January 14 Update: Implications of Federal Shutdown; States Develop Stabilizing Proposals; Integrating Clinical and Behavioral Health; Medicaid Drug Rebate Program

Breaking news from Friday: the partial government shutdown has prompted an appeals court judge to issue a stay in Texas v. Azar lawsuit. For an analysis of where the case stands and implications of the federal shutdown more broadly on health care, listen to this Kaiser Health News’ What the Health? podcast (start at 1:12).

In other news, state proposals to develop Medicaid buy-in or public option programs are getting more attention. As  mentioned in this Pew Stateline Article, in the absence of federal action, states are developing their own proposals to help stabilize their health insurance marketplace and increase affordable coverage options. SHVS has also updated their map to reflect the latest developments in state activity.


  • Alabama – Alabama Medicaid announced six information sessions for providers to learn more about the agency’s proposed Alabama Coordinated Health Networks (ACHN). ACHNs will provide a single care coordination delivery system that will effectively links patients, providers and community resources within each of seven regions and will be implemented as of October 1, 2019 pending approval from the Centers for Medicare & Medicaid Services.
  • California
    • Governor Gavin Newsom announced a series of executive actions and budget proposals to lower prescription drug and health care costs for all California families. In his first budget, Newsom will propose expanding financial help for families and individuals to buy health coverage and expanding Medi-Cal coverage to all eligible undocumented young adults.
    • Covered California, the state’s health insurance marketplace, began its second leg of its statewide bus tour yesterday to encourage consumers to sign up for health care coverage. Consumers have through January 15 to sign up for coverage.
  • Colorado – Kevin Patterson, the Chief Executive Officer of Colorado’s state-based exchange, announced upcoming enrollment events around the state for consumers to sign up for health insurance before the January 15 deadline. He also sat down with local leaders last week to discuss the progress of this year’s open enrollment period in Colorado.
  • Minnesota – MNsure, Minnesota’s state-based exchange, reminded residents they have until midnight January 13 to sign up for health insurance coverage for 2019. Residents are also encouraged to take advantage of the state’s plan comparison tool to see if they qualify for financial help and compare plans.
  • New Mexico – Governor Michelle Lujan Grisham announced that Nicole Comeaux will be the new director of the Medical Assistance Division in the Human Services Department. Comeaux most recently served as a senior advisor in the Data and Systems Group at CMS. Congratulations Nicole!
  • New York – The Office of Alcoholism and Substance Abuse Services (OASAS) and the New York State Office of Mental Health (OMH) have approved awards for five community-based organizations to help educate individuals and families on their legal rights related to insurance coverage for behavioral health services and provide assistance when health insurance coverage for behavioral health services is denied.
  • North Carolina – The North Carolina Perinatal Oral Health Task Force, convened by the Division of Public Health and charged with creating a comprehensive perinatal oral health initiative for the state, released new oral health guidance to advance maternal and infant health. The new guidance promotes collaboration between medical and dental professionals who care for pregnant women and is a component of an overarching strategy to improve the health and quality of life for mothers and young children.
  • Oregon – The Oregon Health Authority (OHA) has released a draft request for applications which lays out the requirements applicants must meet to serve Oregon Health Plan members for the next five years of coordinated care contracts, also known as “CCO 2.0.” Letters of intent to apply will be due to OHA on February 1.
  • Virginia – The Department of Medical Assistance Services created an Expansion Dashboard which provides the latest data on Medicaid expansion enrollment. The Dashboard has a map that breaks down enrollment by locality and provides a breakdown of enrollment by family income and by the age and gender of enrollees.
  • Washington – Governor Jay Inslee announced that he and Democratic lawmakers will introduce legislation that would provide a public health care option. The proposal directs the state’s Health Care Authority to contract with health plans across the state to offer coverage on the Washington Health Benefit Exchange, which guarantees coverage to anyone in the individual insurance market across the state.


Upcoming Webinar – Managing Managed Care: Best Practices for Medicaid Pharmacy

Wednesday, January 23, 2:00 to 3:00 p.m. ET

The prescription drug benefit continues to grow as a portion of Medicaid expenditures. State Medicaid programs commonly rely on contracted Managed Care Organizations (MCOs) and their subcontracted Pharmacy Benefit Managers (PBMs) to manage the prescription drug benefit offered to Medicaid enrollees. What tools do states have available to ensure the MCOs and the PBMs are managing the drug benefit effectively and efficiently? State Health and Value Strategies will host a webinar addressing the complexities of state Medicaid oversight of the pharmacy benefit in the managed care environment. The webinar will offer states real world tips on how to best monitor and evaluate operational and financial performance of their MCOs and their subcontracted PBMs.

Registration (required) at the following link: https://rwjfevents.webex.com/rwjfevents/onstage/g.php?MTID=e8505028c75e4c8f94d2bf9f09954d200


Strengthening the Medicaid Drug Rebate Program

Georgetown University’s Center for Children and Families released a new report last week that examines how to strengthen the Medicaid Drug Rebate Program to address rising Medicaid prescription drug costs. The report focuses on how to build upon and improve the Medicaid Drug Rebate Program at both the federal and state levels in order to help state Medicaid programs better address their rising prescription drug costs and ensure continued access to needed prescription drugs for tens of millions of low-income children, families, people with disabilities and other beneficiaries who rely on Medicaid today. The report’s author highlights for state policymakers the opportunity to adopt several policies already  available under the federal law such as expanding the supplemental rebates that state negotiate with drug manufacturers and maximizing the rebates negotiated by Medicaid managed care plans.


Integrating Clinical and Behavioral Health

The Bipartisan Policy Center (BPC) is hosting a discussion examining the promise and challenges of integrating behavioral health into the broader health care system on January 24. The discussion, timed with the release of a new BPC report on the topic, will feature national leaders in integrating care who will examine the existing delivery structure, public and private program financing, practitioner challenges, accomplishments on the ground, and consumer priorities. The event will be webcast for those of us not in Washington D.C.