New Work and Community Engagement Requirements: Overview of Federal Activity and State Considerations
On January 11th, the Centers for Medicare & Medicaid Services released a State Medicaid Director letter providing guidance for states seeking 1115 waivers that condition Medicaid eligibility on work and community engagement, quickly followed by approval of Kentucky’s 1115 waivers that include these requirements. Both the new guidance and recent waiver approval represents a significant departure from past Administrations’ positions. In this webinar, the State Health and Value Strategies program, together with technical assistance experts from Manatt Health, review the new guidance, including key design parameters, budget neutrality requirements, and monitoring and evaluation criteria. The webinar also discusses state legal, policy and operational considerations for implementing work and community engagement requirements and highlight key elements of Kentucky’s waiver approval.
State Options for Responding to Federal Changes to the Individual Market
State Health and Value Strategies hosted a webinar the first week of January to outline state considerations and options to address federal policy changes that could impact individual market stability. Technical experts from Georgetown’s Center on Health Insurance Reform, Manatt Health, and others discussed the implications of individual mandate repeal in the tax bill and opportunities for state action, including reinsurance and state-level policies to incentivize enrollment. In addition, experts discuss potential changes to short-term policies that could also impact enrollment and premiums in the individual market. The webinar also explores potential budget impacts of the tax legislation on other health programs, including Medicaid.
Leveraging Medicaid to Strengthen Coverage
States continue to develop strategies to strengthen coverage across the individual market and Medicaid. In recent months, we have seen several proposals at both the federal and state levels that would leverage state Medicaid programs as a key component of coverage stability and affordability strategies. The webinar highlights and defines potential policy options, including the “Medicaid Buy-in,” that states may consider to leverage Medicaid to achieve their goals with respect to coverage availability and affordability. We discuss the conditions that make each option more or less favorable for a state, and implementation issues or other considerations in play for states.
Medicaid Managed Care Toolkit
State Medicaid agencies are increasingly turning to managed care organizations (MCOs) to cover more Medicaid enrollees, including those with complex needs. The ongoing shift from a fee-for-service payment model to a value-based payment model at the health plan and provider level puts even more importance on Medicaid managed care procurement strategies and approaches.
Medicaid Work Requirements/Community Engagement: Federal Activity and State Considerations
At least seven states have submitted 1115 waivers requesting authority to introduce work requirements for some Medicaid beneficiaries. Many more states are considering them. We examine key design considerations for states, including the populations to which work requirements may apply; exemptions based on health status or community conditions (e.g. rates of unemployment; access to transportation); definition of work (how many hours per month? Per year? Will school, job training, and volunteer work satisfy a work requirement?); and, use of verification and attestation in determining whether work requirements apply and are being met. We also look at state operational issues including integrating work requirements with a streamlined online, electronic application and renewal process.
Impact of Executive Order and Non-payment of CSRs on State Insurance Markets
State Health and Value Strategies hosted a webinar for states on the Executive Order affecting state insurance markets and the implications for states of discontinuation of CSR payments. The webinar featured insurance market experts from Georgetown’s Center on Health Insurance Reforms and Manatt Health who discussed the elements of the Executive Order, what states can expect in the coming weeks, and the policy decisions states can consider.
Proposals to Renew the Children’s Health Insurance Program: An Update on Developments
Following the expiration of funding for the Children’s Health Insurance Program (CHIP), both the House and the Senate have turned their attention to the program’s renewal. As states know well, the program was provided with funding through fiscal year 2017, which ended on September 30th, creating pressure for Congress to act quickly before states begin to run out of CHIP dollars in the coming weeks and months. Both the Senate and the House recently have taken up legislation to provide funding for an additional five years and make a number of other modifications to the bill.
Understanding the Graham-Cassidy Proposal: Implications for States
In a final effort to pass a bill to repeal and replace the Affordable Care Act before reconciliation instructions expire on September 30th, Senators Graham and Cassidy are advancing a proposal that would retain many key provisions of the Better Care Reconciliation Act (BCRA) – including per capita caps for Medicaid non-expansion populations – and replace federal funding for tax credits, cost sharing reductions, Medicaid expansion, and the Basic Health Program with a capped allotment that would be distributed to states in the form of a block grant.
Future of the Children’s Health Insurance Program: Considerations for States
Federal funding for the Children’s Health Insurance Program (CHIP) is set to expire on September 30th, raising multiple issues for states. State Health and Value Strategies, in partnership with technical experts from Manatt Health, hosted a webinar to discuss key considerations for states as Congress debates CHIP reauthorization. Topics included the funding level and duration of the extension, maintenance of the 23 point FMAP bump, maintenance of effort requirements, and operational implications of reauthorization timing.
Webinar — Understanding the Senate’s Better Care Reconciliation Act of 2017 (BCRA): Key Implications for Medicaid
Following our June 5th webinar, “Per Capita Caps Under Medicaid: Emerging Issues for States,” State Network, in partnership with technical experts from Manatt Health, is hosting a series of conversations that will provide opportunities for state leadership to dive deeper into emerging issues. Given the recent release of the Senate repeal and replace proposal, we will review and discuss the Senate’s BCRA. State Network, in partnership with technical experts from Manatt Health, will host a webinar during which we will review the major Medicaid provisions of the BCRA, providing an opportunity for state leadership to understand how the Senate bill compares to the AHCA and its potential implications for states. This session will start with a short presentation, followed by time for Q&A and a discussion, focusing on the Medicaid provisions of the BCRA.