January 28 Update: Uninsured Rate on the Rise; Best Practices for Medicaid Pharmacy; Proposed 2020 Notice of Benefit and Payment Parameters

In This Week’s Update:

  • Uninsured Rate on the Rise
  • Managing Managed Care: Best Practices for Medicaid Pharmacy
  • State Updates: AK, CA, KS, MA, ME, MI, MT, NE, NJ, TN & WA
  • Proposed 2020 Notice of Benefit and Payment Parameters
  • Opportunities to Address SDOH in Medicaid Managed Care
  • New Measures on Unaffordable Rents and Unhealthy Days



Last week survey results from the Gallup National Health and Well-Being Index showed that the uninsured rate continues to rise, from a low of 10.9 percent as of the fourth quarter of 2016 to the current high of 13.7 percent, a net increase of about 7 million uninsured individuals. For an analysis of what may be contributing to the increase in the number of uninsured, both Health Affairs has a blog post on the subject and the New York Times published an article on their blog The Upshot.

Also last week, State Health and Value Strategies hosted a webinar on the complexities of state Medicaid oversight of the pharmacy benefit in the managed care environment. During the webinar, technical experts from Mercer Government Human Services Consulting discussed the tools states have to ensure managed care organizations (MCOs) and their subcontracted pharmacy benefit managers (PBMs) are managing the drug benefit effectively and efficiently. Pennsylvania’s Pharmacy Director and Clinical Pharmacy Manager also shared their real-world experiences during the webinar monitoring and evaluating the operational and financial performance of their MCOs and their subcontracted PBMs. For those of you who weren’t able to join the webinar, both the slide deck and a recording have been posted to our website.

State Updates: AK, CA, KS, MA, ME, MI, MT, NE, NJ, TN & WA

  • Alaska – The Alaska Department of Health and Human Services released updated scorecards of its state health improvement plan, Healthy Alaskans 2020. The updated scorecard shows that Alaska has met eight of the established goals for improving the health of all Alaskans. A separate scorecard tracks the same health goals for the Alaska Native population and to date, Healthy Alaskans 2020 has met four of the established goals for Alaska Native people.
  • California – Governor Gavin Newsom announced that Dr. Nadine Burke Harris, a national leader in pediatric medicine and adverse childhood experiences (ACEs), will serve as California’s first-ever Surgeon General. The new office will focus on the social determinants of health and combating the root causes of serious health conditions — like adverse childhood experiences and toxic stress — and using the platform of Surgeon General to reach young families across the state.
  • Kansas – Governor Laura Kelly requested $14 million to expand Medicaid to 150,000 low-income individuals in the budget proposal she submitted to the Legislature.
  • Maine – Governor Janet Mills sent a letter to the Centers for Medicare & Medicaid Services informing the agency that Maine would not accept the terms of the pending 1115 Medicaid waiver. Instead, Governor Mills has directed Acting Commissioner of Labor Laura Fortman and Acting Commissioner of Health and Human Services Jeanne Lambrew to make available vocational training and workforce supports to MaineCare participants at every opportunity while increasing access to needed services that keep people in the workforce.
  • Massachusetts – Massachusetts Health Connector, the state’s official health insurance marketplace, has created a resource for consumers, “ABCs of Health Insurance: Words to Know,” that explains common terms encountered when purchasing and using health insurance. The resource includes helpful infographics as well as videos to explain different terms.
  • Michigan – The Michigan Department of Health and Human Services released a second round of Requests for Proposals in support of Michigan’s Child Lead Exposure Elimination Board Action Plan. Up to 11 grants will be issued and fund projects up to $150,000 that demonstrate innovative approaches to the elimination of child lead exposure and have the potential for replication throughout the state. Last year, 11 projects totaling more than $750,000 were funded. These projects are highlighted in the 2018 CLEEC Annual Report.
  • Montana – Governor Steve Bullock launched a new comprehensive set of resources to better equip anyone in a parenting role with easy-to-use tools to support the success of Montana’s children from kindergarten through the teen years. Parenting Montana, which includes a website and media campaign, seeks to cultivate a positive, healthy culture among Montana parents with an emphasis on curbing underage drinking, and to provide tools and resources to address every day parenting challenges.
  • Nebraska – Governor Pete Ricketts announced Dannette R. Smith as the next Chief Executive Officer of the Nebraska Department of Health and Human Services. Smith has more than 25 years of executive leadership experience in large, complex organizations and most recently served as the Director of the Virginia Beach Department of Human Services since 2013.
  • New Jersey
    • Governor Phil Murphy announced new initiatives to combat the opioid epidemic, including Medicaid removing the requirement for prior authorization for Medication Assisted Treatment (MAT). Additionally, Medicaid is launching a suite of initiatives to advance accessibility to MAT, including the launch of the Office Based Addiction Treatment (OBAT) program, which will create new Medicaid reimbursement incentives for primary care providers to provide MAT for opioid addiction.
    • First Lady Tammy Murphy launched Nurture NJ, a statewide awareness campaign committed to reducing infant and maternal mortality and morbidity and ensuring equitable maternal and infant care among women and children of all races and ethnicities. The campaign will include internal collaboration between departments and agencies and connecting family members involved in taking care of a child with state, county, and local resources, in addition to other activities.
  • Tennessee – Governor Bill Lee announced the appointment of Dr. Lisa Piercey to lead the Department of Health. Dr. Piercey is currently the executive vice president of West Tennessee Healthcare and her clinical background is in pediatrics with a specialization in child abuse pediatrics.
  • Washington– The Heath Care Authority (HCA) released a request for drug manufacturers to propose a new approach to providing costly but curative hepatitis C drugs. The proposals must include descriptions of outreach and screening to those potentially living with hepatitis C, and a competitive price on the drug. The request for proposals is open through March 4.

