State Health Policy Highlights: Service Integration and Joint Accountability Across State Agencies and Programs
Health status is largely influenced by factors outside the health care delivery system, particularly for low-income populations. State efforts to improve health and reduce health disparities through the lens of medical care alone will miss opportunities for individuals, particularly the most vulnerable and their communities. As more states focus broadly on population health goals, they seek to employ and coordinate a variety of health and other resources on targeted efforts. This State Health Policy Highlight profiles three State Health and Value Strategies (SHVS) issue briefs that provide states with practical approaches to improve individual and population health and create joint accountability across health care and other sectors.
There is an extensive body of evidence that shows social determinants of health (SDOH) play a powerful role in shaping health and health outcomes. State policymakers are increasingly focused on SDOH because of the influence they have on health, health care outcomes and Medicaid spending. As state Medicaid agencies consider addressing SDOH, there are a range of models they can employ. State Health and Value Strategies (SHVS) has published resources and hosted webinars with information for state health officials on approaches to addressing SDOH. This State Health Policy Highlight profiles two issue briefs and a webinar produced by SHVS on the topic of how state Medicaid programs can address SDOH.
Work and Community Engagement Requirements in Medicaid: State Implementation Requirements and Considerations
The Centers for Medicare & Medicaid Services (CMS) has approved state work/community engagement (CE) waivers in Arkansas, Indiana, Kentucky, and New Hampshire, and additional states have submitted or are poised to submit similar waivers. Manatt Health has produced a series of charts that outline the legal, policy, financial and operational tasks and issues that states will face in adding a work/CE condition to their Medicaid program. This information is intended to highlight for states the complexity of administrative tasks associated with implementing a work/CE requirement.
On July 24th, the Robert Wood Johnson Foundation State Health and Value Strategies (SHVS) program, together with technical assistance experts from Manatt Health, hosted a webinar to review the Stewart v. Azar decision and its potential implications for states with approved, pending or planned Medicaid waivers that include work/community engagement requirements. During the webinar, we reviewed the court’s findings and any Centers for Medicare & Medicaid Services guidance. Even in states not pursuing work/community engagement requirements, the court’s findings may shape what type of analysis will be necessary to demonstrate that future waivers advance the objectives of the Medicaid statute.
Waivers of the Institutions for Mental Disease (IMD) Exclusion: Emerging Opportunities and Challenges
On June 21, the Robert Wood Johnson Foundation’s State Health and Value Strategies program, together with technical assistance experts from Manatt Health, hosted a webinar to discuss the status of state efforts to secure waivers to use federal Medicaid funding to provide care in Institutions for Mental Disease (IMD). The webinar reviewed the requirements states must meet to secure an IMD waiver; the status of requests and approvals; and issues and opportunities arising as states pursue and increasingly implement the IMD waiver. We were joined by leadership from the New Jersey Department of Human Services, which received approval of its IMD waiver in October 2017 and is now in the implementation phase.
In recent months, several proposals have been introduced at both the federal and state levels that would permit people above Medicaid eligibility levels to “buy in” to Medicaid or would leverage the Medicaid program to strengthen coverage across the individual market and Medicaid. In this webinar, the Robert Wood Johnson Foundation’s State Health and Value Strategies (SHVS) program, together with technical assistance experts from Manatt Health, examined the central considerations that a state must take into account when developing a Medicaid buy-in proposal; the primary models for state-administered Medicaid buy-in proposals, and the administrative considerations and authorities needed for each model. The webinar also reviewed Section 1332 waiver authority and related deficit neutrality and pass-through funding implications that states will want to consider as they craft their buy-in proposals. We also highlighted states’ current efforts to develop buy-in initiatives.
States continue to identify and pursue strategies to further reduce the number of uninsured, to make coverage more affordable for consumers and to improve access to care. Several proposals have been introduced at both the federal and state levels that would permit people above Medicaid eligibility levels to “buy in” to Medicaid or would leverage the Medicaid program to strengthen coverage across the individual market and Medicaid. This issue brief presents two possible models for a Medicaid buy-in program for states, and details the design considerations and authorities needed to implement each model.
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.
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. 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.