May 25, 2018: Updated CBO estimate of ACA costs; Developing the behavioral health workforce; Integrating health care and criminal justice data

This week the Congressional Budget Office (CBO) released updated estimates of their baseline projections of the federal costs for premium subsidies under the Affordable Care Act for the 2018 to 2028 period. A few key takeaways: CBO previously estimated that repealing the mandate would reduce coverage by 13 million in 2027 and has now revised its estimate to around 8.7 million. Furthermore, CBO estimates that premiums will be “about 10 percent higher in 2019″ because of the individual mandate repeal. For insights into CBO’s updated health insurance model, consider tuning in to a presentation on June 19 by CBO staff at the Bipartisan Policy Center which will be followed by a panel of budget and health care policy experts sharing their initial reactions to the proposed changes to the model.

In case you missed it, the Robert Wood Johnson Foundation published an article describing bright spots among states that use the federally-facilitated marketplace. Standout states include New Jersey, Montana, Kansas, and Alabama—states that have relatively low enrollment in grandfathered and transition plans and that employed a variant of the “silver loading” approach to pricing this year. Updates follow.

  • Colorado – Connect for Health Colorado, the state’s official health insurance marketplace, is developing a new eligibility system and has created a resource page about the new system and its roll out.
  • California – A new report, commissioned by the California Health Care Foundation, reviews California’s Medicaid rate-setting process and offers recommendations for adjusting that process to encourage health plan investments in benefits and services that improve care and lower costs.
  • Minnesota – Minnesota is requesting a five year 1115 Medicaid demonstration waiver to strengthen and reform the state’s substance abuse disorder delivery system. The state is seeking to test the impact of evidence-based provider referral arrangements and practices on improving SUD outcomes for Medicaid enrollees, while controlling projected Medicaid costs for SUD services in Minnesota. The federal public comment period is open through June 21, 2018.
  • New York – Governor Andrew M. Cuomo announced the launch of a new multi-agency effort to combat maternal depression. As part of the effort, the Department of Financial Services will require all New York commercial health insurance policies to cover maternal depression screenings, including screening for the mother under the child’s policy.
  • Texas – The Texas Health and Human Services Commission announced it is awarding up to $15 million in grant funds to 31 governmental entities and nonprofit organizations to provide mental health services to communities. Grants will fund community programs to expand treatment, promote recovery and improve quality of life for individuals with mental illness.
  • Vermont – Governor Phil Scott signed H 892 which will limit short-term health insurance plans to three months and make them non-renewable. In addition, the legislation also requires short-term plan issuers to submit their marketing materials to the Department of Financial Regulation for review and approval and provides the Department with the authority to set standards for association health plans.
  • Virginia – Governor Ralph Northam vetoed two bills related to promoting association health plans (SB934/935) and catastrophic health insurance (SB964). SB934/935 would have made technical changes to allow non-profit associations and their members to circumvent state and federal consumer protections. SB 964 would have directed the state to submit an application to the Centers for Medicare & Medicaid Services (CMS) to waive eligibility restrictions for catastrophic plans offered on the individual market.
  • Wisconsin – Seventeen counties and four tribes were awarded one-year grants totaling nearly $2.4 million from the Wisconsin Department of Health Services to provide treatment to individuals addicted to opioids. The counties and tribes receiving funding have the greatest unmet opioid-related treatment needs in the state based on wait times for services and the number of deaths from opioid overdoses.

Global Budgeting for Rural Hospitals

State Health and Value Strategies (SHVS) is cosponsoring, with the Milbank Memorial Fund, a Policy Academy on Global Budgeting for Rural Hospitals for states at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland on Wednesday, May 30. The event will be streamed live on the day of the event via webcast from 9:00 AM to 12:00 PM Eastern Time. The webcast will include representatives from Maryland and Pennsylvania, who will describe their experiences with implementing global budgets and a conversation with rural hospital CEOs, who will share their views from the front lines. Our colleague, and host of the Policy Academy meeting, Joshua Sharfstein, recently published an article that examines the results to date of global budgeting in Maryland.

Behavioral Health Integration and Workforce Development

The Millbank Memorial  Fund recently released an issue brief, in partnership with the Reforming States Group, based on interviews with state officials, on integrating behavioral health. The brief finds that to address behavioral health integration (BHI) workforce needs systematically, states need to dedicate and coordinate resources in three key areas: assessing BHI workforce needs; identifying the legal and policy barriers to practice to make BHI programs work more effectively; and aligning workforce development resources based on state priorities and effectiveness of programs to train and retain practitioners. The brief also includes case studies that illustrate how university-based research programs in Washington, Nebraska, and Michigan are addressing behavioral health integration workforce needs.

Integrating Health Care and Criminal Justice Data: Lessons from Camden, New Jersey
A new report by Harvard University’s Kennedy School describes findings from a study on the integration of health care and criminal justice data for people who cycle in and out of hospitals and police precincts in Camden, New Jersey. Researchers from the Camden Coalition of Healthcare Providers (the Coalition) integrated existing data sets and analyzed the experiences of people who showed an extreme number of contacts with both systems. By analyzing these cross-sector data, Coalition researchers found that a small number of Camden residents have an enormous and disproportionate impact on the health care and criminal justice sectors, neither of which is designed to address the underlying problems the individuals face. The report outlines the potential impact of integrated data analysis on public safety, public health, and public policy.