July 15 Update

In This Week’s Update:

  • Affordable Care Act Litigation
  • SHVS Managed Care Webinar
  • State Updates: AZ, CA, DE, NH, NJ, OR, PA & RI
  • Surprise Medical Billing
  • Impact of Integrated Medicaid Managed Care
  • Medicaid Pharmacy Programs


Affordable Care Act Litigation

Last week, a three-judge panel of the Fifth Circuit Court of Appeals held a 90-minute hearing in Texas v. United States, a lawsuit challenging the constitutionality of the individual mandate and, with it, the entire Affordable Care Act (ACA). The hearing was over whether to affirm or reverse a district court decision that declared the entire ACA invalid. Much of the hearing was devoted to whether parties had standing to bring or appeal the lawsuit. For a brief synopsis and analysis, see this Health Affairs blog post.

SHVS Managed Care Webinar

Also last week, State Health & Value Strategies hosted the second webinar in its SHVS Health Equity Through Managed Care webinar series. The webinar, Health Equity and Medicaid Managed Care: Data Collection and Measurement, explored how states can use data collection and measurement to support their efforts to advance health equity in Medicaid managed care and featured two states, Michigan and Minnesota, that are currently measuring and evaluating health disparities in their managed care programs. SHVS posted both the slides and a recording of the webinar on its website, where you can also register for the remaining three webinars in the series.


State Updates: AZ, CA, DE, NH, NJ, OR, PA & RI

  • Arizona – The Arizona Health Care Cost Containment System (AHCCCS) published a statistical snapshot of the state’s Medicaid program, AHCCCS @ A Glance, including data on enrollment, costs, claims, and utilization. The snapshot also includes information on how AHCCCS is responding to the opioid crisis, efforts to house AHCCCS members and data from the Justice In-Reach program, which connects incarcerated individuals to Medicaid coverage.
  • California
    • Governor Gavin Newsom signed legislation that includes a provision requiring residents to purchase health insurance beginning January 2020 and imposes a fine for failure to do so. In addition, Governor Newsom signed the state’s fiscal year 2020 budget, which includes investing $1.45 billion over three years to increase Covered California health insurance premium support for low-income Californians.
    • Covered California, the state’s official health insurance marketplace, announced that the state’s individual market will see a preliminary rate change of 0.8 percent in 2020, the lowest change since Covered California’s launch. The decline in rates is attributed to new state affordability initiatives designed to lower costs and encourage enrollment.
  • Delaware – The Delaware Department of Health and Social Services officially submitted its Section 1332 waiver application for a reinsurance program to the Centers for Medicare & Medicaid Services. This map from SHVS is updated to reflect this latest development.
  • New Hampshire – Department of Health and Human Services Commissioner Jeffrey A. Meyers submitted a letter to the Governor, Senate President, and House Speaker with findings related to the community engagement requirement for the state’s Medicaid program. Under the authority of Senate Bill 290, Commissioner Meyers has temporarily suspended the community engagement requirement through September 30, 2019.
  • New Jersey – Human Services Commissioner Carole Johnson announced that Jennifer Langer Jacobs will lead New Jersey’s Medicaid and the Children’s Health Insurance Programs, which together are known as NJ FamilyCare. Jacobs most recently served as Senior Vice President of Long-Term Care at Sunshine Health, Florida’s largest Medicaid long-term care health plan. From 2010 to 2016, she was a member of the Medicaid leadership team at Amerigroup New Jersey, most recently as Chief Operating Officer.
  • Oregon
    • The Oregon Health Authority (OHA) announced its intent to award 15 organizations contracts to serve as coordinated care organizations (CCOs) for the Oregon Health Plan’s nearly 1 million members. Awardees will be evaluated for their readiness to deliver the services promised in their applications and successful awardees will sign their contracts, totaling more than $6 billion for the 2020 contract year, in the fall. The new CCO contract services start January 1, 2020.
    • OHA released a new statewide assessment of Oregon retailers that carry tobacco. OHA worked with county health department staff, tribes, community partners and volunteers across the state to conduct the assessment of nearly 2,000 Oregon tobacco retailers. The report highlights ads and products designed to appeal to youth and also recommends strategies to make retail outlets healthier for all Oregonians.
  • Pennsylvania – The Department of Human Services’ Pennsylvania eHealth Partnership Program announced that Central Pennsylvania Connect Health Information Exchange is now connected to the Pennsylvania Patient & Provider Network, marking a significant milestone in the statewide health information exchange. Central PA Connect is one of five active health information organizations in Pennsylvania.
  • Rhode Island
    • Governor Gina Raimondo signed the state’s fiscal year 2020 budget, which includes a state individual mandate to buy insurance coverage beginning January 1, 2020 and imposes a penalty for residents who fail to do so.
    • Governor Raimondo also signed three bills into law to address the opioid crisis. The bills will limit first-time opioid prescriptions, place warning signs in pharmacies about the dangers of opioids and remove a potential barrier to possession of life-saving anti-opioid prescriptions.


Bi-Partisan Forum on Surprise Medical Bills

As Congress moves forward with legislative proposals to prohibit surprise medical bills, the Bipartisan Policy Center will bring together experts and medical providers on Wednesday, July 17 to discuss various approaches and analyze their potential impact. Sabrina Corlette from the Center on Health Insurance Reforms at Georgetown University’s Health Policy Institute will be one of the panelists. For those not in Washington, D.C. a live webcast will be available. Register here to participate.


Impact of Integrated Medicaid Managed Care on Practice-Level Integration of Physical and Behavioral Health

A new brief by the Center for Health Care Strategies describes how integrated financing influences the coordination of physical and behavioral health services at the point of care. It distills insights from providers in three states — Arizona, New York, and Washington— that have recently transitioned to integrated managed care. Based on their insights, the brief highlights recommendations for states seeking to improve health outcomes through greater physical-behavioral health integration. It examines three key levers for advancing integrated care: (1) data and quality measures; (2) payment and business practices; and (3) integrated clinical service delivery.


The Effective Medicaid Pharmacy Program: A White Paper for Medicaid Directors and State Agency Personnel

The New England States Consortium Systems Organization and Commonwealth Medicine recently co-authored a white paper for Medicaid Directors and their staff on the components of an effective Medicaid pharmacy program. The authors define such a program as one that provides Medicaid members with access to medically necessary medications, that are cost-effective, aligned with best clinical practice, and provided in a transparent environment. Based on an environmental scan supplemented by key informant interviews, the white paper identifies best practices and emerging opportunities for Medicaid pharmacy programs and notes key factors impacting success, including the program’s administrative structure; the pharmacy benefit delivery system; and the influence of external factors.