In This Week’s Update:

• CDC Report on Maternal Morbidity and Mortality
• State Updates: AR, CA, IA, IN, NE, NJ, NY & WA
• Upcoming SHVS Webinar on Serving Justice-involved Populations
• Individual Insurance Market Performance in 2018
• States Protect Against Short-Term Health Plans
• Health Care’s Role in Social Interventions

CDC Report on Maternal Morbidity and Mortality

Last week, the Centers for Disease Control and Prevention (CDC) released a new Vital Signs report detailing national maternal morbidity and mortality data. The findings are the result of a CDC analysis of 2011 to 2015 national data on pregnancy mortality and of 2013 to 2017 detailed data from 13 state maternal mortality review committees (MMRCs). According to the report, pregnancy-related deaths can occur up to a year after a woman gives birth – but whenever they occur, most of these deaths are preventable. Overall, heart disease and stroke caused more than one in three (34 percent) pregnancy-related deaths. The data also confirm persistent racial disparities: Black and American Indian/Alaska Native women were about three times as likely to die from a pregnancy-related cause as white women. The report includes a summary of potential prevention strategies from the 13 MMRCs. CDC also offers a number of resources for states interested in improving the quality of care for mothers and their babies, including funding state perinatal quality collaboratives and developing the CDC Levels of Care Assessment Tool to help states standardize their assessment of levels of maternal and newborn care for their delivery hospitals. Another report on community-based doula models highlights a strategy for addressing racial disparities in birth outcomes.

State Updates: AR, CA, IA, IN, NE, NJ, NY & WA

• Arkansas – The Department of Human Services is rescheduling open enrollment for the Provider-led Arkansas Shared Savings Entity (PASSE) program from May to October to give PASSEs more time to stabilize and grow their networks of providers. The postponement will also provide families with more information before they need to decide which entities will best meet their needs.
• California – The California Strategic Growth Council (SGC) unanimously adopted a racial equity action plan. The SGC comprises six Secretaries representing transportation, health, agriculture, housing, natural resources, and environment, as well as three appointed public members, and is chaired by the Director of the Governor’s Office of Planning and Research.
• Indiana – Governor Eric J. Holcomb signed a bill implementing two new initiatives aimed at reducing infant mortality: a navigator program to help guide high-risk pregnant women and a program to verbally screen all expectant mothers for substance-use disorder so those who need it will be connected to treatment.
• Iowa – Governor Kim Reynolds signed HF690, a bill that creates and funds a children’s mental health system. The legislation establishes required core services for children, regional crisis stabilization, mobile response teams, 24-hour hotline access to services, and $1.2 million for home and community-based children’s mental health services to eliminate the waiting list that currently exists.
• Nebraska – The Nebraska Department of Health and Human Services announced the release of requests for qualifications (RFQ) for potential providers of services funded through the Families First Prevention Services Act (FFPSA). The RFQ seeks qualified agencies and organizations to provide in-home parenting skills, substance abuse treatment and mental health services to children and families at imminent risk of an out-of-home removal and placement into foster care.
• New Jersey – Governor Phil Murphy signed a legislative package into law that seeks to improve maternal and infant health in New Jersey. The series of bills, which will support the efforts of the Administration’s Nurture NJ campaign, seeks to improve health outcomes for New Jersey’s mothers and babies, as well as address racial disparities in maternal and infant care.
• New York – NY State of Health, the state’s official health insurance marketplace, released detailed demographic data on the 4.7 million New Yorkers enrolled in health coverage through the close of the sixth open enrollment period on January 31, 2019. Marketplace enrollment increased 435,000 people from 2018 and Essential Plan and Qualified Health Plan enrollment now exceed 1 million people.
• Washington – Governor Jay Inslee signed four bills into law with the goal of transforming the state’s mental health system and reshaping how and where patients receive care. The bills will introduce more community-based facilities, establish a University of Washington behavioral health teaching hospital, ensure patients receive care closer to their support systems, and integrate to a more holistic model of behavioral health care for patients.

Upcoming Webinar – Emerging Strategies for Connecting Justice-Involved Populations to Medicaid Coverage and Care

Tuesday, June 18 from 1:00 to 2:00 p.m. ET

State Health and Value Strategies, in partnership with Manatt Health, is hosting a webinar for states that provides an overview of the opportunities available to connect justice-involved populations to Medicaid coverage and care. States are exploring opportunities to engage justice-involved populations–including juveniles and adults–in Medicaid coverage, case management and health care both immediately prior to and following their release from prison or jail. States’ interests are motivated by the high needs and high related health costs of these individuals–who are often eligible for Medicaid upon release, especially in states that have expanded Medicaid. Despite the current prohibition on drawing down federal Medicaid financing to fund health care for people while they are incarcerated, there are a number of strategies states can deploy to meaningfully connect justice-involved populations to critical coverage as well as medication and physical and behavioral health care services when re-entering the community. The webinar will provide an overview of Medicaid enrollment and suspension processes to make sure an individual has active Medicaid coverage and “in-reach” planning pre-release that helps with engagement and care management post-release.

Registration (required) at the following link: https://rwjfevents.webex.com/rwjfevents/onstage/g.php?MTID=e42f965edde2b482d11d5a773035d59c1

Individual Insurance Market Performance in 2018

A new issue brief by the Kaiser Family Foundation finds that individual market insurers saw better financial performance in 2018 than in all the earlier years of the Affordable Care Act (ACA) and returned to, or even exceeded, pre-ACA levels of profitability. The authors of the brief use financial data reported by insurance companies to the National Association of Insurance Commissioners and compiled by Mark Farrah Associates to look at the average premiums, claims, medical loss ratios, gross margins, and enrollee utilization from 2011 through 2018 in the individual insurance market, as well as the amount of medical loss ratio rebates insurers expect to issue to 2018 enrollees. These figures include coverage purchased through the ACA’s exchange marketplaces and ACA-compliant plans purchased directly from insurers outside the marketplaces (which are part of the same risk pool), as well as individual plans originally purchased before the ACA went into effect.

States Step Up to Protect Insurance Markets and Consumers from Short-Term Health Plans

The Commonwealth Fund published an issue brief that examines state activity around regulating short-term health insurance plans and includes tables detailing several policy options states may consider to protect consumers and safeguard individual health insurance markets. The brief summarizes specific policy options, such as banning the sale of short-term plans, instituting duration limits, and protecting coverage for people with pre-existing conditions, and offers perspectives and preliminary outcomes on the insurance markets in those states that have chosen to regulate or ban short-term plans.

Policy Principles to Guide Health Care’s Role in Social Interventions

Community Catalyst released a new document describing ten principles to guide efforts in the health care sphere to better address the social and economic determinants of poor health in ways that elevate and support patients and communities and achieve health justice. The principles build on existing efforts in the health care system and are meant to balance challenges and opportunities in aligning and coordinating efforts that span multiple sectors including housing, food, and transportation. The ten principles also address the role of structural racism and includes making reducing health disparities a core goal of efforts to address the social determinants of health.