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.
Categorizing Value-Based Payment Models According to the LAN Alternative Payment Model Framework: Examples of Payment Models by Category
As the movement from volume to value-based payment progresses, more state purchasers are requiring their contracted health plans to implement alternative payment models (APMs) with the goals of improving the quality of care and reducing costs for taxpayers. The LAN APM Framework is an increasingly common method being used by states to measure plan progress toward implementation of APMs. This brief provides real-world examples of APMs within the LAN categories and can help states and other interested purchasers develop a common understanding of what types of payment models fit within the framework categories.
State Medicaid Approaches for Defining and Tracking Managed Care Organizations Implementation of Alternative Payment Models
As state Medicaid programs emphasize a focus on value-based payment, they are increasingly requiring their Medicaid managed care organizations to implement alternative payment models (APMs). This brief focuses on different ways in which states may set standard APM definitions to a) track MCO progress toward meeting state APM goals, and b) support comparison of APM implementation within a state and nationally.
In response to President Trump’s October 12 executive order (EO), the U.S. Department of Labor (DOL) has published proposed rules to expand the availability of health coverage sold through associations to small businesses and self-employed individuals. The public has until March 6, 2018 to submit comments on these proposed rules and this brief provides state health officials with a review of the content of the proposed rules and examines the implications for those interested in commenting on the rule.
Value-Based Innovation by State Public Employee Health Benefits Programs provides an overview of three areas of value-based innovation and then affords a deeper examination into specific examples of state employee purchaser activity in California, Connecticut, Massachusetts, Minnesota, Tennessee, and Washington. Despite their differences in size and scope, these state health care purchasers found they could learn from their colleagues in other states as they strive to improve the value of care. For a summary of the examples from the six states, we have also published an Overview that highlights policy innovations and findings to date.
With three states using Section 1332 waivers to help fund reinsurance programs for the 2018 plan year, many more state officials are considering the model for their state in future years. Having worked directly with the 2018 reinsurance states, State Health and Value Strategies is pleased to present the following to-do list for states as they consider reinsurance for 2019.
The Children’s Health Insurance Program (CHIP) covers nearly nine million children and is a key contributor to record low levels of uninsurance among children. However, Congress only provided funding for CHIP through fiscal year (FY) 2017, which ended on September 30, 2017 and has not yet acted to authorize new funding for FY 2018. This Issue Brief reviews the current status of state CHIP programs in light of the CHIP funding extension delay and summarizes key features of proposed House and Senate extension legislation.
The brief provides an overview of the most recent changes to the Graham-Cassidy repeal and replace proposal and a just-released preliminary analysis of the proposal by the Congressional Budget Office (CBO). On September 13th, Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA)—along with Senators Dean Heller (R-NV) and Ron Johnson (R-WI) and former Senator Rick Santorum (R-PA)—released a new proposal to repeal and replace the Affordable Care Act (ACA). On September 25th, the sponsors released several updates to the proposed legislation. Also on September 25th, the CBO provided its preliminary analysis of one of the earlier versions of the bill.
This brief provides an overview of the proposal developed by Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) and filed on July 27th as a substitute for the American Health Care Act passed by the House to “repeal and replace” the Affordable Care Act (ACA). The proposal retains many features of the July 20th version of the Better Care Reconciliation Act (BCRA) released by Senate leadership (and rejected by the Senate on July 25th), including per capita caps on Medicaid spending and elimination of the individual and employer mandates.
State policy makers are increasingly focused on social determinants of health (SDOH) because of the important influence of these determinants on health care outcomes and Medicaid spending. This issue brief digs into opportunities that states have to account for SDOH in Medicaid programs.