As the opioid epidemic continues, Medicaid programs are applying for SUD Section 1115 Demonstration waivers (SUD waiver) to expand Medicaid-funded treatment options. Some states with approved SUD waivers have formally implemented the American Society for Addiction Medicine (ASAM) Criteria to promote consistency in client placement for SUD treatment. The ASAM Criteria is a clinically driven multidimensional client assessment model that emphasizes treatment outcomes, client-specific lengths of service, and a team-based approach to care. This issue brief draws from the experiences of states that were among the first to implement their SUD waivers to profile how the ASAM Criteria is used within the context of managed care and utilization review, and the challenges and best practices associated with its use.
Eight states require or will require insurers to offer health plans with standardized benefit plans in the individual market, and several more are considering requiring such standardization in the future. On Wednesday, November 6, 2019 at 1:00 p.m. ET, SHVS hosted a webinar on the opportunities for states to implement standardized benefit designs, either through their health insurance marketplace or as part of a public option plan, issues to consider in developing standardized options, communicating with stakeholders, and leveraging standardized designs to improve affordability for enrollees and encourage maintenance of coverage. The webinar reviewed the development of standardized designs through state-based marketplaces, their role in Washington and other states’ public option proposals, operational requirements to improve the end-user experience, and data collection and analysis needs.
The Department of Homeland Security (DHS) final rule, Inadmissibility on Public Charge Grounds, was published in the Federal Register on August 14, 2019. Public Charge Final Rule: Frequently Asked Questions provides answers to questions about whom the rule will impact, what benefits are implicated by the rule, and how the rule might be administered. The rule was to go into effect as of October 15, but multiple federal courts have issued nationwide preliminary injunctions temporarily blocking the Administration’s implementation of the rule.
On August 12, the Department of Homeland Security (DHS) issued a final version of its public charge rule which was to go into effect on October 15, but has since been delayed as a result of litigation. On September 3, the Robert Wood Johnson Foundation’s State Health and Value Strategies program hosted a webinar on the final rule, facilitated by experts at Manatt Health. The public charge rule will change how DHS determines whether immigrants—when seeking admission to the U.S., an extension of their stay, or status change to become a legal permanent resident—are “likely at any time to become a public charge” (i.e., dependent on the government for financial support). The webinar reviewed the final rule, highlighted changes from the proposed rule, and explored the rule’s potential impacts on consumers, states and providers. Speakers highlighted the key ways the proposed rule departs from current guidance, with a particular focus on the implications for Medicaid and other health-related public benefits, as well as communications and messaging. In addition, New York provided one example of how a state has engaged its assistors to help communicate potential implications of the rule.
On Tuesday, October 22 State Health and Value Strategies convened the fifth, and last, webinar in our series SHVS Health Equity Through Managed Care. For many states, eliminating disparities in Medicaid managed care programs means working with their MCO contractors, and implementing contractual requirements that advance health equity. Previous webinars in this series identified measures and MCO performance requirements that help reduce health disparities and improve health equity for a state’s Medicaid population. This webinar, The Medicaid MCO Experience in Addressing Health Equity, profiled the work of one MCO, HealthPartners, in addressing equity issues within its Medicaid line of business. We heard from Brian Lloyd, who manages Health Partners’ organization-wide equity initiative, which includes collecting data to eliminate disparities in care, supporting language access, partnering with communities, and building an organizational understanding of equity, diversity, inclusion, and bias.
On Friday, June 21 at 1:00 p.m. ET State Health and Value Strategies hosted a webinar for state officials with technical experts to discuss the implications of the health reimbursement arrangements (HRA) rule and possible state responses. The webinar featured Jason Levitis, who led ACA implementation at the U.S. Treasury Department, as well as experts from Georgetown University’s Center on Health Insurance Reforms and from Manatt Health. The U.S. Departments of Health and Human Services, Labor, and Treasury released final regulations easing the rules governing HRA and other account-based, tax-preferred health care on June 13. The final rule represents the third of the three policy changes initiated by the October 12, 2017 Executive Order, which also called for easing the rules on short-term limited-duration coverage and association health plans. Like those changes, the HRA rule could have profound implications for health insurance markets, consumers, and Marketplaces. The rule is effective in 2020, which raises important considerations about Marketplace readiness and potential tax consequences for individuals.
How States Can Use Measurement as a Foundation for Tackling Health Disparities in Medicaid Managed Care
Many people in America face segregation, social exclusion, encounters with prejudice, and unequal access and treatment by the health care system, all of which can impact health. Medicaid programs serve a disproportionate share of populations that are negatively impacted by health disparities. This new State Health and Value Strategies (SHVS) issue brief provides examples from a handful of states that have begun the work of identifying, evaluating, and reducing health disparities within their Medicaid managed care programs. Additionally, it offers an approach for other states interested in measuring disparities in health care quality in Medicaid managed care as a step towards achieving health equity, such that all Medicaid managed care enrollees have a fair and just opportunity to be as healthy as possible.
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. 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. 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.
On Thursday, April 25, State Health and Value Strategies, with Manatt Health, hosted a webinar for states on six key questions that state policymakers need to consider when choosing a buy-in model, designing its features, and introducing a Medicaid buy-in program. Lawmakers across the country are considering “Medicaid buy-in” or public option programs to stabilize the Affordable Care Act (ACA) insurance market and offer a coverage option that is more affordable and accessible than current options in the individual and employer markets. The concept of Medicaid buy-in/public option is evolving, encompassing the original Medicaid-based proposals and extending to other programs through which states can leverage government bargaining power to offer a more affordable coverage option, like state employee health plans or a Basic Health Plan. During the webinar, speakers from Manatt Health discussed considerations related to (1) goal setting, (2) sources of cost-savings, (3) potential impacts on existing insurance markets, (4) federal 1332 waiver considerations, (5) implementation capacity, and (6) key steps for implementation. Additionally, representatives from Colorado, Connecticut, and Washington shared the status of efforts in their respective states.
Lawmakers across the country are considering Medicaid buy-in programs to stabilize the Affordable Care Act insurance market and offer a coverage option that is more affordable and accessible than current options in the individual and employer markets. The concept of Medicaid buy-in is evolving, encompassing the original Medicaid-based proposals and extending to other programs through which the state can leverage its government bargaining power to offer a more affordable coverage option, like state employee health plans or a Basic Health Plans. Some refer to this evolving model as Medicaid buy-in, while others label it a “public option,” particularly for state-sponsored plans in the marketplace.
So far in the 2019 legislative session, more than 10 states have introduced legislation to study or implement a buy-in. The purpose of this issue brief is to identify the key questions that states pursuing these initiatives will want to consider as they seek to design and implement their proposals.