April 1 Update

In This Week’s Update:

  • Health Care in the Courts
  • State Updates: CO, GA, LA, MN, NM, PA, & UT
  • Leveraging Multi-Payer Databases for Value
  • Advancing Health Equity in Medicaid via VBP

Health Care in the Courts

Health care was back in the courts last week. On Monday, the U.S. Department of Justice sent a letter to the Fifth Circuit Court of Appeals supporting a federal judge’s ruling that the entire Affordable Care Act should be invalidated based on the elimination of the individual mandate tax penalty. Additionally, on Wednesday, a federal judge blocked new work requirements for Medicaid recipients in Arkansas and Kentucky for a second time. Last week’s Kaiser Health News’ What the Health podcast [start at 1:30] dives deeper into the implications of these two decisions.

Last Thursday the Federal District Court for the District of Columbia invalidated the U.S. Department of Labor’s (DOL) Association Health Plan (AHP) rule. The Court found that DOL had exceeded its authority under ERISA by failing to set meaningful limits on AHPs. Sabrina Corlette from Georgetown University updated an Expert Perspective to include what this latest ruling might mean for existing AHP regulations and state considerations. For more information, see this Health Affairs blog post.

State Updates: CO, GA, LA, MN, NM, PA, & UT

  • Colorado – Governor Jared Polis announced he signed HB19-1001 into law requiring Colorado hospitals to make more of their financial information available to the public. The state is hoping that access to this data will allow policymakers to differentiate between hospitals in different regions of the state, adopt policies that will lower costs, and track whether or not savings from reform efforts are passed on to consumers.
  • Georgia – Governor Brian Kemp signed Senate Bill 106 authorizing the state to submit Section 1115 and Section 1332 waiver requests to the Centers for Medicare and Medicaid Services (CMS). SHVS updated their Section 1332 state activity map to reflect this latest development. Also part of the law, the Section 1115 waiver request can include expansion of Medicaid eligibility to individuals with incomes up to 100 percent of the federal poverty level.
  • Louisiana – The Louisiana Department of Health and Department of Corrections announced their selection of Asegua Therapeutics LLC (a subsidiary of Gilead Sciences, Inc.) as their hepatitis C subscription model pharmaceutical partner, to provide the state with unrestricted access to its direct-acting antiviral medication. With this partnership, the Departments will have five years of unrestricted access to the antiviral treatment to treat all Medicaid-enrolled and incarcerated individuals infected with the hepatitis C.
  • Minnesota – MNSure, Minnesota’s state-based exchange, is reminding Minnesotans to report changes to their household information outside of open enrollment to ensure their plan and any financial assistance is up to date and accurate and to see if they qualify for a special enrollment period. MNsure has also created a variety of helpful videos to help residents understand how certain qualifying life events can make them eligible for special enrollment.
  • New Mexico – Governor Michelle Lujan Grisham instructed the New Mexico Department of Health and the Human Services Department to develop a Medicaid home and community supports waiver program to assist people with disabilities currently on the wait list for services under the Development Disabilities Waiver. The Departments will study how other states administer the program, what populations are served, and funding allotments for service plans.
  • Pennsylvania — Governor Tom Wolf announced that the departments of Drug and Alcohol Programs and Human Services have awarded $15 million in federal Substance Abuse and Mental Health Services Administration grants for a new program to provide case management and housing support services for Pennsylvanians with an opioid use disorder (OUD). The pilot programs will support innovative practices that increase access to support services for individuals with OUD, keep people engaged in treatment and recovery, and help prevent overdose-related deaths.
  • Utah – CMS approved the state’s Section 1115 waiver request to cover residents who earn up to 100 percent of the federal poverty level. The federal approval allows the state to cap enrollment in the program if there are insufficient state funds available to match the federal funds. The approval also authorizes a work requirement and requires eligible individuals to enroll in their employer-sponsored insurance plans, if available.

New SHVS Publication: Leveraging Multi-Payer Databases for Value

Last week, State Health and Value Strategies (SHVS) released a new publication that examines how states are leveraging multi-payer claims databases to drive value in their health care systems. The brief identifies three broad data use categories and provides a high-level description of the approaches taken by select states and one community organization, with attention to practices that may not be as widely used across states, or in areas that states and community organizations are just beginning to pursue. In case you missed it, SHVS also hosted a companion webinar last week. During the webinar, presenters from the state of Vermont and Rhode Island, as well as the Washington Health Alliance, discussed how they are employing claims databases to enhance the value of care and shared lessons learned for those seeking to optimize their own databases. A slide deck and recording of the webinar can be found on the SHVS website.

Advancing Health Equity in Medicaid: Emerging Value-Based Payment Innovations

A new blog post by the Center for Health Care Strategies (CHCS) explores three promising approaches that selected state Medicaid programs are using to advance health equity via value-based payment (VBP) arrangements. The blog post also highlights a new initiative, Advancing Health Equity: Leading Care, Payment, and Systems Transformation, a national program supported by the Robert Wood Johnson Foundation, that CHCS, along with University of Chicago and the Institute for Medicaid Innovation, is launching to bring together key stakeholders, including state Medicaid directors, Medicaid managed care organizations, and clinical partners, to pursue payment innovations that support health equity. Applications to participate in the initiative are due May 24, 2019. To learn more about the initiative, interested stakeholders can join a 60-minute prospective applicant webinar on April 9, 2019.

Value-Based Payment and Children’s Health Care

The United Hospital Fund released companion reports that find most payment reform efforts have focused on improving health care for adults and that a greater focus on children is needed. The reports—Achieving Payment Reform for Children Through Medicaid and Stakeholder Collaboration and its companion Guide for Action—outline rationales and specific steps that can help children’s health champions and state Medicaid programs work together to refocus health care payments, which in turn can improve the health and well-being of children. The reports are based on interviews with experts from New York state’s efforts to reform Medicaid payments and additional interviews with four other states.