November 5 Update: Resources for a successful OEP; Engaging Medicaid beneficiaries; Scorecard on Payment Reform 2.0

Open enrollment has officially begun! To kick off the OEP season, Georgetown University just launched an updated Navigator Resource Guide last week. The guide provides information on recent policy changes, a list of enrollment tools for consumers and assistors, and answers to hundreds of frequently asked questions (FAQs), ranging from questions about eligibility for marketplace subsidies to post-enrollment issues and small employer coverage. In addition, Kaiser Family Foundation put together a list of over 300 FAQs for consumers, navigators, brokers and other assistors. The FAQs cover a wide range of topics, including the 2019 repeal of the individual mandate tax penalty and a new section on short-term health insurance policies. Updates follow.

  • Arizona – The Arizona Health Care Cost Containment System (AHCCCS) is seeking stakeholder and public input on the development and implementation of Differential Adjustment Payment (DAP) models for payments based on value for contract years ending 2020 and 2021. AHCCCS has used DAP models for several types of providers including hospitals, nursing facilities and physicians and has issued a Request for Information to solicit input on other types of models.
  • Colorado – The Department of Health Care Policy and Financing released a statement that it is reducing dental prescriptions for short-acting opioids and reducing the daily maximum Morphine Milligram Equivalent for Health First Colorado, Colorado’s Medicaid program, members effective November 15, 2018.
  • Montana – The Department of Public Health and Human Services launched an interactive online dashboard which provides a county-by-county snapshot of how Medicaid expansion is affecting health outcomes in Montana and provides data on enrollment as well as cancer, diabetes and hypertension screenings and diagnoses.
  • New Jersey
    • Governor Phil Murphy announced the launch of “Get Covered New Jersey,” a state public awareness campaign to promote the Affordable Care Act’s (ACA) 2019 open enrollment period. The campaign will promote health coverage options available to residents through the ACA marketplace and off the marketplace in the individual insurance market during open enrollment, as well as through the state’s NJFamilyCare program year-round.
    • The New Jersey Department of Banking and Insurance issued two bulletins, one regarding the federal expansion of association health plans, and another on the federal rule promoting longer use of short-term, limited-duration individual health insurance policies.
  • Oklahoma – The Oklahoma Health Care Authority, in partnership with the University of Oklahoma College of Medicine, is expanding the use of the Reach Out and Read program, which encourages families to read aloud together. The initiative will recruit SoonerCare (the state’s Medicaid program) providers to participate in Reach Out and Read, provide training, and offer assistance to improve the quality of the well-child visit in addition to encouraging developmental screenings during the well-child visit with free screening tools for providers and training on how to use them.
  • Oregon – The Oregon Health Authority announced the state is participating in the federally funded Justice Reinvestment Initiative and has formed the Behavioral Health Justice Reinvestment Steering Committee to focus on developing a statewide policy framework to support local governments in improving recidivism and health outcomes for people who repeatedly cycle through both the public safety and health systems.
  • Virginia – As of November 1, state agencies are accepting applications from adults newly eligible for health coverage under the Medicaid expansion. In a press release, Governor Ralph Northam encouraged “all Virginians to get acquainted with the new eligibility rules and learn how they and their family members qualify for access to quality health coverage.” Eligible adults will begin receiving services January 1, 2019.
  • Wisconsin – The Wisconsin Department of Health Services received approval from the Centers for Medicare and Medicaid Services to extend and amend the state’s Section 1115 demonstration waiver, known as the BadgerCare Reform demonstration waiver.

Upcoming Webinar – Save the Date!

The SUPPORT Act: New Tools for States to Address the Opioid Epidemic

Friday, November 16, 2018 12:00 to 1:00 p.m. ET

State Health and Value Strategies (SHVS) will host a webinar, with technical experts from Manatt Health, on H.R. 6, The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (the “SUPPORT Act”) which was signed into law on October 25. Most stakeholders agree that the bill is a significant step forward in addressing the opioid epidemic, reflecting a range of important policy changes such as initiatives to increase access to medication-assisted treatment (MAT), new grant, pilot and demonstration projects, and a series of changes to Medicaid and Medicare. During the webinar, experts from Manatt Health will review the major health provisions of the new law and implications for states.

Registration (required) at the following link:

Engaging Medicaid Beneficiaries to Ensure Services Are Designed to Meet Their Needs

A new blog post on the Robert Wood Johnson Foundation’s Culture of Health Blog shares practical, insightful suggestions from experts regarding how Medicaid can better engage patients in the policymaking and implementation process. The Foundation, along with the Center for Health Care Strategies, recently engaged experts, including representatives from across the patient advocacy world, on this topic and the findings from that work is discussed in the blog post. In addition to providing seven suggestions as to how Medicaid can more effectively engage patients, the blog post also profiles a specific initiative undertaken by Massachusetts.

Scorecard on Payment Reform 2.0: Results from Three State Pilots

Catalyst for Payment Reform (CPR) is hosting a free virtual summit on Scorecard 2.0, the goal of which is to help purchasers and other stakeholders in both the private and public sector track progress on payment reform, as well as identify any high-level indicators of its impact on the cost and quality of health care. CPR is piloting Scorecard 2.0 in three states–Colorado, New Jersey, and Virginia—and is helping stakeholders understand what’s happening with provider payment in their states and establish a benchmark to shed light on the impact payment reform has on cost and quality at a macro-level. The summit on November 29 will feature CPR program staff and the local sponsors of each Scorecard to go over the results and implications of the three state pilots.

State Individual Mandates: Hows and Whys

Jason Levitis has published a paper on enacting an individual mandate at the state level. The paper explains how the ACA and the Massachusetts law took similar but slightly different approaches to developing and implementing an individual mandate, and dives deeper into the key changes necessary to adapt the federal law for state legislation. Jason also discusses a range of policy options states may elect, including some specific provisions of the Massachusetts law. With Jason, SHVS has helped states, including the District of Columbia and New Jersey, consider and develop their own individual mandate. SHVS also has a template for states interested in implementing their own individual state mandate.