June 22 Update: Release of final AHP rule; Two-generation strategies for states; Medicaid directors on the opioid crisis

This week, the U.S. Department of Labor (DOL) released a final rule that alters the way that association health plans (AHPs) are regulated. The rule was accompanied by a press release and a new webpage. The DOL rule significantly loosens the conditions under which a group of employers – or the self-employed – can join together under an AHP and be considered a “single employer” under the Employee Retirement Income Security Act (ERISA). Such AHPs would be regulated under federal law as large-group coverage, making them exempt from Affordable Care Act (ACA) and other federal and state requirements that apply only to the individual and small-group insurance markets. The final rule includes an implementation timeline and a pathway for AHPs to gain single employer status under ERISA. It also clarifies rules against health discrimination and which ACA protections AHPs are still subject to. Our friend and colleague Sabrina Corlette, from Georgetown University, provides an Experts Perspective of the rule and notes key implications states must consider when regulating AHPs.

In case you missed it, Atul Gawande was named the CEO of the new health care company led by Amazon, Berkshire Hathaway and JPMorgan Chase. He will oversee the company’s venture of addressing rising health care costs for the three companies combined workforce of more than 1 million employees. He will start his new role on July 9th. Updates follow.

  • California – The Board of Covered California, the state’s official health insurance marketplace, voted to adopt a $350 million budget for fiscal year 2019. The approved budget includes $107 million for marketing and outreach to promote enrollment and maintain a healthy mix of consumers. The board also elected Mike Wilkening, the new secretary of the California Health and Human Services Agency, to serve as chair.
  • Colorado – Connect for Health Colorado, the state’s official health insurance marketplace, released a request for proposals soliciting qualified entities able to provide a technical and operational solution to implement three different decision-support tools.
  • District of Columbia – The DC Health Benefit Exchange Authority, the official health insurance marketplace for the District, was awarded the Amazon Web Services Best Practices Award for the second time for the City on a Cloud Innovation Challenge. The Best Practices Award recognizes a local or regional government entity that has deployed an innovative solution to solve a government challenge.
  • Louisiana – The Department of Health announced the kick off of open enrollment for Healthy Louisiana, the state’s Medicaid managed care program, which runs through July 31, 2018. During open enrollment, enrollees have the opportunity to choose a new health plan or do nothing and remain with their current plan. There are five health plans that deliver physical and behavioral health care services to the nearly 1.5 million Healthy Louisiana enrollees.
  • Vermont – The Green Mountain Care Board, the state’s health care oversight authority, formed the Individual Mandate Working Group, the creation of which was stipulated in the individual mandate bill recently signed by Governor Phill Scott. The Working Group, which was convened for the first time last week, is charged with developing recommendations for the “administration and enforcement of the individual mandate.”

Practical Solutions that Lift Up Children and Families from Seven States

Ascend at the Aspen Institute is the national hub for breakthrough ideas and collaborations that move children and the adults in their lives to educational success, economic security, and health and well-being. States Leading the Way: Practical Solutions that Lift Up Children and Families is a new report published by Ascend that offers a bipartisan blueprint for state and local leaders looking to put families on a path out of poverty through a two-generation approach that focuses on both children and parents together. The report is part of Ascend’s Solutions Series and profiles successful strategies implemented by Democratic and Republican leaders in eight states: Colorado, Connecticut, Florida, Georgia, Maryland, Minnesota, Tennessee, and Utah.

How Two Medicaid Directors are Combatting Opioid Misuse

Our friends at the Center for Health Care Strategies have a blog post up that features a conversation with Tennessee and West Virginia’s Medicaid directors who share how they are creating synergies across state agencies to confront the opioid epidemic. In the post, Wendy Long, MD, TennCare Director and Deputy Commissioner, and Cynthia Beane, MSW, LCSW, Commissioner of the West Virginia Bureau for Medical Services, discuss how they are pioneering ways to combat their own states’ epidemics through cross-sector collaboration and relationship building, while carefully navigating the political complexities and challenges.

Improving Access to Care for Children under the Medicaid Managed Care Rule

Next month, states face new federal requirements for establishing and maintaining Medicaid managed care provider networks. In a recent blog post, our friends at the National Academy of State Health Policy describe how these new requirements may have implications for how children and youth with special health care needs (CYSHCN) can access care. The post summarizes how states provide managed care services to CYSHCN that are enrolled in Medicaid and highlights state examples of developing network adequacy standards and other strategies state Medicaid agencies and MCOs have used to ensure CYSHCN have access to specialty providers.