January 21 Update

In This Week’s Update:

  • Proposed Medicaid Fiscal Accountability Rule
  • State Updates: IL, KY, NH, NJ, OK, VA & WY
  • New SHVS Publication on Supportive Housing
  • Marketplace Premiums and Insurer Participation
  • Medicaid Expansion and Opioid Overdose Mortality


Proposed Medicaid Fiscal Accountability Rule

Last week, State Health and Value Strategies (SHVS) hosted a webinar on the proposed Medicaid fiscal accountability rule released by the Centers for Medicare & Medicaid Services (CMS) in November. The webinar, facilitated by experts at Manatt Health, provided an overview of the proposed rule, highlighting the provisions with the most significant implications for states, and also discussed how the rulemaking process may unfold over the next several months and what states can do to prepare. A slide deck and recording of the webinar are posted on the SHVS website.


State Updates: IL, KY, NH, NJ, OK, VA & WY

  • Illinois – The state submitted an application to CMS for a new five-year Section 1115 demonstration that seeks authority for three initiatives: the extension of the postpartum coverage from 60 days to 12 months; managed care organization reinstatement for Medicaid beneficiaries who submit late redetermination paperwork within 90 days; and the waiving of hospital presumptive eligibility. Comments can be submitted to CMS through February 13, 2020.
  • Kentucky – The state released a statewide Medicaid managed care request for proposals following Gov. Andy Beshear’s decision to cancel the contracts issued by the outgoing governor. The state plans to contract with up to five Medicaid managed care organizations, with one of the selected MCOs also providing services for children in foster care, adoption assistance, and in the juvenile justice system under the Supporting Kentucky Youth program.
  • New Hampshire – Governor Chris Sununu announced that the state intends to submit an application to CMS to implement a state reinsurance program. SHVS is tracking state Section 1332 activity via its map.
  • New Jersey – Governor Phil Murphy signed a package of bills that codify provisions of the Affordable Care Act (ACA) in New Jersey. The bills include protections for no-cost preventive care and contraception, prohibits exclusions for pre-existing conditions, allows children to stay on their parents’ plan until age 26, and incorporates mental health and maternity care as part of essential benefits, among others. 
  • Oklahoma – The Oklahoma Health Care Authority announced two new policies for SoonerCare members. SoonerCare, the state’s Medicaid program, is adding diabetes self-management training as a benefit and establishing registered behavior technicians as SoonerCare providers. The policies were enacted by emergency rules that Governor J. Kevin Stitt signed earlier this month.
  • Virginia – The Virginia Department of Medical Assistance Services released a new dashboard documenting how newly eligible Virginia adults are using their Medicaid coverage. More than 370,000 Virginia adults are now enrolled and receiving health services through Medicaid expansion.
  • Wyoming – The state’s Section 1115 demonstration request to expand Medicaid coverage for air ambulance transport services to all Wyoming residents was denied by CMS.


New SHVS Publication: State Investments in Supportive Housing

SHVS published a new issue brief, authored by experts at Manatt Health, that provides an overview of the federal authorities under which states are able to cover nonclinical housing-related services for high-need Medicaid enrollees. Research shows that access to affordable, safe, and stable housing can improve health outcomes and reduce health care costs. While Medicaid typically does not pay for housing (room and board), it does pay for some clinical and non-clinical services that can help people obtain and maintain their housing. The issue brief reviews how states are using federal authorities to invest in supportive housing for diverse, high-need Medicaid populations. As a companion to the issue brief, Manatt Health also developed State Investments in Supportive Housing: An Inventory of State Efforts, which provides an in-depth look at states that are leveraging federal authorities to offer supportive housing benefits.


Marketplace Premiums and Insurer Participation: 2017-2020

With support from the Robert Wood Johnson Foundation, the Urban Institute recently published a report detailing the changes in the average lowest silver premiums from 2017 to 2020 by state. The report found that in in most rating regions, premiums increased considerably between 2017 and 2018, yet stabilized in 2019 and 2020. Costs for the lowest-priced silver plans fell by an average of 3.5 percent. Researchers also noted low-cost silver premium states had more competition, which was often created by the participation of at least one Medicaid insurer, several other non-Medicaid insurers offering plans, or the state instituting a reinsurance program.


Medicaid Expansion and Opioid Overdose Mortality in the United States

A new study published in the Journal of the American Medical Association found that the rates of opioid overdose deaths, particularly those involving heroin and fentanyl, dropped in states that expanded their Medicaid program between 2001 and 2017. Researchers from California, New York, and Rhode Island examined mortality data from the Centers for Disease Control and Prevention’s National Vital Statistics System of 3,109 counties in 49 states and the District of Columbia to determine whether the ACA-related Medicaid expansion had an effect on opioid-related overdose deaths. While opioid overdose death rates were generally higher in expansion states than in non-expansion states, the researchers found that adoption of Medicaid expansion was associated with a six percent lower rate of total opioid overdose deaths compared with the rate in non-expansion states. The study notes that as states invest more resources in addressing the opioid overdose epidemic, attention should be paid to the role that Medicaid expansion may play in reducing opioid overdose mortality, in part through greater access to medications for opioid use disorder.