="3"> </td> </tr> <tr> <td class="updaterow" align="left" valign="top"><strong>New</strong></td> <td class="updaterow" align="left" valign="top"> <p> <a href="/web/20090720052009/http://www.statehealthfacts.org/comparereport.jsp?rep=6&cat=7">Standardized Plans in the Individual Market, as of March 2009</a> <br/><br/> <em>Data are also available for the small group market.</em> </p> </td> <td class="updaterowend" align="left" valign="top">5/13/09</td> </tr> <tr> <td class="updaterow" align="left" valign="top"><strong>New</strong></td> <td class="updaterow" align="left" valign="top"> <p> <a href="/web/20090720052009/http://www.statehealthfacts.org/comparereport.jsp?rep=3&cat=7">Health Insurance Subsidies in the Individual Market, as of March 2009</a> <br/><br/> <em>Data are also available for the small group market.</em> </p> </td> <td class="updaterowend" align="left" valign="top">5/7/09</td> </tr> <tr> <td class="updaterow" align="left" valign="top"><strong>New</strong></td> <td class="updaterow" align="left" valign="top"> <p> <a href="/web/20090720052009/http://www.statehealthfacts.org/comparereport.jsp?rep=1&cat=7">State Mandated Benefits in the Individual Private Health Insurance Market: Mandated Coverage in Mental Health, as of January 2009</a> <br/><br/> <em>Data are also available for the small group market.</em> </p> </td> <td class="updaterowend" align="left" valign="top">5/7/09</td> </tr> <tr> <td class="updaterow" align="left" valign="top"><strong>New</strong></td> <td class="updaterow" align="left" valign="top"> <p> <a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=686&cat=7">Mandated Coverage of Infertility Treatment, January 2009</a> <br/><br/> <em>New data on maternity care also available.</em> </p> </td> <td class="updaterowend" align="left" valign="top">5/6/09</td> </tr> <tr> <td class="updaterow" align="left" valign="top"><strong>Updated</strong></td> <td class="updaterow" align="left" valign="top"> <p> <a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=683&cat=7">State Tax Credits for Private Health Insurance: Targeting Individuals and Small Employers, January 2009</a> <br/><br/> <em> </em> </p> </td> <td class="updaterowend" align="left" valign="top">5/6/09</td> </tr> <tr> <td class="updaterow" align="left" valign="top"><strong>Updated</strong></td> <td class="updaterow" align="left" valign="top"> <p> <a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=609&cat=7">State High Risk Pool Costs, December 2007</a> <br/><br/> <em>Data on high risk pool enrollment, eligibility, portability rules, and financing mechanisms are also available.</em> </p> </td> <td class="updaterowend" align="left" valign="top">5/6/09</td> </tr> <tr> <td class="updaterow" align="left" valign="top"><strong>Updated</strong></td> <td class="updaterow" align="left" valign="top"> <p> <a href="/web/20090720052009/http://www.statehealthfacts.org/comparemaptable.jsp?ind=347&cat=7&sort=a">Number of HMOs, July 2008</a> <br/><br/> <em>Data are also available on total HMO enrollment and HMO penetration rates.</em> </p> </td> <td class="updaterowend" align="left" valign="top">3/4/09</td> </tr> <tr> <td class="updaterow" align="left" valign="top"><strong>Updated</strong></td> <td class="updaterow" align="left" valign="top"> <p> <a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=357&cat=7">Expanded COBRA Continuation Coverage for Small Firm Employees, 2009</a> <br/><br/> <em>Data on state conversion coverage for small firm employees and definition of dependency by age are also available.</em> </p> </td> <td class="updaterowend" align="left" valign="top">3/3/09</td> </tr> <tr> <td class="updaterow" align="left" valign="top"><strong>Updated</strong></td> <td class="updaterow" align="left" valign="top"> <p> <a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=353&cat=7">Individual Market Guaranteed Issue (Not Applicable to HIPAA Eligible Individuals), 2008</a> <br/><br/> <em>Data on rate restrictions, portability rules, and HIPAA rules are also available.</em> </p> </td> <td class="updaterowend" align="left" valign="top">2/17/09</td> </tr> <tr> <td class="updaterow" align="left" valign="top"><strong>Updated</strong></td> <td class="updaterow" align="left" valign="top"> <p> <a href="/web/20090720052009/http://www.statehealthfacts.org/comparemaptable.jsp?ind=378&cat=7">States That Allow Individuals to Deduct Health Savings Accounts Contributions, 2008</a> <br/><br/> <em> </em> </p> </td> <td class="updaterowend" align="left" valign="top">7/1/08</td> </tr> <tr> <td class="updaterow" align="left" valign="top"><strong>Updated</strong></td> <td class="updaterow" align="left" valign="top"> <p> <a href="/web/20090720052009/http://www.statehealthfacts.org/comparemaptable.jsp?ind=379&cat=7">State Authorization of Tax Credits or Deductions to Small Employers Offering Health Insurance</a> <br/><br/> <em> </em> </p> </td> <td class="updaterowend" align="left" valign="top">7/1/08</td> </tr> <tr> <td class="updaterow" align="left" valign="top"><strong>Updated</strong></td> <td class="updaterow" align="left" valign="top"> <p> <a href="/web/20090720052009/http://www.statehealthfacts.org/comparetable.jsp?ind=381&cat=7">Long-Term Care Insurance Tax Incentives Offered by States, 2008</a> <br/><br/> <em> </em> </p> </td> <td class="updaterowend" align="left" valign="top">5/29/08</td> </tr> </tbody> </table> <br/><br/><br/><br/><br/><br/><br/><br/><br/><br/><br/><br/><br/><br/> </div> </div> <div style="clear: both"> </div> </div> </div>   <div id="ftr" align="center">  <table cellpadding="0" cellspacing="0" align="left"><tr><td nowrap="nowrap"><div 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