In 2019, the Washington legislature enacted a bill requiring insurers on the state’s health insurance exchange to offer plans with standardized benefit designs, beginning in 2021. Colorado and Maryland are considering similar requirements. As these and other states consider the option of standardized health plans, they can benefit from the experiences of California, the District of Columbia (D.C.), Connecticut, Massachusetts, New York, Oregon, and Vermont, all of which require insurers to offer standardized benefit designs. This Expert Perspective outlines benefits and risks of plan standardization, and raises critical questions that states will need to consider, and offers a decision roadmap for states implementing a standardized benefit design requirement.
Medicaid Managed Care Toolkit
State Medicaid agencies are increasingly turning to managed care organizations (MCOs) to cover more Medicaid enrollees, including those with complex needs. The ongoing shift from a fee-for-service payment model to a value-based payment model at the health plan and provider level puts even more importance on Medicaid managed care procurement strategies and approaches.
This webinar, drawn from the SHVS resource for states, Value-Based Purchasing for Managed Care Procurements: A Toolkit for State Medicaid Agencies, highlights key activities for state Medicaid agencies as they tackle managed care procurements. The webinar emphasizes the link between a state’s value objectives, RFP development, and model contract oversight. Beth Waldman and Mary Beth Dyer from Bailit Health discuss key steps and timelines for procurements, as well as important steps to take once contracts are in place to ensure a strong partnership between state Medicaid agencies and the health plans with which they contract. States with recent procurement experience will offer lessons learned from their own procurements.
Kim Hamilton, Director of the Managed Care Plan Division at Michigan Department of Health and Human Services shared with SHVS the provider survey implemented in Michigan and referenced during the webinar.