In the absence of federal legislation, states are actively seeking tools to reform their health care systems. While 1115 waivers rightly get a lot of attention, because of their ability to reshape state Medicaid programs, the Affordable Care Act’s Section 1332 waivers continue to be a promising avenue for states to stabilize their health insurance marketplace. SHVS is tracking state activity and has many resources, including a template, for states interested in pursuing a Section 1332 waiver.
On January 23, State Health and Value Strategies will host a webinar examining the complexities of state Medicaid oversight of the pharmacy benefit in the managed care environment. State Medicaid programs commonly rely on contracted Managed Care Organizations (MCOs) and their subcontracted Pharmacy Benefit Managers (PBMs) to manage the prescription drug benefit offered to Medicaid enrollees. The webinar will offer states real world tips on how to best monitor and evaluate operational and financial performance of their MCOs and their subcontracted PBMs.
On December 17, 2018 State Health and Value Strategies hosted a webinar on Medicaid buy-in proposals. Over the past year, state policy makers and advocates have expressed interest in proposals that would permit people above Medicaid eligibility levels to “buy in” to Medicaid (i.e., leverage the state’s bargaining power in some way) in order to offer more affordable and accessible coverage. During this webinar, Manatt Health discussed state considerations for developing a Medicaid buy-in proposal, evolving models of state proposals, and the administrative considerations and authorities needed for each model.