Expert Perspectives

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.

Jan 17, 2018 

CHIP Announcements and Notification Letters

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.

Jul 20, 2017 

How States Can Integrate Social Determinants of Health (SDOH) into Payment and Quality Improvement Policies

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.

Jun 22, 2017 

Resources for States on Medicaid Financing Proposals

A major element of the federal legislative proposals to repeal and replace the Affordable Care Act is a change to the financing structure for Medicaid. Understanding the effect this funding change will have on Medicaid programs is a critical priority for states. The State Health and Value Strategies program is working to analyze the financing changes from a state perspective.