November 11 Update

In This Week’s Update:

  • CMS Releases T-MSIS Data
  • Webinar: Standardized Designs Through State Marketplaces
  • State Updates: CO, DC, GA, IN, ME, NJ, OH, PA & UT
  • 2020 Marketplace Premium Changes by County
  • Impact of Medicaid Expansion on Premature Deaths
  • Practical Solutions for Serving Complex Populations


CMS Releases T-MSIS Data

Last week, the Centers for Medicare & Medicaid Services (CMS) announced the availability of new Medicaid and CHIP Transformed Medicaid Statistical Information System (T-MSIS) data. To facilitate research, CMS also released detailed T-MSIS Analytic Files (TAFs), as well as supplemental state-level data quality briefs and technical documentation that further explain the data. The release includes data from 2014, 2015, and 2016. TAFs for 2017 and 2018 are expected to be released in 2020.


Webinar: Standardized Designs Through State Marketplaces

Also last week, State Health and Value Strategies hosted a webinar on the opportunities for states to implement standardized health benefit designs. The webinar reviewed the development of standardized designs through state-based marketplaces, their connection to public option proposals, operational requirements, and data collection and analysis needs, and featured speakers from marketplaces in the District of Columbia, Massachusetts, and New York. You can view the slide deck and recording of the webinar on the SHVS website.


State Updates: CO, DC, GA, IN, ME, NJ, OH, PA & UT

  • Colorado – The state submitted a Section 1115 substance use disorder demonstration waiver application to provide services in residential and inpatient settings, otherwise known as Institutions of Mental Disease.
  • District of Columbia – The District of Columbia received federal approval for a Section 1115 waiver demonstration to expand behavioral health treatment services to individuals in short-term mental health facilities who are suffering from substance use disorder, serious mental illness, and/or serious emotional disturbance. The demonstration will allow D.C. to use federal funds to support community-based services designed to improve behavioral health care.
  • Georgia – Governor Brian Kemp released drafts of Section 1332 and Section 1115 waiver applications. The draft Section 1332 application proposes a two-phase approach: a state-based reinsurance program to begin in plan year 2021, followed by a transition to the Georgia Access model beginning in plan year 2022. The Georgia Access model would eliminate the use of, transitioning consumers to decentralized enrollment through private web-brokers and insurers. In its draft Section 1115 waiver, Georgia proposes to implement a partial Medicaid expansion that would increase eligibility up to 100 percent of poverty, require beneficiaries to pay a monthly premium, and implement work requirements. The state is seeking an enhanced federal match for the partial expansion.
  • Indiana – The Indiana Family and Social Services Administration announced that it will temporarily suspend the reporting requirements of the Gateway to Work program due to a pending legal challenge. Last month, the lawsuit Rose v. Azar was filed in federal court, challenging Gateway to Work along with several other components of the Healthy Indiana Plan.
  • Maine – Governor Janet Mills penned an op-ed in the Portland Press Herald celebrating the two-year anniversary of the successful Medicaid expansion referendum and highlighting how residents of the state now have better access to health care coverage.
  • New Jersey – Governor Phil Murphy, joined by Department of Banking and Insurance (DOBI) Commissioner Marlene Caride and enrollment assisters from across the state, announced Navigator grant awards totaling $1.1 million to provide enrollment assistance to residents shopping for health coverage during the six-week open enrollment window.
  • Ohio – The Ohio Department of Medicaid finalized and published the Unified Preferred Drug List in preparation for implementation beginning January 1, 2020. The new preferred drug list will result in all Ohio managed care plans using a standard drug list and the same prior authorization criteria.
  • Pennsylvania
    • The Pennsylvania Departments of Human Services (DHS) and Corrections (DOC) announced that all of the DOC state-run correctional facilities are now connected to the DHS Pennsylvania Patient & Provider Network (P3N). When an individual first enters a state-run correctional facility, that facility will access that person’s medical data via the P3N to review the treatments and services they received from health care providers prior to their incarceration.
    • Governor Tom Wolf and Insurance Commissioner Jessica Altman held a press conference during which they advised Pennsylvanians to buy health insurance on the federal exchange, This is the last enrollment period that Pennsylvania will rely on for health insurance plans: Governor Wolf signed a bill in July to create a state-based exchange that is expected to be operational in 2021. Governor Wolf also announced that the uninsured rate in the state is at 5.5 percent, the lowest on record for the state.
  • Utah – The state of Utah submitted an amendment to their Section 1115 demonstration, Primary Care Network. The amendment requests authority to receive enhanced match for the adult expansion population and cover beneficiaries with incomes up to 133 percent of the federal poverty level (FPL), and charge premiums to beneficiaries with incomes above 100 percent of the FPL, in addition to several other initiatives. The federal comment period is open through December 7, 2019.


How ACA Marketplace Premiums Are Changing by County in 2020

The Kaiser Family Foundation released a new analysis on how premiums are changing at the county-level both before and after subsidies in 2020. The analysis includes interactive maps that illustrate changes for lowest-cost bronze, silver, and gold plans across the country and found that premiums for ACA Marketplace benchmark silver plans are decreasing on average across the U.S. in 2020. Premium changes vary widely by location and by metal level, including premium increases in a number of counties and plans.


Impact of Medicaid Expansion on Premature Deaths

The Center on Budget and Policy Priorities published findings from a study examining the impacts of Medicaid expansion on low-income adults in preventing premature deaths. According to the study, state decisions to expand Medicaid saved the lives of at least 19,200 adults aged 55 to 64 over a four-year period from 2014 to 2017. Conversely, 15,600 older adults died prematurely because of state decisions not to expand Medicaid. The findings are consistent with a large body of research that has already documented that Medicaid expansion improves access to care and health outcomes. For example, research shows that Medicaid expansion increased the share of low-income adults using medications to control chronic conditions like heart disease and diabetes. The new study finds particularly clear evidence of a drop in mortality from conditions like these, which are amenable to medication and other treatment.


Practical Solutions for Serving Complex Populations

The Camden Coalition of Healthcare Providers, in partnership with the National Center for Complex Health and Social Needs and the Better Care Playbook, developed a series of four blog posts and accompanying practical information centered on local and national innovations to offer guidance on serving complex populations. Co-supported by the Robert Wood Johnson Foundation, the four-part series examines the Camden Coalition’s efforts to develop cross-sector partnerships between health care and social service agencies through data-sharing, build shared outcomes with community-based organizations, and use asset maps to match community supports for complex patients, and documents the Camden Coalition’s approach to patient engagement.