August 12 Update

In This Week’s Update:

  • CMS Bulletin on ABP Benchmark Plans
  • State Updates: DE, IL, KY, LA, MT, NE, NY, OR & WV
  • Evidence-Based Strategies for Reducing Health Disparities
  • Surprise Medical Bills: State Considerations
  • State Trends in the Opioid Crisis
  • Increasing Rural Health Department Capacity to Address SDOH


CMS Bulletin on ABP Benchmark Plans

Last week the Centers for Medicare & Medicaid Services (CMS) issued an Informational Bulletin explaining changes necessary in states seeking to update their Medicaid Alternative Benefit Plan (ABP) benchmark plans or establish a new ABP, effective January 1, 2020. States with existing ABPs will not need to make changes to their existing benchmark plan selection, including when seeking amendments to their ABP. However, states that wish to select a new benchmark plan for their ABP or establish an entirely new ABP are now presented with several options, outlined in the Informational Bulletin. The new Informational Bulletin also includes a Q&A for states, an example of acceptable methodologies to compare benefits across benchmark plans, and procedural reminders for states about how to amend their ABPs. State Health and Value Strategies is continuing to analyze the Informational Bulletin to determine its impact on states.


State Updates: DE, IL, KY, LA, MT, NE, NY, OR & WV

  • Delaware
    • The Department of Health and Social Services (DHSS) received approval from CMS for a waiver amendment allowing DHSS to use federal Medicaid funding for addiction-related treatment of individuals in institutions of mental disease (IMDs).
    • Governor John Carney signed Senate Bill 35, which codifies the consumer protections of the Affordable Care Act into Delaware law—including protections for Delawareans with pre-existing conditions, the guaranteed availability of coverage, and permissible rating factors. The Governor also signed Senate Substitute 1 for Senate Bill 92 that will provide dental coverage for all eligible adult Medicaid recipients.
  • Illinois – Governor J.B. Pritzker signed into law legislation that increase the timeliness of processing Medicaid applications and re-determinations. The new statute also requires managed care organizations to pay provider claims within 30 days.
  • Kentucky – The Cabinet for Health and Family Services launched the Kentucky Integrated Health Insurance Premium Payment (KI-HIPP) program which helps eligible Medicaid members cover the cost of an employer-sponsored health insurance plan. Kentuckians qualify for KI-HIPP if they or a member of their household are eligible for Medicaid and have access to health insurance through their employer. When a member enrolls, KI-HIPP pays for their share of the cost of the insurance premium.
  • Louisiana – The Louisiana Department of Health announced its intent to contract with four Medicaid managed care organizations. The Department has selected AmeriHealth Caritas Louisiana, Community Care Health Plan of Louisiana (Healthy Blue), Humana Health Benefit Plan of Louisiana, and United Healthcare Community Plan as its managed care partners beginning in January 2020.
  • Montana – Governor Steve Bullock announced that six emergency medical services (EMS) will pilot a model of community-based health care which will expand the role of EMS providers to include the delivery of non-emergency, out-of-hospital medical services. Paramedics and emergency medical technicians will operate in expanded public health and primary care roles to help patients access more appropriate care in non-emergency situations than an ambulance transport and emergency room visit. 
  • Nebraska – The Department of Health and Human Services submitted to the Nebraska Legislature its first monthly report on its progress in launching expansion for the childless adult population. The Department also posted a video that addresses questions regarding the community engagement requirement for the Medicaid expansion population.
  • New York – Governor Andrew M. Cuomo signed into law legislation to create a Maternal Mortality Review Board charged with reviewing the cause of each maternal death in New York state and making recommendations to the Department of Health on strategies for preventing future deaths and improving overall health outcomes.
  • Oregon – Governor Kate Brown signed Oregon’s Paid Family Medical Leave bill, House Bill 2005, into law. Under the legislation, workers will receive up to 12 weeks of paid time off that can be used to care for a new baby, recover from a serious illness, or support newly adopted or foster children. It also provides paid time off for victims of domestic violence and guarantees 100 percent of wages to low-income workers. 
  • West Virginia – West Virginia submitted a request to amend its Creating a Continuum of Care for Medicaid Enrollees with Substance Use Disorders Section 1115(a) demonstration. The amendment will provide the necessary authority to allow the Children with Serious Emotional Disorder 1915(c) demonstration to be limited to a single specialized managed care organization. The federal public comment period is open through September 6, 2019.


Webinar – Evidence-Based Strategies for Reducing Health Disparities

State Health and Value Strategies is convening the third webinar in its series SHVS Health Equity Through Managed Care. The upcoming webinar, Evidence-Based Strategies for Reducing Health Disparities, will identify evidence-based interventions that states can use to address disparities in their Medicaid managed care programs. The webinar takes place Tuesday, August 27, from 2:30-3:30 p.m. EST. During the webinar, Dr. Marshall Chin, Co-Director of Advancing Health Equity: Leading Care, Payment and Systems Transformation at the University of Chicago, will provide an overview of approaches for reducing disparities, drawing from a review of over 400 disparity intervention studies and from his program’s experience providing technical assistance to health care organizations. The webinar will also provide a road map to guide the work of Medicaid managed care programs to reduce disparities in care and elucidate the role of consumers in those interventions.

Registration (required) at the following link:


Protecting Consumers from Surprise Medical Bills: Considerations for Governors

An increasing number of states have enacted consumer protection laws to shield individuals from the high costs associated with surprise medical bills. Eleven states have enacted new legislation since 2017, including six states that enacted laws in 2019. A new report by the National Governors Association Center for Best Practices summarizes key challenges and opportunities for states to protect consumers from surprise medical bills. The report is based on a series of expert roundtable meetings, interviews and research from 14 states, and highlights the planning, financing, and operational strategies these states are taking to implement legislation.  


Observing the Changes in the Opioid Crisis through State-level Data

An upcoming webinar by the State Health Access Data Assistance Center (SHADAC) will examine the U.S. opioid epidemic through national and state-level data on drug overdose deaths, including opioids such as prescription painkillers, heroin and synthetic opioids, and non-opioids (but related drugs) such as cocaine and psychostimulants (e.g., methamphetamine). Using data available through SHADAC’s State Health Compare, the webinar will detail changing trends in the opioid crisis and how the specifics vary across states—both in the scale of the epidemic and differences in the top substances of concern. The webinar will take place September 4. Interested individuals can register here.  


Increasing Rural Local Health Department Capacity to Address SDOH

The National Association of County and City Health Officials (NACCHO) and the Centers for Disease Control and Prevention released a new report that builds on previous work exploring how rural local health departments are addressing social determinants of health in their communities. The report is based on the experiences of communities who are actively engaged in this work and explores the five key themes that emerged as foundational elements. The themes include developing partnerships, leveraging leadership, engaging community members, collecting data and evaluating results, and engaging in community-wide strategic planning.