As we enter the last week of open enrollment for states operating health insurance marketplaces through healthcare.gov, the Centers for Medicaid & Medicare Services (CMS) released their weekly enrollment snapshot for week five. To date, nearly 3.2 million people have selected plans, of which 812,263 are new consumers; this is down from the 3.6 million people who had selected plans by this time last year. While there are many potential drivers of lower enrollment, we will likely have to wait till the dust settles on this open enrollment period to better understand the dynamics. However, as profiled below, several states that run their own state-based exchanges, and have extended open enrollments, are seeing sign-ups that are higher than last year.

Also last week the CMS Office of the Actuary announced the release of 2017 national health expenditures and the data show that overall national health spending grew at a rate of 3.9 percent in 2017, slowing from growth of 4.8 percent in 2016. And, in case you missed it, State Health and Value Strategies will be hosting a webinar on the landscape of Medicaid buy-in proposals on December 17. See the details below and the link to register. Updates follow.

• Alaska – Health and Human Services (HHS) Secretary Alex Azar declared a public health emergency in Alaska last Tuesday. The declaration triggers other legal authorities that give Medicare and Medicaid beneficiaries, their health care providers and suppliers greater flexibility in meeting emergency health needs in the aftermath of the earthquake.
• California – Covered California announced that more than 90,500 new consumers signed up for coverage through November 30. While the number of plan selections is ahead of the pace set during 2016, which marked the last time Covered California delayed its marketing push until after Election Day, it is slightly behind the pace set last year when 102,000 consumers signed up through November. California’s final deadline to sign up for coverage is January 15, 2019.
• Colorado – Connect for Health Colorado, the state’s health insurance marketplace, shared the news that more than 46,000 Coloradans selected health coverage during November, which is six percent ahead of last year’s pace. Fifteen percent of the plan selections are by customers who are new to Connect for Health Colorado and 85 percent are renewing customers.
• Nebraska – CMS has opened the federal comment period on Nebraska’s 1115 demonstration application in which it requests waiving the requirement of 15 day stay maximums in institutions of mental diseases for individuals with substance use disorders. Comments will be accepted through January 5, 2019.
• New York  – NY State of Health, the official health plan marketplace, announced that over the course of the first four weeks of the 2019 open enrollment period, enrollment is outpacing last year. More than 930,000 consumers have enrolled or renewed coverage in a Qualified Health Plan or the Essential Plan for 2019.  Consumers must enroll or renew by December 15, for coverage beginning January 1, 2019.
• Ohio – The Department of Health publicized the release of the 2017 Ohio Infant Mortality Report which finds that the number of infant deaths overall declined compared to 2016. However, the disparity in birth outcomes continued, with black infants dying at three times the rate as white infants.
• Texas – The Select Committee on Opioids and Substance Abuse of the Texas House of Representatives’ released the results from their study of the effects of the opioids and substance abuse epidemic in Texas and outline recommendations for the upcoming legislative session.
• Washington – The Washington Health Benefit Exchange, the state’s official health insurance marketplace, announced that more than 195,000 customers have used Washington Healthplanfinder to select a health plan for 2019 coverage – a nearly three percent increase over the same time last year.

Upcoming Webinar – Save the Date!

Medicaid Buy-In: Emerging Models and Considerations

Monday, December 17, 2018  2:30 p.m. – 3:30 p.m. ET

Over the past year, state policy makers and advocates have expressed interest in proposals that would permit people above Medicaid eligibility levels to “buy in” to Medicaid (i.e., leverage the state’s bargaining power in some way) in order to offer more affordable and accessible coverage. State Health and Value Strategies will host a webinar for state officials to discuss Medicaid buy-in proposals. During this webinar, experts from Manatt Health will discuss state considerations for developing a Medicaid buy-in proposal, evolving models of state proposals, and the administrative considerations and authorities needed for each model.

Registration (required) at the following link: https://rwjfevents.webex.com/rwjfevents/onstage/g.php?MTID=edfe40630585d5af9fef531db660d4755

Milbank Memorial Fund and AcademyHealth Accepting Nominations for State and Local Health Care Data Innovation Award

The Milbank Memorial Fund is partnering for the second year with AcademyHealth to recognize state and local efforts to advance the use of data to improve the health of populations and the performance of health systems. This year’s award will recognize up to three organizations that are developing or have developed data analytic roadmaps (DARs) to help state and local health agencies collect, organize, and analyze their data. DARs are developed to provide solutions to analytic challenges like defining a population health concept, measuring performance, or carrying out another operation. One representative for each of the three finalists will receive travel assistance and complimentary registration in order to attend the 2019 Health Datapalooza. A final winner will be announced from the main stage of the meeting. Nominations will be accepted through January 14.

Reducing Dental Opioid Prescribing in Oregon

The Center for Health Care Strategies published a blog post this week that relates a conversation with Statewide Dental Director Bruce Austin, DMD and Dental Program Manager Kellie Skenandore from the Oregon Health Authority who have been working to educate dental providers on Oregon’s prescribing guidelines and increase the use of the Prescription Drug Monitoring Program (PDMP) by dentists in their state. The post details CHCS’ recent conversation with Dr. Austin and Ms. Skenandore to discuss the state’s strategy to prevent opioid addiction. Both Dr. Austin and Ms. Skenandore are recent fellows of CHCS’ State Oral Health Leadership Institute.

Resource for States Using Non-HEDIS and Modified HEDIS Measures: Buying Value Benchmark Repository

Bailit Health, with support from the Robert Wood Johnson Foundation and State Health and Value Strategies, developed the new Buying Value Benchmark Repository, a centralized source of non-HEDIS and modified HEDIS health care performance measures. State purchasers can use the database for measure selection and benchmarking purposes as non-HEDIS and modified HEDIS measures rarely have national benchmarks which states can employ to assess and possibly reward provider, accountable care organization or managed care organization performance in value-based payment arrangements. The Repository now has 35 measures from four states, with additions planned in the coming weeks. Go to www.buyingvalue.org to download the spreadsheet, or to submit measures in use within your organization.