April 6, 2018: Marketplace Enrollment, 1332 Waivers, Grants for Mental Health

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

This week the Centers for Medicare & Medicaid Services (CMS) released the final report of enrollment activity for the individual marketplaces during open enrollment for plan year 2018. In total, 11.8 million people selected plans or were automatically re-enrolled in plans across the 50 states and the District of Columbia. In addition to the report, CMS has made available a public use file that provides state-level data on plan selections and the demographics of consumers, which states can use to analyze enrollment in their individual states.

States are in the thick of applying for Section 1332 waivers and we have included progress reports for several states below and updated our map to reflect recent activity. Also, we have revised our 1332 application template and were excited to learn that it has proved to be very helpful to states pursuing reinsurance applications this year. Updates follow.

  • Alabama — Alabama Medicaid Agency released a concept paper outlining the design and implementation of an Integrated Care Network to support the state’s proposed Primary Care Case Management program for long-term care.
  • Iowa – Governor Kim Reynolds signed a bill creating a new form of health coverage in Iowa. The bill allows associations of employers or certain agricultural organizations to create health plans that use underwriting and do not include Essential Health Benefits as set forth in the Affordable Care Act.
  • Maine— The state released a draft Section 1332 waiver application to implement a reinsurance program for plan year 2019. We have updated our map that tracks state 1332 activity with a link to the draft application.
  • Maryland — Governor Hogan announced that he signed legislation creating the structure for a reinsurance program to be administered by the Maryland Health Benefit Exchange. Our map includes a link to the legislative language.
  • New Jersey – The Department of Health’s Office of Minority and Multicultural Health (OMMH) released a request for applications for mini-grants through the Community Health Disparity Prevention Program. The OMMH will fund up to 17 applicants to implement evidence-based or new intervention strategies to promote health and prevent and control chronic disease that disproportionately impact minority populations.
  • New York — NY State of Health, the state’s official health insurance Marketplace, announced changes to the Small Business Marketplace (SHOP). Four new health insurers will now be included in the SHOP 2018 health plan line-up and the three insurers already participating in SHOP will offer additional plan options.
  • North Carolina — The Department of Health and Human Services announced the release of a request for applications for community projects to combat the opioid crisis by advancing the goals of the NC Opioid Action Plan. Organizations can seek one-time, state-funded grants of up to $150,000 to support community activities that improve access to treatment and recovery supports.
  • Ohio — Late last week the Ohio Department of Insurance submitted a Section 1332 waiver application to CMS seeking to waive the individual mandate. We have posted links to both the application and the authorizing legislation on our map.
  • Wisconsin — As the state wrapped up public hearings on its proposed Section 1332 waiver to implement a reinsurance program, it released its draft application. Our map includes a link to the draft application and the legislation passed earlier this year and signed by Governor Walker.

Analysis of 2018 Marketplace Enrollment: Adjusting for Termination of Cost-Sharing Reduction Subsidies

On the Health Affairs blog this week is an initial analysis of enrollment in health plans for 2018 that examines how enrollment was impacted in state-based marketplaces (SBM) by how states directed their insurers to adjust for the termination of cost-sharing reduction (CSR) payments. SBMs had four strategies to choose from to allocate the costs of CSR subsidies and the response a state adopted to the termination of CSRs yielded different implications for subsidized buyers.

Grants to Treat Serious Mental Illness

The Substance Abuse and Mental Health Services Administration (SAMHSA) announced that it is accepting applications for its Assertive Community Treatment grants. The grants will be used to improve behavioral health outcomes by reducing the rates of hospitalization and death for people with a serious mental illness (SMI). SAMHSA expects that the program will also reduce the rates of substance use, homelessness and involvement with the criminal justice system among people with SMI. SAMHSA will award seven grants of up to $678,000 per year for up to five years. Applications are due May 29, 2018.

Reflections From a Departing Medicaid Director

Jason A. Helgerson, formerly the Medicaid director in Wisconsin, and currently finishing up his last week as New York’s Medicaid director, has a blog post up on Health Affairs in which he reflects on his tenure as a Medicaid director in two states for a total of 11 years. The blog post highlights a few “basic but important facts” about the Medicaid program. Helgerson also shares his five major lessons learned over the course of his 11 years and underscores the important role Medicaid has to play in transforming health care in the United States.