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.

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.

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.

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.

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.

The U.S. Departments of Health & Human Services (HHS), Labor, and Treasury (collectively the “tri-agencies”) have finalized a new federal definition of short-term, limited duration insurance (“short-term plans”). The new policy is effective 60 days after publication of the rule in the federal register, meaning that short-term plans could be available for sale by early October.

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.

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.

January 23, 2018 UPDATE: With passage of a continuing resolution on January 22, Congress reauthorized funding for the Children’s Health Insurance Program (CHIP) for six years through federal fiscal year 2023.

Since federal funding expired for CHIP, states have had to forecast when their existing funds might run out. The states that will deplete their funds soonest have started to notify enrollees of the possibility of coverage loss. State Health and Value Strategies will be tracking notifications and other actions that states are taking on CHIP and will update this map as new information becomes available.

Where people live, work and play — and the experiences they have, especially growing up — matters. These social determinants of health (SDOH) include a broad array of social and environmental risk factors such as poverty, housing stability, early childhood education, access to primary care, access to healthy food, incarceration and discrimination. State policy makers are increasingly focused on SDOH because of their important influence on health care outcomes and Medicaid spending.