Expert Perspectives

Sep 9, 2022 

Federal Court Decision Threatens the ACA’s Preventive Services Benefit: State Options to Mitigate Harm to Consumers

The same U.S. federal district judge that declared the Affordable Care Act (ACA) unconstitutional in Texas v. California has issued a ruling in a lawsuit, Braidwood Management Inc. v. Becerra (formerly known as Kelley v. Becerra), that strikes down a requirement that health plans cover and waive cost-sharing for many critical preventive services. Although the U.S. Department of Justice is likely to appeal the ruling, some legal experts believe the Braidwood Management plaintiffs may prevail in the higher courts, too. If the ACA’s preventive services provision is gutted, only Congress can fully restore it. This expert perspective examines the potential implications of the ruling for the ACA and the opportunities available to states to mitigate the impact on consumers.

Sep 2, 2022 

Expanding Equitable Telehealth Access: Federal Funding Opportunities to Support Universal Broadband

Despite the important role of telehealth in enabling access to care during the public health emergency (PHE), there is growing recognition that a “digital divide”—the gap between individuals who use or have access to telecommunications and information technologies and those who do not—is a social determinant of health that exacerbates existing disparities in healthcare access and outcomes. The Biden administration and Congress have committed historic amounts of funding to: (1) build infrastructure in support of universal broadband access; and (2) launch planning, mapping, equity, and adoption projects that address the digital divide. This expert perspective describes recent federal funding initiatives and outlines considerations for state policymakers as they consider how to direct funding toward healthcare priorities. In particular, there is a key upcoming deadline for states to submit plans to the Treasury for ARP’s Capital Projects Fund on September 24, 2022.

Aug 26, 2022 

The No Surprises Act Final Rule: Implications for State Regulators

On August 19, the federal government issued a new final rule to further implement the federal independent dispute resolution process under the No Surprises Act (NSA). This expert perspective reviews the final rule and discusses its implications for state balance billing protections and oversight.

Aug 16, 2022 

Healthcare Provisions in the Inflation Reduction Act: Implications for States

On August 16, President Biden signed the Inflation Reduction Act (IRA), a $740 billion reconciliation package, into law. This expert perspective describes the healthcare provisions included in the IRA, such as provisions to improve the affordability of healthcare for Medicare and Affordable Care Act (ACA) Marketplace enrollees. The expert perspective also describes several significant healthcare policies included in the House-passed Build Back Better Act that were left out of the IRA.

Aug 5, 2022 

Leveraging Section 1902(e)(14) Waiver Authority Amid Unwinding

The unwinding related section 1902(e)(14) strategies newly available to Medicaid and CHIP agencies can provide significant relief to states facing pending eligibility and enrollment actions and processing delays, workforce and systems limitations, and other operational challenges. Ensuring eligible individuals do not lose coverage for procedural or administrative reasons and supporting those who are ineligible for Medicaid/CHIP transition to Marketplace coverage will be paramount for all states as they begin to resume normal operations when the federal public health emergency (PHE) ends. This expert perspective outlines the time-limited targeted enrollment flexibilities that CMS has availed to states through section 1902(e)(14) waiver authority and discusses considerations beyond the strategies described in federal guidance and supplemental resources. This expert perspective has been updated as of August 5, 2022 to include reference to additional guidance released by the Centers for Medicare & Medicaid Services.