March 30, 2018: Coverage Options, 1115 Waivers, Consumer Support Tools

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

Insurance market technical experts at Georgetown’s Center on Health Insurance Reforms have produced a new report that examines how states regulate coverage arrangements that do not comply with the Affordable Care Act’s (ACA) individual health insurance market reforms. Sabrina Corlette, one of the report’s authors, recently authored an Expert Perspective and led a webinar for State Health and Value Strategies on the proposed rule on short-term limited duration insurance, one of the coverage options that do not comply with the ACA profiled in the report. Just a reminder that the deadline for submitting comments on the proposed rule is April 23. SHVS has been working with interested Departments of Insurance on the topic of short-term plans; for more information, please let me know. Updates follow.

  • Minnesota – The Minnesota Department of Human Services published a report, Medicaid Matters: The Impact of Minnesota’s Medicaid Program, that tells the story of Medicaid’s history in the state. It also provides a detailed snapshot of who is currently eligible and what services they receive and describes Medicaid’s impact on the state’s individual communities.
  • New Jersey — The proposed fiscal year 2019 budget released by Governor Murphy assumes coverage of curative Hepatitis C drugs for all Medicaid enrollees with a Hepatitis C diagnosis. The Department of Human Services will lift restrictions on who qualifies for treatment so that residents will no longer have to demonstrate signs of liver damage to qualify for new antiviral drugs that can cure hepatitis C but that are very expensive.
  • New York

o   The New York State Department of Health (DOH) published Medicaid Redesign Team Structural Roadmap: Roles and Responsibilities in a Value Based Payment World, the goal of which is to provide clarity on the roles and responsibilities of organizations in the “middle layer” of the health care system in New York. DOH hopes that the document will generate “community-wide conversations and significant feedback” and is currently seeking public comments on the paper.

o   The Bureau of Social Determinants of Health is launching a new initiative designed to identify new or existing ideas for how to effectively address the social determinants of health for Medicaid members across New York. On May 1 New York State DOH will release the request for innovation that will solicit proposals from community-based organizations to identify new strategies that could be deployed to assist health care providers address the social determinants of health.

  • Ohio – The Department of Medicaid released a white paper that outlines the transformation strategy for Ohio’s non-emergency medical transportation system (NEMT). Ohio will implement a state-level brokerage system, currently employed by 29 other states, and will contract with one or more third-party transportation brokers to manage NEMT services.
  • Texas — The Texas Health and Human Services Commission announced it is awarding $10 million in grant funds to 20 organizations across the state for phase three of the state’s Texas Veterans + Family Alliance grant program. The grants help expand and coordinate access to mental health and supportive services for veterans and their families. Examples of services include face-to-face counseling and tele-counseling in rural communities, continuity of care services to help veterans transition from military to civilian life, and transportation coordination to help veterans and families access mental health services.

Medicaid Section 1115 Waiver Trends in an Era of State Flexibility

The National Association of Medicaid Directors (NAMD) published an issue brief that identifies seven trends that are likely to surface in the next 12 to 24 months as Medicaid directors submit Section 1115 waivers to the Centers for Medicare & Medicaid Services (CMS). As NAMD explains, the Trump Administration has voiced its intent to support state flexibility in Medicaid, including through Section 1115 waivers. As the Administration’s parameters for state flexibility are taking shape, Medicaid Directors may have an opportunity to test new ways to improve the delivery of care, contain health care cost growth, and ensure the sustainability of Medicaid. The brief details recently approved new 1115 waiver concepts in addition to outlining the seven trends that Medicaid directors are currently pursuing or likely to pursue in the coming months.

Consumer Decision Support Tools in ACA State Marketplaces

Kathy Hempstead at the Robert Wood Johnson Foundation recently published an analysis of the progress states made in 2018 in implementing consumer support tools. Progress in 2018 includes the adoption of out-of-pocket cost calculators by the few remaining state-based Marketplaces (SBM) that didn’t have them and the near universal presence of provider and formulary lookup tools across SBMs. Kathy also found that states with State-Federal partnership and State-based federally supported marketplace status provide a considerable amount of information to consumers about marketplace plans and some, such as Illinois and New Mexico, have stepped up their efforts this year to compensate for federal reductions in outreach and advertising.

Rethinking Evaluation Strategies for Complex Care Programs

The Center for Health Care Strategies (CHCS) is hosting a webinar on April 9 that will review the merits and limitations of traditional complex care evaluation approaches, explore new ways to effectively evaluate these programs, and discuss the broader policy implications of evaluating complex care programs. The webinar is cosponsored by the CHCS’ Complex Care Innovation Lab and the National Center for Complex Health and Social Needs and is part of a quarterly series on complex care hosted by the Policy Committee of the National Center.