Expert Perspectives

Sep 23, 2021 

Final Round of Rulemaking for 2022 Affordable Care Act Marketplaces: Implications for States

On September 17, 2021, the U.S. Departments of Health and Human Services and Treasury finalized the 2022 Notice of Benefit and Payment Parameters (NBPP) rule and announced a significant expansion of their oversight of health plans’ provider networks. This expert perspective reviews provisions of the rule of particular import to the state-based marketplaces (SBMs) and state insurance regulators.

Sep 21, 2021 

The No Surprises Act Proposed Rule on Air Ambulances and Enforcement: Implications for States

On September 10, the U.S. Departments of Health and Human Services (HHS), Treasury, and Labor (DOL) and the Office of Personnel Management (OPM) released a second rule implementing the No Surprises Act (NSA), the comprehensive federal law banning balance bills in emergency and certain non-emergency settings beginning January 1, 2022. This Notice of Proposed Rulemaking (NPRM) details the data on air ambulance services that must be reported to HHS and the Department of Transportation (DOT) and discusses the departments’ proposed approach to enforcement of the NSA. Beyond the NSA provisions, the NPRM also provides guidance on new federal requirements that individual market and short-term plan insurers disclose broker compensation to current and potential enrollees as well as to HHS. Comments on the NPRM are due October 18, 2021. This expert perspective summarizes the provisions of the NPRM and notes particular implications for state regulators and marketplace officials.

Sep 17, 2021 

The End of the COVID Public Health Emergency: Potential Health Equity Implications of Ending Medicaid Continuous Coverage

Medicaid enrollment has increased by over 10 million (or 15 percent) from February 2020 through February 2021 across all states since the outbreak of the COVID-19 pandemic. States have a clear imperative to center health equity as they plan for the end of the public health emergency (PHE) given that Black, Latino/a, and other people of color are most at risk of coverage loss. This expert perspective highlights strategies states can implement to ensure that the end of the PHE does not exacerbate already widespread racial and ethnic disparities in our health care system.

Sep 15, 2021 

Strategies for Working with Managed Care Organizations to Increase COVID-19 Vaccination Rates

COVID-19 vaccines are now widely accessible in the United States and free to everyone over the age of 12. Given the spread of the Delta variant, there is an urgent need to increase vaccination rates, particularly among Medicaid enrollees. States across the country continue to report Medicaid enrollees are getting vaccinated at lower rates than the general population. This expert perspective explores how state Medicaid managed care programs and health plans can work collaboratively to increase COVID-19 vaccination rates for the more than 55 million Medicaid enrollees in comprehensive managed care plans.

Sep 9, 2021 

New York State of Health Pilot Yields Increased Race and Ethnicity Question Response Rates

Many states are looking to fill gaps in race and ethnicity data for Medicaid and related agencies. Working with the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota, with support from the State Health and Value Strategies (SHVS) program, New York tested multiple strategies aimed at encouraging applicants to answer the optional race and ethnicity questions. This expert perspective highlights an effort by New York’s official state-based marketplace, NY State of Health, to improve the completeness of race and ethnicity data that applicants share when applying for Medicaid; Child Health Plus, the state’s Children’s Health Insurance Program (CHIP); the Essential Plan, New York’s Basic Health Program (BHP); or Qualified Health Plan (QHP) coverage through its Marketplace.

Aug 27, 2021 

States Are Leveraging Medicaid Managed Care to Further Health Equity

To support state efforts, SHVS continues to sponsor ongoing updates to Medicaid Managed Care Contract Language: Health Disparities and Health Equity compendium. The compendium provides Medicaid agencies with examples of how different states are leveraging their managed care programs, inclusive of contracts, quality programs, and procurement processes, to promote health equity and address health disparities. This expert perspective highlights the latest update to the SHVS compendium which incorporates excerpts from Medicaid managed care procurements and model contracts in California, Indiana, Louisiana, and Nevada.