March 25 Update

In This Week’s Update:

  • Monitoring and Evaluating Section 1115 Waivers
  • State Updates: CO, ME, NJ, OH, TN, TX, & VA
  • County Health Rankings and Housing Costs
  • Strengthening Medicaid LTSS: A Toolkit for States
  • How Oregon Uses Systems-level Data



Monitoring and Evaluating Section 1115 Waivers

On the heels of federal guidance released for states applying for and evaluating Section 1115 demonstration waivers, Manatt Health, with support from the Robert Wood Johnson Foundation, published a new resource guide that examines monitoring and evaluation of work/community engagement demonstrations. The guide reviews the data assets and infrastructure necessary to support states and their researcher partners in robust monitoring and evaluation efforts.

State updates: CO, ME, NJ, OH, TN, TX, & VA

  • Colorado
    • The Department of Regulatory Agencies’ Division of Insurance released an actuarial study of a proposed reinsurance program for health insurance in the individual market. The study was commissioned by the Division to evaluate what premium decrease would result from the Colorado model for funding reinsurance, and to demonstrate the effectiveness of the model.
    • Connect for Health Colorado, the state’s official health insurance marketplace, released the 2019 Open Enrollment Report which shows that Coloradans who get financial help buying health insurance through Connect for Health Colorado are paying an average 14 percent less in “net premium,” what they pay after assistance, compared to the average net premium in 2018.
  • Maine – Governor Janet Mills signed into law a bill, LD 1 “An Act to Protect Health Care Coverage for Maine Families,” that codifies into state law the patient protections outlined in the Affordable Care Act (ACA) by ensuring no one with a pre-existing condition is denied coverage and prohibits charging seniors substantially higher rates due to age, in addition to other protections.
  • New Jersey – Governor Phil Murphy announced that New Jersey will move to a state-based exchange for the year 2021 and, as such, sent a Declaration Letter notifying the Centers for Medicare & Medicaid Services (CMS) of the state’s intent. In the announcement, the Murphy Administration is also proposing to secure the protections in the ACA by codifying major provisions of the federal law.
  • Ohio – CMS approved the state’s 1115 waiver request to implement work and community engagement requirements as a condition of Medicaid eligibility. Medicaid expansion enrollees will now need to demonstrate they work 20 hours per week or are engaged in other allowable activities, including job search, education and training, or community service.
  • Tennessee – TennCare launched a new Medicaid application processing system, TennCare Connect, including a web portal, call center, and internal computer system for eligibility determinations.
  • Texas – The Texas Health and Human Services Commission (HHSC) is developing the state’s first Intellectual and Developmental Disability (IDD) Strategic Plan and has posted the plan’s foundation online. The foundation is the first phase in the development of the full plan and aims to provide an initial understanding of the Texas system for people with IDD. HHSC has also updated its legislatively mandated five-year Statewide Behavioral Health Strategic Plan to address gaps in the mental health and substance use services system.
  • Virginia – Governor Ralph Northam signed Senate Bill 1693 and House Bill 2577, which expands access to adequate health insurance for individuals with autism. Current law only requires coverage be provided to individuals between ages two and ten and the legislation removes the age cap for autism coverage, expanding access to care for nearly 10,000 Virginians living with autism, including transition-age youth and adults. It will be effective beginning January 1, 2020.


Upcoming Webinar – Leveraging Multi-Payer Claims Databases for Value

Wednesday, March 27, 2019 from 3:00 to 4:00 p.m. ET

More states are leveraging multi-payer claims databases to better understand how their health care systems are operating and implementing data-driven decision-making. States may not be aware, however, of the strategies other states and organizations are adopting to leverage claims databases to support health care transformation goals. State Health and Value Strategies, in partnership with the Peterson Center on Healthcare, will host a webinar on the ways in which several states and one community organization are using their multi-payer claims databases. During the webinar, presenters from the state of Vermont and Rhode Island, as well as the Washington Health Alliance, will discuss how they are employing claims databases to enhance the value of care and will share lessons learned for those seeking to optimize their own databases.

Registration (required) at the following link:


Burden of Severe Housing Cost Tied to Poor Health

A new report by the Robert Wood Johnson Foundation’s County Health Rankings and Roadmaps program examines housing affordability by place and by race and finds that more than 1 in 10 households live with the burden of severe housing costs. Additionally, across and within counties, there are stark differences in affordability, depending on race, income, and zip code. In addition to the county-level data, the County Health Rankings & Roadmaps also feature a database of more than 400 evidence-informed strategies to support local policymakers as they take steps toward expanding opportunities and improving health.


Strengthening Medicaid Long-Term Services and Supports in an Evolving Policy Environment: A Toolkit for States

With support from the Milbank Memorial Fund and The SCAN Foundation, Manatt Health and the Center for Health Care Strategies released an updated toolkit that provides a menu of promising strategies and best practices for states to advance person-centered, cost-effective long-term services and supports (LTSS) options through their Medicaid programs. The updated toolkit includes changes to federal policy and state case studies based on new reforms and developments since December 2017. Additionally, the toolkit includes a brief for state policymakers that highlights actionable strategies for Medicaid agencies developing LTSS reforms to improve the quality of care and help contain program costs.


Maximizing System-Level Data to Address Health and Social Complexity in Children: Spotlight on Oregon

The Lucille Packard Foundation for Children’s Health is hosting a webinar April 2 on how Oregon uses systems-level data to identify children with health and social complexities to improve the quality of care in the state. Speakers will provide an overview of the statewide population-level health complexity findings and share how the data has been utilized by Oregon’s coordinated care organizations.