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.
Medicaid’s Crucial Role in Combating the Maternal Mortality and Morbidity Crisis
Patti Boozang, Chiquita Brooks-LaSure, and Gayle Mauser, Manatt Health
Medicaid has a pivotal role in improving national health outcomes for pregnant and postpartum women. Nearly half of all U.S. births are financed by Medicaid. Medicaid-enrolled pregnant women are more likely than women enrolled in private coverage to have had a preterm birth, to have had a low birthweight baby, and to experience certain chronic conditions (e.g., diabetes)—putting them at higher risk for poor maternal outcomes. States have flexibility to shape Medicaid policy related to maternal care, including who is covered, the duration of their coverage, the benefits they receive, and the delivery system through which they receive care. Further, state Medicaid agencies, in partnership with sister agencies, can use their purchasing power and “bully pulpit” to drive broader policy and cultural change to improve maternal health outcomes and the lives and health of mothers and of their children.
This issue brief, developed by our colleagues at Manatt Health, describes select policy and strategy levers that Medicaid agencies can employ to improve maternal health outcomes and address outcome disparities in five areas: coverage, enrollment, benefits, models of care, and quality improvement. In some cases, the Medicaid agency will be responsible for implementing these policies; in other cases, the Medicaid agency can lead collaboration with other state agencies such as the public health department or the state marketplace.
On March 11, State Health and Value Strategies hosted a companion webinar that highlighted and discussed select strategies from the issue brief.