August 17 Update: Section 1332 waiver news; Pharmaceuticals and public health crises; Health care sharing ministries

With the announcement this week by the Centers for Medicare & Medicaid Services (CMS) of the approval of New Jersey’s Section 1332 waiver to create a reinsurance program, there are now a total of seven states with approved Section 1332 waivers, with six approved to implement reinsurance programs. The New Jersey Department of Banking and Insurance put out a press release announcing the approval, which is projected to achieve a 15 percent reduction in what premiums would otherwise be without a reinsurance program. We have updated our map of state activity, with links to applications, approval letters, and more.

Also this week the Centers for Medicare & Medicaid Services (CMS) issued a second Informational Bulletin related to State Plan Amendment (SPA) and 1915 waiver process improvements. The Bulletin outlines the initial strategies CMS has adopted to implement more efficient SPA and 1915 waiver review and adjudication processes, and highlights additional longer term process improvements CMS is implementing. Updates follow.

  • Arkansas – A lawsuit was filed this week seeking to prevent Arkansas from conditioning Medicaid eligibility on work or community engagement.
  • Arizona – The Arizona Health Care Cost Containment System is accepting public comments on the 2019 Substance Abuse and Mental Health Block Grant Combined Behavioral Health Assessment and Plan update which will support substance abuse prevention and treatment and behavioral health services.
  • Louisiana – The Louisiana Department of Health announced it is seeking comments from the public, health care professionals, pharmaceutical companies, and others on a plan to create a subscription-based payment model for Hepatitis C medication.
  • Nevada – Nevada Health Link, the state’s health insurance marketplace, announced that GetInsured has been awarded a contract to operate the exchange’s technology platform for eligibility and enrollment, as well as its call center, when it transitions to a state-based exchange next year.
  • Oklahoma — The Oklahoma Health Care Authority is accepting comments and input from the public through September 3, regarding changes to the SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver programs’ work and community engagement requirements.
  • Texas – As the one year anniversary of Hurricane Harvey approaches, Texas Health and Human Services is reminding residents that the federally funded Texans Recovering Together program is offering free counseling, education and local resource referrals to help survivors and communities recover.

Resource Hub for State Health Policy Research

In case you missed it, SHVS recently published an issue brief by Bailit Health and Georgetown’s Center on Health Insurance Reforms on state oversight of provider risk-bearing organizations. You can find this brief and others on the Robert Wood Johnson Foundation’s new hub for Foundation-funded state-level health policy research at the newly revamped and refreshed The site brings together resources from across RWJF grantees into one easy-to-navigate place, so you never lose a brief again. You can also subscribe to new product alert emails, and bookmark the site for your future research.

Improving Access to Pharmaceutical Interventions in Public Health Crises

The National Governors Association Center for Best Practices (NGA Center) published a report which summarizes potential state strategies to address public health crises by improving access to evidence-based pharmaceutical interventions while ensuring fiscal sustainability of public programs. The strategies were vetted by 11 states and include some that select states are currently executing or pursuing and more novel approaches yet to be tried. The report also outlines considerations for states and key takeaways from discussions with a broad group of stakeholders, including pharmaceutical manufacturers, insurers, and pharmacy benefit managers.

Health Care Sharing Ministries: What Are the Risks to Consumers and Insurance Markets?

The Commonwealth Fund published a report analyzing state laws governing health care sharing ministries (HCSMs) and includes lessons learned from officials in 13 states. The report highlights key features of five HCSMs and discusses key challenges states face, including lack of data and consumer confusion stemming from marketing strategies, as well as options states may consider to mitigate these challenges.