June 8, 2018: Latest Affordable Care Act legal action; New SHVS webinar on IMD exclusion waivers; Implementing the 6|18 initiative

The Affordable Care Act (ACA) is in the news this week with the announcement by the U.S. Department of Justice (DOJ) that it will not defend the ACA’s constitutionality and is siding with Texas and 19 other states in a lawsuit filed earlier this year. The lawsuit being pursued by Texas and other states claims that Congress’ decision to eliminate the ACA’s individual mandate penalty requires that all or some provisions of the law be ruled invalid. In a brief filed yesterday by the DOJ in response to the lawsuit, the administration argued that “this Court should hold that the ACA’s individual mandate will be unconstitutional as of January 1, 2019, and that the ACA’s guaranteed-issue and community-rating provisions are inseverable from the mandate.” For further analysis of the DOJ’s actions, check out this take in a Health Affairs blog post on the subject. Updates follow.

  • Maryland – The Maryland Health Benefit Exchange, the state’s official health insurance marketplace, submitted on behalf of the state its Section 1332 waiver application to implement a reinsurance program. We have updated our map with a link to the submitted application.
  • Oklahoma — The Oklahoma Health Care Authority (OHCA), Pharmacy Management Consultants (PMC)  and Amgen announced a new collaborative agreement that will use de-identified claims data to gain insights about medication adherence, missed diagnoses, heightened disease risk and other clinical indicators in Oklahoma’s Medicaid population.
  • Pennsylvania – Insurance Commissioner Jessica Altman announced that health insurance rates in Pennsylvania have moderated significantly, counter to the national trend. The health insurers that currently sell in Pennsylvania’s individual market will all stay in the market and filed plans for 2019 requesting aggregate statewide increases of 4.9 percent.
  • Rhode Island – The Market Stability Workgroup, convened by the Office of the Health Insurance Commissioner and HealthSource RI, published its key findings and recommendations. The report identifies near-term recommendations and further work to be undertaken to maintain the stability of Rhode Island’s health insurance markets.
  • Tennessee – TennCare, the state’s Medicaid program, submitted an application to CMS proposing to amend its TennCare demonstration to cover short-term substance use disorder treatment services in facilities that meet the definition of an institution for mental diseases (IMD). CMS is accepting public comments on the application through July 6.
  • Virginia – Governor Ralph Northam signed the state budget bill, and in so doing, made Virginia the 33rd state to adopt Medicaid expansion.
  • Washington – Washington Health Benefit Exchange, the state’s official health insurance marketplace, issued a statement regarding proposed 2019 health insurance rates for the state. In the statement, CEO Pam MacEwan said the Exchange was encouraged that the proposed 2019 individual rates will not increase as dramatically as what was experienced for 2018 and that every county will have access to coverage next year.
  • West Virginia – The West Virginia Department of Health and Human Resources (DHHR) announced the implementation of recently passed Senate Bill 273, which sets limitations on opioid prescriptions and authorizes a “nonopioid directive” patients can put in their medical files, formally notifying health care professionals they do not want to be prescribed or administered opioid medications. Also this week, DHHR publicized that efforts are underway to distribute naloxone statewide to emergency first responders. Senate Bill 272, effective this week, establishes that all first responders will carry naloxone subject to sufficient funding and supplies and be trained to reduce overdose deaths in West Virginia.

Upcoming Webinar – Save the Date!

Waivers of the Institutions for Mental Disease (IMD) Exclusion: Emerging Opportunities and Challenges

Thursday, June 21, 2018 12:30 to 1:30 p.m. ET

State Health and Value Strategies, together with technical assistance experts from Manatt Health, will host a webinar to discuss the status of state efforts to secure waivers to use federal Medicaid funding to provide care in Institutions for Mental Disease (IMD). The webinar will review the requirements states must meet to secure an IMD waiver; the status of requests and approvals; and issues and opportunities arising as states pursue and increasingly implement the IMD waiver. We will be joined by leadership from the New Jersey Department of Human Services, which received approval of its IMD waiver in October 2017 and is now in the implementation phase.

Registration (required) at the following link: https://rwjfevents.webex.com/rwjfevents/onstage/g.php?MTID=ee50b37f7ab9d0892a190d1a2656686e4

Resource Center for Implementing the 6|18 Initiative

Our friends at the Center for Health Care Strategies (CHCS) recently launched a resource center to advance implementation of the Centers for Disease Control and Prevention’s 6|18 Initiative by Medicaid, state and local health departments, and other payers and purchasers. The resource center builds on state technical assistance activities provided by CHCS and offers practical tools and state examples to guide stakeholders in spending smarter for healthier populations. The resources are targeted to help specific stakeholder groups (state Medicaid agencies, public health departments, or managed care organizations) plan, design, implement, and assess 6|18 – related prevention activities and are complemented by a collection of tools to help address the specific conditions within the 6|18 initiative.

Tracking 2019 Premium Changes on ACA Exchanges

The Kaiser Family Foundation released a new resource that tracks proposed 2019 marketplace premiums by state. The analysis looks at preliminary lowest-cost bronze and second lowest-cost silver premiums in the 50 states and the District of Columbia and notes that about 63 percent of marketplace enrollees are in silver plans this year and 29 percent are enrolled in bronze plans. The resource highlights data that show premiums before and after applying premium tax credits for a major city in each state with current public data. The authors note that as insurers set rates for 2019, they are taking into account repeal of the individual mandate penalty and the likely proliferation of short-term, limited duration health plans. Additionally, some insurers may be changing which plans are subject to increased premiums to compensate for the loss of cost-sharing reduction payments. The resource will continue to be updated as more data becomes publically available for additional states.

Addressing Housing and Health

With support from the Robert Wood Johnson Foundation, Health Affairs released a series of four briefs focused on the connection between housing and health. The first brief provides an overview of the literature, finding strong evidence that housing stability, quality, safety, and affordability all affect health outcomes, as do physical and social characteristics of neighborhoods. The brief provides high-level direction for future research and policy agendas. Three additional briefs take a closer look at specific challenges and potential interventions that policy makers, advocates and researchers are likely to confront when trying to improve health and well-being in collaboration with the housing sector. Those briefs specifically focus on examining housing mobility programs, inclusionary zoning policies, and low-income housing tax credits.