April 20, 2018: More state action on 1332 Waivers, 2019 Payment Notice and implications for states, new health equity measure

Weekly updates on the latest state-level health care news from Heather Howard, program director of State Health and Value Strategies.

This week saw several states moving forward with Section 1332 waiver applications. On Wednesday, the Office of the Commissioner of Insurance in Wisconsin submitted the state’s 1332 waiver application to implement a reinsurance program, and today, Maryland posted its draft Section 1332 application and announced it will hold four public hearings. State Health and Value Strategies (SHVS) has updated the map we use to track state action on Section 1332 waivers with links to both Wisconsin’s final application and Maryland’s draft. Also, in case you missed it, SHVS hosted a webinar on the final 2019 Payment Notice Rule and the implications for states. The slides and recording from the webinar are posted on shvs.org.

State Updates

  • Maryland – The Governor of Maryland signed legislation that would limit the market for short-term limited duration insurance. The bill limits the contract duration of such plans to three months; prohibits plan extensions or renewals; requires issuers to use the same underwriting standards for all applicants, regardless of whether they’ve previously been covered by short-term insurance; and requires the policies to include a notice to consumers consistent with the notice prescribed by federal law.
  • Montana – The Montana Healthcare Foundation and the Headwaters Foundation commissioned a report entitled The Economic Impact of Medicaid Expansion In Montana. Prepared by the University of Montana’s Bureau of Business and Economic Research, the report finds that, assuming enrollment plateaus near current levels, Medicaid expansion will introduce approximately $350 to $400 million of new spending to Montana’s economy each year.
  • North Carolina – The North Carolina Department of Health and Human Services announced the release of an interactive map with a series of overlays showing social determinants of health indicators in North Carolina, including the economic, social and neighborhood, and housing and transportation status of residents across the state.
  • New York – The Department of Health received approval from the Centers for Medicare & Medicaid Services (CMS) of a state plan amendment that authorizes Care Coordination Organizations to provide Health Home Care Management services to people with intellectual and/or developmental disabilities beginning July 1, 2018.
  • Rhode Island – HealthSource RI, the state’s official health insurance Marketplace, and the Office of the Health Insurance Commissioner announced this week the establishment of the Market Stability Workgroup that is charged with determining state-level solutions to keep Rhode Island’s health insurance markets stable.
  • West Virginia – The West Virginia Department of Health and Human Resources released county-level Neonatal Abstinence Syndrome (NAS) data for 2017 showing the overall incidence rate of NAS was 50.6 cases per 1,000 live births (5.06 percent) for West Virginia residents. West Virginia is one of a few states that collects NAS surveillance data.
  • Wisconsin –  The Wisconsin Department of Health Services (DHS) awarded four $250,000 grants to one county, one tribe, and two nonprofit organizations to support the expansion of medication-assisted treatment for opioid use disorder.

State Performance on New Population Health Measure Depends on Importance Placed on Health Equity

National and state health goals are often framed in terms of improving the overall health of the population (often measured as a mean) and reducing disparities within the population. The University of Wisconsin-Madison has created a Population Health Performance Index (PHPI) for states, which combines performance on both the population mean and disparity for two measures: infant mortality by race and unhealthy days by education. In a recent Health Affairs blog post, the team that developed the PHPI discuss the metric and how they think it could be useful to state and national policy makers and others as they evaluate performance on these two population health outcome and disparity measures.

Evolving Immigration Policies Could Affect Nearly 20 Million Children’s Access to Health Coverage

The Kaiser Family Foundation published a data note this week that examines how potential changes to public charge policies could lead to losses in health coverage. In a fact sheet published earlier this year, Kaiser reviewed the draft version of a proposed rule by the Trump administration that would make changes to public charge policies, which govern how use of public benefits may affect individuals’ immigration status. The data note provides insight into the scope of potential impacts of continually evolving immigration policy on children by providing nationwide and state-level estimates of citizen children living in immigrant families and the number currently covered by Medicaid/CHIP coverage.

Global Budgeting for Hospitals

Austin Frakt, a health care policy blogger and associate professor at Boston University’s School of Public Health, wrote an article for the New York Times earlier this week on Maryland’s global budgeting for hospitals. The article reviews the research to date on the success of Maryland’s global budgeting initiative to reduce hospital usage and spending on health care. It is likely that several more years are needed to fully evaluate Maryland’s initiative. Josh Sharfstein, from Johns Hopkins Bloomberg School of Public Health, one of the co-sponsors, along with SHVS, of a Policy Academy for states on Global Budgeting for Rural Hospitals to be held in Baltimore on May 30, is quoted in the article.