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January 2018

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01.2018 / By Urban Institute

This brief provides an analysis of legislation recently introduced in the U.S. Senate that would create a mechanism for states to offer their residents the opportunity to buy a Medicaid-based public insurance option.

Webinar & Presentations

On January 11, 2018, CMS released 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 represent a significant departure from past Administrations’ positions. This webinar reviews the new guidance and discusses state legal, policy, and operational considerations.


This report examines the issue that with no individual mandate and expanded non-comprehensive coverage, the divisions between states will deepen, and market conditions will deteriorate for unsubsidized farmers and others seeking coverage in states that don’t protect their risk pool.


In response to President Trump’s October 12 executive order (EO), the U.S. Department of Labor (DOL) published proposed rules to expand the availability of health coverage sold through associations to small businesses and self-employed individuals. The full brief provides state health officials with a detailed review of the content of the proposed rule and examines the implications for states.


Studies show that health disparities are often passed down from socially disadvantaged parents to their children and grandchildren. Poor children begin life on an uneven playing field; they face greater challenges than their healthier, more advantaged classmates; and they often struggle as adults to accumulate wealth to share with—and bequeath to—their children. State and federal health policymakers play a crucial role in breaking this cycle of poverty and inequity so that all can live healthy, prosperous lives.


This report highlights policy levers, performance measurement strategies, and sustainable financing options that states can use to support accountable health structures.

Journal Article

This article details a qualitative analysis that (1) identified facilitators and barriers to utilizing a community health worker (CHW) model among patient-centered medical homes (PCMHs) in Minnesota; and (2) defined roles played by the CHW workforce within the PCMH team. Four themes emerged as facilitators and barriers: the presence of leaders with knowledge of CHWs who championed the model; a clinic culture that favored piloting innovation vs. maintaining established care models; clinic prioritization of patients' nonmedical needs; and leadership perceptions of sustainability.


Prior to the passage of the Affordable Care Act in 2010, Minnesota's health insurance market was relatively high-functioning across indicators of health insurance access and quality of care, although the state faced common challenges in the area of health care costs. This report considers Minnesota's health insurance market before and after the passage of the ACA and the outlook for the state's market given the current policy environment.


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