In response to President Trump’s October 12 executive order (EO), the U.S. Department of Labor (DOL) has published proposed rules to expand the availability of health coverage sold through associations to small businesses and self-employed individuals. The public has until March 6, 2018 to submit comments on these proposed rules and this brief provides state health officials with a review of the content of the proposed rules and examines the implications for those interested in commenting on the rule.
New Work and Community Engagement Requirements: Overview of Federal Activity and State Considerations
On January 11th, the Centers for Medicare & Medicaid Services released a State Medicaid Director letter providing guidance for states seeking 1115 waivers that condition Medicaid eligibility on work and community engagement, quickly followed by approval of Kentucky’s 1115 waivers that include these requirements. Both the new guidance and recent waiver approval represents a significant departure from past Administrations’ positions. In this webinar, the State Health and Value Strategies program, together with technical assistance experts from Manatt Health, review the new guidance, including key design parameters, budget neutrality requirements, and monitoring and evaluation criteria. The webinar also discusses state legal, policy and operational considerations for implementing work and community engagement requirements and highlight key elements of Kentucky’s waiver approval.
States are utilizing a variety of approaches to require and assess the use of APM strategies through their contracted health plans. Beth Waldman from Bailit Health highlight findings from a second State Health and Value Strategies resource entitled State Medicaid Approaches for Defining and Tracking Managed Care Organizations Implementation of Alternative Payment Methodologies. This webinar highlights selected approaches and tools used by states to track and assess MCO progress on increasing APMs. Medicaid staff from one of the profiled states shares their APM approaches and insights.
Many state purchasers are referring to the Health Care Payment and Learning Action Network (LAN) Alternative Payment Models (APM) Framework when measuring and assessing health plan progress towards APM requirements. Megan Burns from Bailit Health will highlight findings from an upcoming State Health and Value Strategies resource for states, Categorizing Value-Based Payment Models According to the LAN Alternative Payment Model Framework: Examples of Payment Models by Category. The webinar provides real-world examples of what types of payment models fit within the LAN categories. Kat Latet, Manager, Health System Innovation at Community Health Plan of Washington participates and discusses the development and categorization of their APM.
State Health and Value Strategies hosted a webinar the first week of January to outline state considerations and options to address federal policy changes that could impact individual market stability. Technical experts from Georgetown’s Center on Health Insurance Reform, Manatt Health, and others discussed the implications of individual mandate repeal in the tax bill and opportunities for state action, including reinsurance and state-level policies to incentivize enrollment. In addition, experts discuss potential changes to short-term policies that could also impact enrollment and premiums in the individual market. The webinar also explores potential budget impacts of the tax legislation on other health programs, including Medicaid.
[*Updated January 8, 2018*] The tax bill passed in December 2017 repealed the penalty associated with the Affordable Care Act’s (ACA) individual shared responsibility provision, also known as the individual mandate. The provision required those who could afford health coverage to either maintain coverage, qualify for an exemption, or make a payment with their federal income tax return. Frequent State Health and Value Strategies partner Jason Levitis, health tax expert and former Counselor and ACA Implementation Lead at the U.S. Department of the Treasury, has developed model legislation for states interested in a state-level individual mandate.
States continue to develop strategies to strengthen coverage across the individual market and Medicaid. In recent months, we have seen several proposals at both the federal and state levels that would leverage state Medicaid programs as a key component of coverage stability and affordability strategies. The webinar highlights and defines potential policy options, including the “Medicaid Buy-in,” that states may consider to leverage Medicaid to achieve their goals with respect to coverage availability and affordability. We discuss the conditions that make each option more or less favorable for a state, and implementation issues or other considerations in play for states.
State Medicaid agencies are increasingly turning to managed care organizations (MCOs) to cover more Medicaid enrollees, including those with complex needs. The ongoing shift from a fee-for-service payment model to a value-based payment model at the health plan and provider level puts even more importance on Medicaid managed care procurement strategies and approaches.
At least seven states have submitted 1115 waivers requesting authority to introduce work requirements for some Medicaid beneficiaries. Many more states are considering them. We examine key design considerations for states, including the populations to which work requirements may apply; exemptions based on health status or community conditions (e.g. rates of unemployment; access to transportation); definition of work (how many hours per month? Per year? Will school, job training, and volunteer work satisfy a work requirement?); and, use of verification and attestation in determining whether work requirements apply and are being met. We also look at state operational issues including integrating work requirements with a streamlined online, electronic application and renewal process.
Value-Based Innovation by State Public Employee Health Benefits Programs provides an overview of three areas of value-based innovation and then affords a deeper examination into specific examples of state employee purchaser activity in California, Connecticut, Massachusetts, Minnesota, Tennessee, and Washington. Despite their differences in size and scope, these state health care purchasers found they could learn from their colleagues in other states as they strive to improve the value of care. For a summary of the examples from the six states, we have also published an Overview that highlights policy innovations and findings to date.