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.
Addressing Social Factors That Affect Health: Emerging Trends and Leading Edge Practices in Medicaid
Medicaid programs are increasingly considering how best to address social factors, such as housing, healthy food, and economic security, that can affect health and medical expenditures. Often referred to as social determinants of health (SDOH), these factors are significant drivers of population health outcomes. While states historically have had some experience tackling such issues for specialized, high-need populations, they are now confronting whether, and how, Medicaid should address SDOH for a broader population of Medicaid enrollees in order to achieve better health outcomes. This issue brief explores the “next generation” practices that states are deploying to address social factors using Medicaid 1115 waivers and managed care contracts, as well as the specific steps states can take to implement these practices.
On Wednesday, March 27, 2019, State Health and Value Strategies, in partnership with the Peterson Center on Healthcare, hosted a webinar on the ways in which several states and one community organization are using their multi-payer claims databases. More states are leveraging multi-payer claims databases to better understand how their health care systems are operating and implementing data-driven decision-making. States may not be aware, however, of the strategies other states and organizations are adopting to leverage claims databases to support health care transformation goals. During the webinar, presenters from the state of Vermont and Rhode Island, as well as the Washington Health Alliance, discussed how they are employing claims databases to enhance the value of care and will share lessons learned for those seeking to optimize their own databases.
All payer claims databases (APCDs) and multi-payer claims databases are a source of information that, when used effectively, can provide insight into how states’ health care systems are functioning and facilitate data-driven decision-making. This issue brief looks at the progress states and community organizations have made in using their APCDs and other multi-payer claims databases for various strategic purposes, and offers considerations for states that are seeking to optimize their own claims databases to achieve health care system performance improvement goals. The State Health Policy Highlight, Achieving Transparency and Value Using Multi-Payer Claims Databases, provides an overview of how states are leveraging their claims databases and reviews the lessons experienced states and community organizations have to offer other states seeking to optimize their own databases.
UPDATED 2/19/2019–State Health and Value Strategies, in partnership with health tax expert Jason Levitis, has created a template to help states develop an application for a state innovation waiver under the Affordable Care Act (ACA) section 1332 to implement a state reinsurance program. Section 1332 gives states flexibility to waive certain ACA provisions and receive federal funding to implement state-based health care policies. Reinsurance programs are a proven method of reducing premiums and promoting competition and market stability. This template seeks to make application development as simple as possible by adapting language from the successful Oregon application and indicating where elements need to be filled in or otherwise customized.
Faced with a fluid federal regulatory environment, many states continue to encounter challenges in stabilizing their individual health insurance markets, including large premium increases and declining insurer participation. One solution to continued market instability is a state-based reinsurance program similar to the federal program that reduced premiums by more than 10 percent per year from 2014 to 2016. The brief provides a roadmap of policy, program design, and financing considerations for states that are contemplating development of a state-based reinsurance program under 1332 waiver authority.
The Centers for Medicare & Medicaid Services (CMS) recently released the proposed annual Notice of Benefit and Payment Parameters for plan year 2020. The Notice proposes regulatory and financial parameters for qualified health plans on the Exchanges, plans in the individual, small group, and large group markets, and self-funded group health plans. State Health and Value Strategies hosted a webinar for states Friday, January 25 at 1:00 p.m. E.T. During this webinar, experts walked through key components of the notice and discuss potential state considerations and options for commenting on the proposed rule.
On January 23, State Health and Value Strategies hosted a webinar examining the complexities of state Medicaid oversight of the pharmacy benefit in the managed care environment. State Medicaid programs commonly rely on contracted Managed Care Organizations (MCOs) and their subcontracted Pharmacy Benefit Managers (PBMs) to manage the prescription drug benefit offered to Medicaid enrollees. The webinar offered states real world tips on how to best monitor and evaluate operational and financial performance of their MCOs and their subcontracted PBMs.
On December 17, 2018 State Health and Value Strategies hosted a webinar on Medicaid buy-in proposals. Over the past year, state policy makers and advocates have expressed interest in proposals that would permit people above Medicaid eligibility levels to “buy in” to Medicaid (i.e., leverage the state’s bargaining power in some way) in order to offer more affordable and accessible coverage. During this webinar, Manatt Health discussed state considerations for developing a Medicaid buy-in proposal, evolving models of state proposals, and the administrative considerations and authorities needed for each model.
On Wednesday, November 28, State Health and Value Strategies hosted a webinar for state officials with technical experts to discuss the implications of the proposed health reimbursement arrangements (HRA) rule and possible state responses. The U.S. Departments of Health and Human Services, Labor, and Treasury recently released proposed regulations easing the rules governing HRA and other account-based, tax-preferred health care benefits. 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.