Safeguarding Financial Stability of Provider Risk-Bearing Organizations

An increasingly common feature of health care payment models is the transfer of financial risk from payers to providers for health care services delivered to a defined population of patients. In these “value-based payment” models, providers accept financial responsibility should spending for most, or all, services for an attributed patient population exceed targeted levels. This financial liability is often shared with payers, and maximum risk exposure is typically capped. This issue brief explores options for states as they consider oversight of risk-bearing organizations, with a focus on states that have elected to act to protect against provider insolvency.

State Health and Value Strategies hosted a companion webinar, Safeguarding Financial Stability of Provider Risk-Bearing Organizations, based on the issue brief that provided an overview of options for states as they consider oversight of risk-bearing organizations (RBOs) as well as a deeper dive on the Massachusetts approach.

Explaining the Stewart v. Azar Decision and Implications for States

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.

State Policy Academy on Global Budgeting for Rural Hospitals

State Health and Value Strategies collaborated with the Milbank Memorial Fund to support a State Policy Academy on Global Budgeting for Rural Hospitals hosted by Johns Hopkins University in Baltimore, Maryland on May 30, 2018. To view a recording of the morning session of the Academy and the agenda for the full day meeting, please visit the event website.

Toward Hospital Global Budgeting: State Considerations

As state policymakers seek to identify strategies to deliver higher-quality care at lower costs, payment reform efforts have largely centered on moving from a fee-for-service health care system based on paying for volume, to one based on paying for value. More recently, payment models including prospective episode-based payment, hospital global budgets and per member per month global capitation arrangements have gained attention. This issue brief provides an overview of hospital global budgeting, which represents a middle-ground approach between the narrow bundling of services and global capitation that transfers higher levels of financial risk to a hospital.

Medicaid Buy-in: State Options and Design Considerations

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.

Medicaid Buy-In: State Options, Design Considerations and Section 1332 Waiver Implications

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.

Analysis of the 2019 Affordable Care Act Payment Notice: Implications for States

The U.S. Department of Health & Human Services released on April 9, 2018 its annual Notice of Benefit and Payment Parameters, a collection of policies governing the ACA’s marketplaces, insurance reforms, and premium stabilization programs. The first such annual notice issued under the Trump Administration, it contains a number of provisions that require state officials to make important decisions on short notice that will affect plan benefits, premiums, and marketplace operations. State Health and Value Strategies hosted a webinar, together with experts Sabrina Corlette and Justin Giovannelli from Georgetown’s Center on Health Insurance Reforms, Joel Ario from Manatt Health and Jason Levitis, to help participants untangle the rule and its many implications for states.

Protected: 2018 SGC Resources

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.

Children’s Health Insurance Program Extended through Fiscal Year 2027

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.