May 11, 2018: Reducing the cost of prescription drugs; New rural health strategy; How states are addressing social determinants of health

Today President Trump gave a much anticipated speech on reducing the cost of prescriptions drugs and released American Patients First: The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs. The blueprint outlines actions that the Department of Health and Human Services (HHS) will take including advancing generics to increase competition and exploring changes to the Medicaid Drug Rebate Program rules. Also this week, the Centers for Medicare & Medicaid Services (CMS) released its Rural Health Strategy, an interagency effort that seeks to improve access and quality of care for rural Americans. Updates follow.

  • Illinois — The Illinois Department of Healthcare and Family Services received approval from CMS authorizing the state to receive federal financial participation for the Better Care Illinois Behavioral Health initiative that will provide a continuum of services to treat addictions to opioids, other substances and other health conditions.
  • Kansas – In a letter to the Acting Medicaid Director Jon Hamdorf, the CMS Administrator Seema Verma explained that while CMS is still reviewing Kansas’ request to extend their 1115 waiver demonstration KanCare, CMS will not approve the state’s request to impose lifetime limits on Medicaid benefits for eligible individuals.
  • Maine – The Bureau of Insurance submitted its Section 1332 waiver application this week to CMS. As always, we are tracking state action on 1332 waivers via our map.
  • North Dakota — The North Dakota Insurance Department announced that it is seeking to work with a consultant to perform actuarial and other analysis of state proposals to reform North Dakota’s individual health insurance market.
  • New Hampshire — CMS approved New Hampshire’s request for an amendment to its Section 1115 demonstration project. The state will begin implementation of the community engagement requirement added through the amendment no sooner than January 1, 2019.
  • Wisconsin
    • The state was notified this week that the Section 1332 waiver application it submitted to CMS was deemed complete. We have updated our map and included a link to the letter from CMS.
    • The Department of Health Services announced that it has awarded grants to nine local health departments for projects that promote local opioid harm prevention activities.
  • Utah — The Utah Department of Health is holding two public hearings, one today and one on May 17, to discuss proposed amendments to its 1115 Waiver, which includes a request for authority to implement Medicaid eligibility for adults age 19 to 64 with household incomes up to 95 percent of the federal poverty level.
  • Minnesota and New York – The U.S. Department of Health and Human Services (HHS) will pay New York $151 million and Minnesota $17 million for their Basic Health Programs (BHP). The New York Attorney General’s office released a statement announcing New York’s interim agreement with HHS.

Upcoming Webinar – Save the Date!

Medicaid Buy-In: State Options and Design Considerations

Tuesday, May 15, 2018 3:30 to 4:30 p.m. ET

In recent months, several proposals have been introduced at both the federal and state levels that would permit people above Medicaid eligibility levels to “buy in” to Medicaid or would leverage the Medicaid program to strengthen coverage across the individual market and Medicaid. In this webinar, the Robert Wood Johnson Foundation’s State Health and Value Strategies (SHVS) program, together with technical assistance experts from Manatt Health, will examine the central considerations that a state must take into account when developing a Medicaid buy-in proposal, the primary models for state-administered Medicaid buy-in proposals, and the administrative considerations and authorities needed for each model. The webinar will also review Section 1332 waiver authority and related deficit neutrality and pass-through funding implications that states will want to consider as they craft their buy-in proposals. We will also highlight states’ current efforts to develop buy-in initiatives.

Registration (required) at the following link:

New Rules to Expand Association Health Plans and How They Will Affect the Individual Market

In a new study published in The Actuary, our friend and colleague Sabrina Corlette from Georgetown’s Center on Health Insurance Reforms, with fellow authors Josh Hammerquist and Pete Nakahata, provides an overview of the federal and state regulatory framework for Association Health Plans (AHP) and quantifies the effects of an expansion of the AHP market on enrollment and the health of the risk pool in the Affordable Care Act-compliant individual market. Their examination includes projections of the effects both on- and off-exchange, and by type of plan. The Trump administration is expected to finalize rules expanding AHPs very soon.

Initiatives to Address Social Determinants of Health

Kaiser Family Foundation has a new issue brief that explores the growing number of initiatives to address the social determinants of health. Some of the initiatives detailed are policies and programs in non-health sectors that impact health and health equity, but the issue brief focuses primarily on efforts on the part of the health care system to address broader social and environmental factors that influence health. Federal and state initiatives, as well as efforts within Medicaid are profiled and provide helpful blueprints for states interested in learning more about the multiple strategies and funding mechanisms for addressing social determinants.