With three states using Section 1332 waivers to help fund reinsurance programs for the 2018 plan year, many more state officials are considering the model for their state in future years. Having worked directly with the 2018 reinsurance states, State Health and Value Strategies is pleased to present the following to-do list for states as they consider reinsurance for 2019.
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.
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 Health and Value Strategies hosted a webinar for states on the Executive Order affecting state insurance markets and the implications for states of discontinuation of CSR payments. The webinar featured insurance market experts from Georgetown’s Center on Health Insurance Reforms and Manatt Health who discussed the elements of the Executive Order, what states can expect in the coming weeks, and the policy decisions states can consider.
Following the expiration of funding for the Children’s Health Insurance Program (CHIP), both the House and the Senate have turned their attention to the program’s renewal. As states know well, the program was provided with funding through fiscal year 2017, which ended on September 30th, creating pressure for Congress to act quickly before states begin to run out of CHIP dollars in the coming weeks and months. Both the Senate and the House recently have taken up legislation to provide funding for an additional five years and make a number of other modifications to the bill.
Value Based Purchasing for Managed Care Procurement: A Toolkit for State Medicaid Agencies is designed to assist states interested in implementing value-based purchasing (VBP) approaches with their Medicaid managed care organizations (MCOs). Using a VBP approach can mean significant and ongoing changes for a state Medicaid agency and its MCOs. The Toolkit is designed to guide Medicaid agencies through key action steps and considerations in four phases of the managed care procurement cycle – 1) strategic procurement planning, 2) solicitation development, 3) bidder selection, and 4) contract management.
The Children’s Health Insurance Program (CHIP) covers nearly nine million children and is a key contributor to record low levels of uninsurance among children. However, Congress only provided funding for CHIP through fiscal year (FY) 2017, which ended on September 30, 2017 and has not yet acted to authorize new funding for FY 2018. This Issue Brief reviews the current status of state CHIP programs in light of the CHIP funding extension delay and summarizes key features of proposed House and Senate extension legislation.
The expiration of Children’s Health Insurance Program (CHIP) funding on September 30, 2017 raises four critical issues for states: 1) the timing of reauthorization, and what the level of allotment and duration of any extension will be, 2) whether the 23 percent increase to federal matching funds will continue, 3) whether maintenance of effort (MOE) requirements will continue unchanged, and 4) operational considerations for states, including notices to members and budget planning.
The brief provides an overview of the most recent changes to the Graham-Cassidy repeal and replace proposal and a just-released preliminary analysis of the proposal by the Congressional Budget Office (CBO). On September 13th, Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA)—along with Senators Dean Heller (R-NV) and Ron Johnson (R-WI) and former Senator Rick Santorum (R-PA)—released a new proposal to repeal and replace the Affordable Care Act (ACA). On September 25th, the sponsors released several updates to the proposed legislation. Also on September 25th, the CBO provided its preliminary analysis of one of the earlier versions of the bill.
In a final effort to pass a bill to repeal and replace the Affordable Care Act before reconciliation instructions expire on September 30th, Senators Graham and Cassidy are advancing a proposal that would retain many key provisions of the Better Care Reconciliation Act (BCRA) – including per capita caps for Medicaid non-expansion populations – and replace federal funding for tax credits, cost sharing reductions, Medicaid expansion, and the Basic Health Program with a capped allotment that would be distributed to states in the form of a block grant.