July 20 Update: CMS re-opens comment period for KY’s waiver; Characteristics of remaining uninsured; State & local health data innovation

In light of the federal district court’s decision in Stewart v. Azar, the Centers for Medicare and Medicaid Services (CMS) announced it is re-opening the comment period for Kentucky’s Section 1115 waiver application, which included work/community engagement requirements. In the announcement, CMS noted that “[a]lthough an additional public comment period is not legally required, CMS is conducting one to ensure that interested stakeholders have an opportunity to comment on the issues raised in the litigation and in the court’s decision.” The agency is accepting comments through August 18, 2018. To learn more about the Stewart v. Azar decision and its implications for states, join us for our upcoming webinar (see below for the link to register).

Last week, CMS also announced $10 million in funding for the federal navigator program for 2019, a reduction from $36.8 million for the 2018 plan year. The new funding opportunity announcement for the navigator program for the 34 states with a federally-facilitated marketplace was released with a series of frequently asked questions and an overview of the application process; applications are due August 9, 2018. For background on the federal navigator program and a summary of the announcement, Health Affairs has a useful blog post. For a synopsis of the latest federal activity in health policy this summer, check out Tim Jost’s article in Health Affairs. Updates follow.

  • Illinois – Governor Bruce Rauner and the Illinois Department of Insurance announced that the state is seeking federal permission to update the state’s benchmark plan to include alternative therapies for chronic pain, remove barriers to prescribing buprenorphine to treat opioid use disorder, and expand care for mental health and substance use disorders through tele-psychiatry. The changes, if approved, would go into effect in 2020.
  • Maryland – Governor Larry Hogan and CMS Administrator Seema Verma  signed and enacted the state’s Total Cost of Care All-Payer Model. The new five-year contract goes into effect in 2019, expanding the state’s previous all-payer model beyond hospitals to the entire health care system, including mental health, long-term care, primary care and community resources for population health. The contract extends through 2023 and can be extended for an additional five years.
  • Minnesota – MNSure, the state-based marketplace, announced it is extending the open enrollment period for 2019 health coverage to give Minnesotans more time to shop. Open enrollment will begin on November 1, 2018, and run through January 13, 2019 – a month longer than the federal open enrollment period that ends December 15, 2018.
  • New Hampshire – CMS approved the state’s waiver request to allow the state to receive Medicaid payments for patients receiving substance use treatment at certain inpatient facilities. The waiver will allow the state to increase access to treatment for opioid use and other substance use disorders for Medicaid beneficiaries.
  • New Jersey – The state’s Section 1332 waiver application to implement a reinsurance program was deemed complete by CMS. We have updated our map of Section 1332 waiver activity to reflect the progress of New Jersey’s application.
  • New York – Governor Andrew Cuomo directed the State Department of Financial Services to review the impact and implement an affordable health access action plan in light of the Trump Administration’s suspension of the Affordable Care Act’s Risk Adjustment Program. The expanded State Risk Adjustment Program is an option the state would consider if the federal program is not reinstated.
  • Rhode Island – CMS is accepting comments on the state’s request for a five-year extension of its section 1115 Demonstration to build on the state’s Health System Transformation Project and implement reforms that will focus on paying for value and coordinating physical, behavioral, and long-term health care with the goal of making Medicaid more effective, efficient, and sustainable in the future. Comments can be submitted through August 17, 2018.

Upcoming Webinar – Save the Date!

Explaining the Stewart v. Azar Decision and Implications for States

Tuesday, July 24, 2018 4:00 to 5:00 p.m. ET

State Health and Value Strategies (SHVS) program, together with technical assistance experts from Manatt Health, will host a webinar to review the Stewart v. Azar decision and its potential implications for states with approved, pending or planned Medicaid waivers that include work/community engagement requirements. During the webinar, we will review the court’s findings and any Centers for Medicare & Medicaid Services guidance. Even in states not pursuing work/community engagement requirements, the court’s findings may shape what type of analysis will be necessary to demonstrate that future waivers advance the objectives of the Medicaid statute.

Registration (required) at the following link: https://rwjfevents.webex.com/rwjfevents/onstage/g.php?MTID=e9cc2e9ff4fcb39a192f820292752503e

Characteristics of the Remaining Uninsured in the United States

The number of uninsured, nonelderly people in the United States dropped by nearly 2.9 million between 2015 and 2017, from 32.9 million to 30.1 million. A new brief by the Urban Institute highlights the characteristics of the remaining 30.1 million uninsured and outlines strategies to reach this population. Researchers found that uninsured rates declined significantly among non-Hispanic whites, Asians/Pacific Islanders, and Hispanics between 2015 and 2017, but the uninsured rate among non-Hispanic African Americans remained unchanged. One of the key findings is that a disproportionate share of coverage gains occurred among people with the lowest incomes, least education and most limited attachment to the workforce, implying that those who remain uninsured likely will be harder to reach.

Winners of Milbank Memorial Fund and AcademyHealth State and Local Innovation Prize Profiled

The Milbank Memorial Fund and AcademyHealth launched the State and Local Innovation Prize this year to recognize initiatives that engage in the smart use of data to transform health care delivery. More than 40 applicants responded to the call for nominations. A group of expert reviewers looked for projects that demonstrated innovation in overcoming traditional public sector barriers and challenges to leveraging data for policy and programs; measurable impact on specific metrics of population health; sustainability of effort and likely future impact on policy and programs; and the potential to scale and/or replicate. The winner, the Chicago Childhood Lead Paint Data-Sharing Project, and the two runners-up of the inaugural prize are profiled in a new publication released this week. The case studies tell the story of the three winning projects—the problems they solved, the inspiration behind their developments, and the opportunities for innovation they uncovered.