November 4 Update

In This Week’s Update:

  • Open Enrollment Began Last Week
  • State Updates: CA, GA, ID, NY, OR, TN & TX
  • Webinar: Standardizing Health Plan Benefit Design
  • Updated Navigator Resource Guide
  • Comparing Latest Estimates of Uninsured
  • Addressing Rural Health Care Needs


Open Enrollment Began Last Week

Last week marked the start of 2020 open enrollment, which runs through December 15. Premiums for the most popular plans on are down an average of four percent and coverage at the county level continues to improve, such that 28 states will have counties with more insurers compared to 2019. Last week’s What the Health? podcast (starts at 1:10) reviews the current state of the Affordable Care Act (ACA) marketplaces, discusses concerns about affordability, and analyzes how this year’s OEP might be affected by a ruling from a federal appeals court on the ACA. 


State Updates: CA, GA, ID, NY, OR, TN & TX

  • California – The Department of Health Care Services released a proposal for California Advancing and Innovating Medi-Cal (CalAIM), a multi-year initiative which calls for implementing broad delivery system, program and payment reforms across the Medi-Cal program. The major components of CalAIM build upon the outcomes of various pilots from previous federal waivers. The CalAIM proposal would replace the state’s Section 1115 and 1915(b) waivers, which are set to expire in 2020.
  • Georgia – The state released initial information about its Section 1332 waiver plan, which includes a reinsurance program and state-based subsidies. The complete draft application is scheduled to be released today.
  • Idaho – The state has requested a new five-year Section 1115 demonstration which would require beneficiaries who receive services through the Healthy Connections/Primary Care Case Management program to seek a referral from their primary care provider prior to receiving services or supplies from a family planning provider outside of their medical home. The federal public comment period is open through November 28, 2019.
  • New York – Having recently concluded a series of listening sessions, the New York Department of Health released a request for information to solicit information from vendors regarding electronic visit verification (EVV) solutions to assist the state in identifying EVV solutions that address and reflect input received from stakeholders and meet the EVV requirements.
  • Oregon – The Oregon Opioid Tapering Task Force approved clinical guidelines on opioid tapering. The guidelines build on the work of previous task forces that developed statewide opioid guidelines for chronic pain, acute pain, dentists, and pregnant women. The new clinical guidelines draw from available evidence, other federal and state guidelines, expert opinion, and public comment to inform clinical decisions, and encourage safe and compassionate prescribing and pain treatment statewide.
  • Tennessee – TennCare, the state’s Medicaid program, released a series of reports that detail results from the implementation of three Delivery System Transformation programs, Tennessee Health Link, Patient-Centered Medical Homes, and Episodes of Care. The findings profiled in the reports highlight how implementation of the Delivery System Transformation programs are driving improvements in the care received by TennCare members, as well as savings for Tennessee taxpayers. TennCare has also produced videos of two members who share how participating in Delivery System Transformation programs has improved their health (watch the videos here and here).
  • Texas – The Texas Health and Human Services Commission announced STAR+PLUS procurement awards. The STAR+PLUS programs integrates acute care with long-term services and supports for the aged, blind, or disabled population. Implementation will begin September 1, 2020, with contracts running for three years, with possible extension periods not to exceed a total of eight years.


Standardizing Health Plan Benefit Design in the Individual Market: Opportunities and Implications

Wednesday, November 6, 1:00 to 2:00 p.m. EST

State Health and Value Strategies will host a webinar on the opportunities for states to implement standardized benefit designs, either through their health insurance marketplace or as part of a public option plan. The webinar will explore issues to consider in developing standardized options, communicating with stakeholders, and leveraging standardized designs to improve affordability for enrollees and encourage maintenance of coverage. The webinar will also review the development of standardized designs through state-based marketplaces, their connection to public option proposals, operational requirements to improve the end-user experience, and data collection and analysis needs.

Registration (required) at the following link:


Navigator Resource Guide

Georgetown’s Center on Health Insurance Reforms has updated and improved their Navigator Resource Guide, which is designed to help marketplace Navigators and others assisting consumers with marketplace eligibility and enrollment. The Guide is a practical, hands-on resource with over 300 frequently asked questions (FAQs) on topics such as marketplace eligibility, premium and cost-sharing assistance, the individual mandate, and post-enrollment issues for individuals. It also provides answers to commonly asked questions for small businesses and individuals with employer-based coverage. This year’s Guide also includes a “What’s New in 2020” section. This new section includes critical information about the new policies for marketplace coverage in 2020 that could affect this year’s open enrollment.


Comparing the Latest National and State Insurance Estimates

The State Health Access Data Assistance Center (SHADAC) has updated and published its annual brief, Comparing Federal Surveys that Count the Uninsured, following the final release of new health insurance coverage estimates from the U.S. Census Bureau, the Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention. The brief contains the latest national and state uninsurance estimates from four major federal surveys—the American Community Survey (ACS), the Current Population Survey (CPS), the Medical Expenditure Panel Survey – Household Component (MEPS-HC), and the National Health Interview Survey (NHIS)—and also provides guidance on understanding variations between estimates across the different surveys.


Innovative Solutions to Addressing the Health Care Needs of Rural Populations

The National Institute for Health Care Management (NIHCM) Foundation is hosting a webinar on November 13 at 2:00 p.m. EST that will explore how leaders in rural health are leveraging the unique strengths of rural communities to develop and implement promising solutions to address the health disparities experienced by rural populations. Increasing urbanization is leaving behind an older, sicker, and poorer population in rural America that may struggle with social risk factors such as limited access to medical care and healthy food. These challenges contribute to rural-urban health inequities in rates of chronic conditions like obesity and diabetes. The webinar will explore the current rural health landscape and federal strategies to improve rural health, as well as innovative initiatives to respond to unmet social needs, address provider shortages, and expand telehealth.