With the Patient Protection and Affordable Care Act’s (ACA’s) ninth open enrollment period (OEP) set to launch in less than a month, the ACA Marketplaces are seeing record enrollment numbers with more generous subsidies, new carrier competition, and a relatively stable rating environment. At the same time, there is uncertainty with the trajectory of the COVID-19 pandemic and medical costs trending upward as the economy recovers, albeit at an uneven pace. These trends have made for a challenging rate review process in the 47 states plus the District of Columbia (D.C.) that conduct their own ACA rate reviews of carrier-proposed rates using federal review standards. State announcements of 2022 rates have trickled out at a slower pace than in prior years, and it is likely that many states will not publish their approved rates until the beginning of open enrollment. As always, state rate results vary widely and, even within states, there often are substantial variations among carriers and across different regions in geographically diverse states. With these caveats, this expert perspective highlights some observations about the factors that are impacting rate changes this year and the kind of variations that exist among states.
Emerging Strategies for Connecting Justice-Involved Populations to Medicaid Coverage and Care
States are exploring opportunities to engage justice-involved populations–including juveniles and adults–in Medicaid coverage, case management and health care both immediately prior to and following their release from prison or jail. States’ interests are motivated by the high needs and high related health costs of these individuals–who are often eligible for Medicaid upon release, especially in states that have expanded Medicaid. The health needs of the justice-involved are considerable: an estimated 80 percent of individuals released from prison in the United States each year have a substance use disorder or chronic medical or psychiatric condition and incarcerated individuals have 9 to 10 times the rate of hepatitis C and eight to nine times the rate of HIV infection than the general population.
On Tuesday, June 18 at 1:00 p.m. ET, State Health and Value Strategies, in partnership with Manatt Health, hosted a webinar for states that provides an overview of the opportunities available to connect justice involved populations to Medicaid coverage and care. Despite the current prohibition on drawing down federal Medicaid financing to fund health care for people while they are incarcerated, there are a number of strategies states can deploy to meaningfully connect justice-involved populations to critical coverage as well as medication and physical and behavioral health care services when re-entering the community. The webinar provided an overview of Medicaid enrollment and suspension processes to make sure an individual has active Medicaid coverage and “in-reach” planning pre-release that helps with engagement and care management post-release. Additionally, the webinar reviewed the new federal requirements under the SUPPORT Act, opioid legislation enacted last year by Congress, related to justice-involved populations and discuss emerging 1115 Waiver activity nationally to enable Medicaid coverage to commence even before community re-entry.
As a follow-up to the webinar, SHVS produced a compendium of questions and answers from the webinar.