On January 8, the Centers for Medicare and Medicaid Services approved a ten-year Medicaid demonstration project in Tennessee that imposes an aggregate cap on federal funding (subject to certain adjustments). The waiver has received much attention because it has been described as a “block grant” and allows Tennessee to access “shared savings,” but also because it allows the state to operate a closed formulary without foregoing rebates, sets a 10-year term for the waiver, and continues a sizable uncompensated care pool. While certain features may generate interest from some states, the waiver is unlikely to establish significant new precedent that will be observed by the Biden administration. This expert perspective provides an overview of the waiver and discusses implications for states.

Updates from the states as of February 5, 2021

Updates from the states as of January 29, 2021.

States have risen to meet new and unforeseen challenges during this year’s annual open enrollment period (OEP) by implementing new marketing and communications tactics that provide valuable lessons learned as ongoing work to get and keep consumers covered continues in 2021. Despite the success of open enrollment, ongoing economic conditions will likely mean that more individuals will need marketplace coverage because of job or coverage loss. States will need to be cognizant of the ongoing work that will need to be done throughout 2021 to assist with enrollment, especially given that the Biden administration opened a new special enrollment period (SEP) for states using healthcare.gov and many state-based marketplaces have followed suit. This expert perspective highlights the marketing and communications tactics SBMs employed during OEP and may serve as examples moving forward to engage and enroll consumers in health coverage.

As the COVID-19 pandemic continues, states face new fiscal challenges in crafting their budgets for fiscal year 2022 amid significant uncertainty with regard to the trajectory of the virus and the promise of more federal relief. This expert perspective provides an updated view of the current state budget landscape, examining in greater detail the health care implications of choices states made to address deficits and balance their budgets in the face of the severe budget shortfalls they confronted for fiscal year 2021.

As the country struggles to respond to and recover from the devastating fallout of the COVID-19 pandemic, the case for Medicaid expansion has never been stronger. The public health crisis has focused a spotlight on both the benefits of stable health coverage and the gaps in the nation’s system of coverage and care. This expert perspective reviews what Medicaid expansion would mean in the 12 states that have not yet expanded.

Updates from the states as of January 22, 2021.

Updates from the states as of January 15, 2021.

On November 25, 2020, the U.S. Departments of Health & Human Services (HHS) and Treasury released the proposed 2022 “Notice of Benefit & Payment Parameters” (NBPP), the annual rule governing core provisions of the Affordable Care Act (ACA), including the operation of the marketplaces, standards for insurers, and the risk adjustment program. This expert perspective focuses on several provisions that have implications for state oversight of insurance markets and the state-based marketplaces. Comments on the proposed rule are due by December 30, 2020.

Updates from the states as of January 8, 2021.