Proposed 2020 Notice of Benefit and Payment Parameters: Summary and Implications for States

Sabrina Corlette at Georgetown University recently wrote a blog post describing the 2020 Notice of Benefit and Payment Parameters (NBPP) and considerations for states as they prepare comments on the proposed rule. The blog post highlights key technical and benefit design changes in the proposed rule and state actions that may be needed. Also, in case you missed it, State and Health Value Strategies hosted a webinar on the proposed NBPP (on which Sabrina also presented). Webinar slides and a recording can be accessed here. Comments on the proposed rule are due February 19, 2019.

Opportunities to Address SDOH in Medicaid Managed Care

The Institute for Medicaid Innovation (IMI) released a new report, “Innovation and Opportunities to Address Social Determinants of Health in Medicaid Managed Care,” that sheds light on the economic and social conditions affecting health outcomes in underserved populations in Medicaid. The report highlights the opportunities for the Medicaid program and its stakeholders, especially the managed care organizations that cover the vast majority of its enrollees, to identify and address the social risk factors, such as housing instability and food insecurity, that can affect health outcomes of this vulnerable population. The report also features case studies that showcase state-led initiatives that take on SDOH, but also describes the barriers that can impede progress. Additionally, SHVS has a number of resources for states interested in addressing social determinants of health, highlighted in a recent publication.

Exploring Disparities Using New and Updated Measures on Unaffordable Rents and Unhealthy Days

The State Health Access Data Assistance Center (SHADAC) is hosting a webinar February 6 to introduce two new measures of health outcomes and social determinants of health on SHADAC’s State Health Compare, SHADAC’s tool  highlighting state-level data on a wide range of topics including health insurance coverage, cost of care, health behaviors, health outcomes, and access to and utilization of care. Speakers on the webinar will examine the new measures, Unhealthy Days and Unaffordable Rents, and highlight how the estimates can be used to explore disparities between states and among sub-populations. The webinar will also provide a virtual tour of some of the more than 40 state-level measures currently available on State Health Compare tool.