March 23, 2018: Spending Bill, Global Budgeting, Medicaid Waivers, Marketplace Premiums

Weekly updates on the latest state-level health care news from Heather Howard, program director of State Health and Value Strategies.

Today marks the eighth anniversary of the enactment of the Affordable Care Act (ACA). The ACA has proven to be resilient, and despite efforts to repeal and replace it over the past eight years, the law’s fundamental elements remain in effect. In other news today, President Trump signed into law the $1.3 trillion spending package. The omnibus bill does not include any funding to stabilize the Affordable Care Act individual markets, but it does include additional funding for the opioid crisis and mental health care. Updates follow.

  • Florida – The Agency for Health Care Administration announced a 30-day public notice and comment period through April 19, 2018 on their Medicaid 1115 Managed Medical Assistance Waiver. Two public meetings are scheduled, one in Tampa and one in Tallahassee.
  • Maryland – A new report issued by the Department of Health examines the results of Maryland’s All-Payer Hospital Model and finds that the state has seen reductions in hospital admissions and cost savings in the first three years of the model. The five-year initiative launched in 2014 holds hospitals accountable for the total cost of hospital care, effectively penalizing them for not finding less expensive outpatient alternatives.
  • Michigan – The Michigan Department of Health and Human Services awarded contracts for three regional pilot projects to fully financially integrate Medicaid physical and behavioral health benefits. The pilots will contract with the state and each Medicaid managed care organization in the relevant geographic area.
  • North Carolina – North Carolina Health and Human Services released three concept papers on specific subjects related to the proposed Medicaid and NC Health Choice managed care program design. One paper is a draft of the state’s Medicaid Managed Care Quality Strategy, while another is on Provider Health Plan Quality Performance and Accountability.
  • Pennsylvania – Law enforcement and human services officials are collaborating on a centralized repository, the Pennsylvania Overdose Information Network, to track overdoses, naloxone administrations, and investigative drug information that may be used by police, public safety, and healthcare professionals to better track and share all types of information related to opioid abuse in their communities.
  • Rhode Island – HealthSource RI, the state’s official health insurance Marketplace, reported this week that enrollment increased five percent this year, one of the largest increases in the country. HealthSource RI added 8,000 new enrollees, an increase of over 40 percent compared to the previous year. About 35 percent of new 2018 customers were individuals between the ages of 18 and 34, up from approximately 25 percent compared to HealthSource RI’s 2017 population.

Global Budgeting for Rural Hospitals State Policy Academy

Global budgeting is an innovative payment approach for rural hospitals that can enhance financial solvency and advance population health. Hospitals with global budgets know their revenues in advance of the year and so can concentrate on providing the services their communities need as well as on the prevention and management of chronic illness. Johns Hopkins University is hosting a State Policy Academy in collaboration with the Milbank Memorial Fund, the Robert Wood Johnson Foundation’s State Health and Value Strategies, and the National Rural Health Association to be held in Baltimore on May 30. The deadline to apply for the Policy Academy is week from today, Friday, March 30. Funding for the Policy Academy is provided by the Robert Wood Johnson Foundation and Milbank Memorial Fund. Participant travel expenses will be covered. Please review the webinar slides or the webinar recording and contact Publichealthpractice@jhu.edu with any questions about the application or the State Policy Academy.

Evaluating Medicaid Waivers

Anne Weiss at the Robert Wood Johnson Foundation has a blog post up this week on Health Affairs on the importance of ensuring that the lessons from state efforts to test policy and other similar efforts to reshape Medicaid are accurately captured by rigorous, timely evaluations. As Anne explains, as states experiment they would benefit from evidence regarding the effects of the new models they are implementing. The blog post lays out five principles for Medicaid waiver evaluations that stakeholders such as the Centers for Medicare & Medicaid Services, funders and the research community can adopt to further an understanding of the impact of potentially significant policies before they are adopted as legislative reforms.

Changes in Marketplace Premiums

The Urban Institute released a report this week that examines the changes in Marketplace premiums from 2017 to 2018. While Marketplace premiums increased nationwide, there was variation in and among states: Iowa experienced the largest increase in its lowest priced silver premium (117.5%), from $320 in 2017 to $695 in 2018 while Alaska had the largest decrease (-22.5%), from $901 in 2017 to $698 in 2018. The report found that more insurers exited markets than entered new markets in 2018, which reflects the uncertainty in the Marketplace. States with Medicaid managed care organizations and/or many competing insurers offering Marketplace coverage tended to have the lowest premiums. The report authors conclude that policy changes, insurer exits and uncertainty in the health insurance marketplace contributed to the premium increases.