Expert Perspectives

Jun 4, 2019 

Map: State Efforts to Develop Medicaid Buy-In Programs

In recent months, states have increasingly introduced proposals for individuals above Medicaid eligibility levels to “buy-in” to Medicaid or leverage the Medicaid program to strengthen coverage across the individual market and Medicaid. State Health and Value Strategies is tracking current state activity and has mapped out which states are pursuing a program and those that are establishing task forces to understand the impact of a Medicaid buy-in program.

Apr 5, 2019 

Work Requirements Litigation

On March 27, for the second time, a federal judge vacated the Centers for Medicare & Medicaid Services (CMS) approval of Kentucky’s Medicaid 1115 demonstration waiver to test, among other things, a work requirement as a condition of Medicaid eligibility. In a related case of Arkansas’s Medicaid work requirements demonstration, the judge likewise vacated the federal approval, remanding it to CMS for further consideration. Notably, because Arkansas, unlike Kentucky, had already implemented the work requirements, the decision requires the state to cease its work requirement and related Medicaid disenrollments. This expert perspective reviews the court’s decision and its implications for both Kentucky and Arkansas and other states with similar approved or pending waiver requests, as well as for states contemplating imposing work or other “community engagement” requirements on Medicaid beneficiaries.

Mar 29, 2019 

What’s in the Association Health Plan Final Rule? Implications for States

President Trump issued an executive order on October 12, 2017 to encourage the expansion of association health plans (AHPs) for small businesses and the self-employed. On June 19, 2018 the U.S. Department of Labor (DOL) released a final regulation to implement that order. The final rule is similar to a draft version that the administration issued in January 2018. The new AHP policy raises numerous issues affecting state regulators, insurance markets, and the consumers and small businesses who buy coverage.

Mar 6, 2019 

What, if Anything, Do the Latest Cost Sharing Reduction (CSR) Court Rulings Mean for 2020 Premiums?

Several recent federal court decisions have held that the federal government owes insurers billions in cost-sharing reduction (CSR) payments. The Administration cut off those payments in October 2017, after efforts to repeal the Affordable Care Act (ACA) failed in Congress. Insurers promptly sued, arguing that the government had breached its statutory obligation to compensate insurers for offering the mandated low cost-sharing plans. Of note, the court decisions suggest that the government continues to owe these CSR payments even though most insurers were able to mitigate their losses by increasing plan premiums in 2018 and beyond. Because this litigation is almost certain to carry over into 2020 or beyond, this Expert Perspective post suggests that states not change their approach to insurers’ rating practices for 2020. However, states should consider what their approach should be if insurers do prevail in the litigation and states have an opportunity to recoup what otherwise would be a windfall for insurers.

 

Nov 30, 2018 

New Concepts for Section 1332 Waivers Present Options–and Questions–for States

Following guidance released earlier this fall, on November 29, 2018 the Centers for Medicare & Medicaid Services (CMS) released a discussion paper entitled “Section 1332 State Relief and Empowerment Waiver Concepts” to provide states with additional guidance and information about four types of waiver concepts that could be approved under the earlier guidance. This expert perspective reviews the four waiver concepts proposed in the discussion paper and the potential opportunities they present for states.

Nov 21, 2018 

Proposed Marketplace Program Integrity Rule: Summary and Implications for States

On November 9, 2018, the U.S. Department of Health & Human Services (HHS) published a proposed set of new standards for the Affordable Care Act (ACA) marketplaces. The preamble describes these standards as part of HHS’ efforts to improve marketplace “oversight and financial integrity.” If finalized, they will be effective for the 2020 plan year. HHS is asking for comments on the proposal by January 8, 2019.

Aug 24, 2018 

CMS Issues Additional Guidance on Budget Neutrality for Section 1115 Waivers

On Wednesday, August 22, the Centers for Medicare & Medicaid Services (CMS) released a State Medicaid Director Letter (SMDL) memorializing CMS policy for ensuring that Section 1115 waivers remain budget neutral to the federal government. The SMDL describes CMS policy for calculating budget neutrality both for new waivers and for extensions of existing waivers with the implications for states with existing waivers, and those seeking to apply for waivers, discussed in this expert perspective.

Apr 13, 2018 

The 2019 Affordable Care Act Payment Rule: Summary and Implications for States

On April 9, 2018, the U.S. Department of Health & Human Services (HHS) released its final Notice of Benefit and Payment Parameters for 2019, referred to here as the Payment Notice. This is an annual rule that includes a wide range of policy and operational changes for the Affordable Care Act (ACA) marketplaces, insurance market reforms, and premium stabilization programs. Concurrent with the 2019 Payment Notice, HHS also released sub-regulatory guidance, including the final annual letter to issuers, key dates for health plans participating in the individual and small-group markets in 2019, and an expansion of the circumstances under which individuals can qualify for exemptions to the ACA’s individual mandate. This expert perspective focuses on major provisions of the Payment Notice and accompanying guidance documents that require state decision-making or have other significant implications for states.

Feb 23, 2018 

Short-Term, Limited Duration Insurance Proposed Rule: Summary and Options for States

In response to President Trump’s October 12 executive order (EO), the U.S. Departments of Health and Human Services (HHS), Labor (DOL) and Treasury have published proposed rules to expand the availability of health coverage sold through short-term, limited duration insurance (STDLI). The public has until April 23, 2018 to submit comments on these proposed rules; the new standards are slated to be effective 60 days after publication of the final rules.