State Health and Value Strategies (SHVS) hosted a Small Group Convening on April 12 and 13, 2018 in Minneapolis, Minnesota bringing together state officials and technical experts to discuss issues currently being confronted by state Medicaid agencies.
Webinar on April 20, 2018 — The U.S. Department of Health & Human Services released on April 9, 2018 its annual Notice of Benefit and Payment Parameters, a collection of policies governing the ACA’s marketplaces, insurance reforms, and premium stabilization programs. The first such annual notice issued under the Trump Administration, it contains a number of provisions that require state officials to make important decisions on short notice that will affect plan benefits, premiums, and marketplace operations. State Health and Value Strategies is hosting a webinar, together with experts Sabrina Corlette and Justin Giovannelli from Georgetown’s Center on Health Insurance Reforms, Joel Ario from Manatt Health and Jason Levitis, to help participants untangle the rule and its many implications for states.
CHIP covers nearly 9 million children and is a key contributor to record-low levels of uninsurance among children. However, Congress only provided funding for CHIP through FY 2017, which ended September 30. After a series of short-term patches that left states with a great deal of uncertainty, Congress passed a six-year extension of CHIP in January. Three weeks later, on February 9, Congress extended the program for another four years, reauthorizing the program through FY 2027. This issue brief summarizes key features of the 10-year CHIP extension.
The nation’s opioid epidemic claimed more than 42,000 lives in 2016, and more than 2 million people in the United States have an opioid use disorder (OUD)—with nearly another 10 million at risk due to misuse of these drugs. Yet, only 1 in 5 people suffering from an OUD receive treatment. The federal government has responded to the crisis by declaring a public health emergency and making over $500 million of OUD-targeted funding available to states last year. While critical, these dollars (and the programs they fund) pale in comparison to the scale and scope of resources the Medicaid program brings to states to combat the opioid epidemic and other substance use disorders (SUD). Indeed, today, Medicaid covers more than 1 in 3 people with an OUD, and program spending for people with an OUD in 2013 (before Medicaid expansion in many states) was more than $9 billion. In this issue brief, data from three states—New Hampshire, Ohio and West Virginia—highlight Medicaid’s role as the linchpin in states’ efforts to combat the opioid epidemic.
Faced with a fluid federal regulatory environment, many states continue to encounter challenges in stabilizing their individual health insurance markets, including large premium increases and declining insurer participation. One solution to continued market instability is a state-based reinsurance program similar to the federal program that reduced premiums by more than 10 percent per year from 2014 to 2016. The brief provides a roadmap of policy, program design, and financing considerations for states that are contemplating development of a state-based reinsurance program under 1332 waiver authority.
Global budgeting is an innovative payment approach for rural hospitals that can enhance financial solvency and advance population health. Hospitals with global budgets know their revenues in advance of the year and so can concentrate on providing the services their communities need as well as on the prevention and management of chronic illness. Maryland rural hospitals have received global budgets since 2010; selected Pennsylvania rural hospitals will be starting on global budgets soon.
UPDATED 4/6/2018–State Health and Value Strategies, in partnership with health tax expert Jason Levitis, has created a template to help states develop an application for a state innovation waiver under the Affordable Care Act (ACA) section 1332 to implement a state reinsurance program. Section 1332 gives states flexibility to waive certain ACA provisions and receive federal funding to implement state-based health care policies. Reinsurance programs are a proven method of reducing premiums and promoting competition and market stability. This template seeks to make application development as simple as possible by adapting language from the successful Oregon application and indicating where elements need to be filled in or otherwise customized.
On May 30, 2018, a State Policy Academy on Global Budgeting for Rural Hospitals will take place in Baltimore, Maryland. Up to five state teams (with up to five members each) will be selected to participate. The State Policy Academy will be hosted by Johns Hopkins University, in collaboration with the Milbank Memorial Fund, the Robert Wood Johnson Foundation’s State Health and Value Strategies, and the National Rural Health Association. Funding for the Policy Academy is provided by the Robert Wood Johnson Foundation and Milbank Memorial Fund. Participant travel expenses will be covered.
Analysis of the Trump Administration’s Proposed Short-Term Health Plan Rule: Implications for States
The Secretaries of Health and Human Services, Treasury, and Labor released a proposed rule to implement the President’s October 12, 2017 executive order calling for expanded availability of short-term limited duration health plans that do not have to comply with Affordable Care Act standards. The proposed rule would relax current federal rules by allowing short-term plans to be sold for a duration of up to 12 months. It also modifies required consumer disclosures about these products.
[*Updated Feb. 21, 2018*] The tax bill passed in December 2017 repealed the penalty associated with the Affordable Care Act’s individual shared responsibility provision, also known as the individual mandate. The provision required those who could afford health coverage to either maintain coverage, qualify for an exemption, or make a payment with their federal income tax return. The Congressional Budget Office projects that repealing the mandate penalty will increase insurance premiums by 10 percent on average and result in 13 million more persons being uninsured. A number of states have expressed an interested in examining a state-level individual mandate, which Massachusetts has had in place since before the ACA.