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 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.
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.
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.
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.
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.
Global budgeting is an innovative payment approach for rural hospitals that can enhance financial solvency and advance population health. Hospitals with global budgets know their revenues in advance of the year and so can concentrate on providing the services their communities need as well as on the prevention and management of chronic illness. Maryland rural hospitals have received global budgets since 2010; selected Pennsylvania rural hospitals will be starting on global budgets soon.