September 28 Update: Public charge proposed rule; new data source for examining life expectancy; state health care quality trends

This week began with the release of a proposed rule by the Department of Homeland Security (DHS) that seeks to change how DHS determines whether immigrants are dependent on the government for financial support. On Monday, October 1, State Health and Value Strategies hosted a webinar, facilitated by experts at Manatt Health, on the changes proposed by DHS in determining whether immigrants—when seeking admission to the United States, an extension of their stay, or status change to become a legal permanent resident—are “likely at any time to become a public charge,” which may put immigration status at risk, and the implications of the proposed rule for Medicaid. Updates follow.

  • California
    • Governor Jerry Brown signed SB 910 which prohibits the sale of short-term limited duration health insurance plans, in addition to SB 1375, which limits Association Health Plans.
    • Covered California was honored for its public policy research, studies and reports on the Patient Protection and Affordable Care Act at the PR News Platinum Awards, a national contest recognizing outstanding public relations efforts. The state’s official health insurance marketplace was recognized as the top organization in the External Publications category and received honorable mentions in three other categories.
  • Connecticut – Governor Daniel P. Malloy announced that the state will receive a $12.2 million grant from the Centers for Medicare & Medicaid Services (CMS) to support the development of a statewide health information exchange. The new grant follows $5 million in federal funding the state received in 2017 that facilitated health information exchange planning.
  • Florida – The Agency for Health Care Administration highlighted this week that beneficiaries are very satisfied with Florida Medicaid according to a survey of enrollees. Of the measures included in the survey, 71 percent showed improvement since the Medicaid managed care program’s first survey of enrollees in 2015.
  • Hawaii – CMS notified Hawaii of the amount of pass through funding the state will receive through its Section 1332 waiver for 2019. The waiver allows Hawaii to continue operations of its Prepaid Health Plan and waives the requirement that it operate a Small Business Health Options Program, as well as related provisions. As a reminder, SHVS has a map of Section 1332 waiver activity.
  • New Mexico – At the September 21 board meeting of beWellnm, New Mexico’s Health Insurance Exchange, the board of directors voted unanimously to transition to a state-based marketplace in 2020.
  • North Carolina – The North Carolina Department of Health and Human Services announced additional flexibilities to expand its efforts to ensure Medicaid and NC Health Choice services can be quickly delivered to those impacted by Hurricane Florence. These new flexibilities will help people in Medicaid receive care without disruption and give health care providers leeway to deliver services with fewer limits. NC Medicaid temporary provisions for those affected by Hurricane Florence address certain eligibility, enrollment, benefits and cost-sharing policies.
  • North Dakota – Insurance Commissioner Jon Godfread announced that he had presented findings from a study of the options available and potential impact of attempting to stabilize the individual health insurance market in North Dakota to the interim Health Care Reform Review Committee. The study identified two options for North Dakota: the creation of an invisible reinsurance pool and of a state-based plan to be sold by insurance companies.
  • South Carolina — The South Carolina Department of Health and Human Services (SCDHHS) reiterated it is committed to ensuring reimbursement for services rendered by qualified providers, in good faith, during the Hurricane Florence emergency response period. SCDHHS has implemented several emergency response provisions and flexibilities to ensure continued access to care for Healthy Connections Medicaid beneficiaries.

Upcoming Webinar

Measure Selection, Alignment and Performance Benchmarking: A New Resource for States
Friday, October 12, 2018 2:00 to 3:00 p.m. ET   

SHVS will host a webinar, facilitated by experts at Bailit Health, on a new suite of publicly available resources that support states in their measure selection, alignment and performance benchmarking efforts. The Buying Value Benchmark Repository builds upon the Buying Value Measure Selection Tool and is a downloadable database of non-HEDIS and modified HEDIS measures that states and regional health improvement collaboratives are using for reporting, payment or other purposes. During the webinar, technical experts from Bailit Health will provide an overview of the repository and discuss how states can both utilize the tool and contribute measures to it.
Registration (required) at the following link:

New Data Source Provides Insight into Life Expectancy Gaps

The Robert Wood Johnson Foundation shared the news of a new data resource, compiled by the United States Small-Area Life Expectancy Estimate Project (USALEEP), which makes available for the first time life expectancy at birth estimates down to the neighborhood level for virtually every community in America. USALEEP is a joint effort of the National Center for Health Statistics at the Centers for Disease Control, which prepared the data for release; the National Association for Public Health Information Systems, which gathered the vital statistics; and the Robert Wood Johnson Foundation, which funded the project. Existing county- and city-level data have helped policymakers understand how people live and where they die too early. However, higher-level data, by averaging across neighborhoods or communities, can mask gaps in opportunities for health from block to block, neighborhood to neighborhood. These new data are available to everyone via an easy-to-use interactive tool and policymakers can use these data to prioritize funding and policy change.

State-Specific Health Care Quality Trends: 2017 State Snapshots

The Agency for Healthcare Research and Quality (AHRQ) released this week its 2017 State Snapshots, a set of online dashboards that each year provide updated, detailed analyses of how each state, plus the District of Columbia, is performing in important areas of health care quality. State health care leaders and policymakers can use the data to review how their state performs according to achievable benchmarks. The resource identifies trends in health care quality and disparities—fundamental information that can inform ongoing efforts to address gaps in the quality of care and access to services. Data in the State Snapshots are drawn from AHRQ’s 2017 National Healthcare Quality and Disparities Report (QDR), also released this week with updated data. The QDR, a report mandated by Congress, provides a broader, national view of trends in health care quality.

Hospital Mergers and Public Accountability: How Two States are Employing Certificates of Public Advantage

A new report, published by our friends at Milbank Memorial Fund, explores how states are responding to the growing trend of hospital system mergers. As health care consolidation increases, policymakers have to reconcile growing evidence that most consolidations raise prices with the political pressure regulators face to approve these mergers. Some states have responded by issuing certificates of public advantage (COPAs), a legal mechanism through which they can approve mergers that reduce or eliminate competition in return for commitments to make public benefit investments and control health care cost growth. In effect, a COPA creates a state-monitored monopoly—or a public utility model of health care delivery. The report describes the experience of Tennessee and Virginia, who used their COPA laws to approve a large health system merger that spanned their state borders.