September 3 Update

In This Week’s Update:

  • Health Equity Webinar Recap
  • Health Care Affordability Forum
  • State Updates: FL, ID, ME, PA, RI & VA
  • Public Charge Rule Webinar
  • Drivers of Health Literature Review
  • TennCare’s Episodes Payment Model


Health Equity Webinar Recap

Last week, State Health and Value Strategies hosted the third webinar in its series on health equity through managed care. During the webinar, Evidence-Based Strategies for Reducing Health Disparities, Dr. Marshall Chin from the University of Chicago shared five lessons to guide the design and implementation of efforts to address disparities. If you missed the webinar, the slides are available on the SHVS website, as well as a recording.


Health Care Affordability Forum

Also last week, SHVS Program Director Heather Howard participated in a forum in Portland, Maine on health care coverage and affordability convened by Governor Janet Mills. The panel was on how states are leveraging Section 1332 waivers to stabilize their markets and the potential of 1332 waivers to support state innovation. The presentations and a recording of the day’s proceedings, which included panels on health insurance marketplace options and controlling costs, are available here. 


State Updates: FL, ID, ME, PA, RI & VA

  • Florida – The state submitted a request to the Centers for Medicare & Medicaid Services (CMS) to amend its Section 1115(a) demonstration. Among the goals of the amendment is increasing the behavioral health and supportive housing assistance services annual enrollment limit. The federal public comment period will be open from Aug. 27, 2019 through Sept. 26, 2019.
  • Idaho – The state was notified in a letter from CMS that Idaho’s Section 1332 waiver application was deemed incomplete. Governor Little and legislative leaders issued a joint statement in response to CMS. Idaho’s was the last pending Section 1332 waiver application and SHVS has updated its map tracking Section 1332 waivers with a link to the letter from CMS.
  • Maine – Governor Janet Mills announced that Maine submitted a letter of intent to CMS indicating that the state will pursue a state-based health insurance marketplace using the federal website to enroll consumers for the 2021 health insurance plan year. She expects to introduce legislation to establish the details of the new state-based marketplace when the Legislature reconvenes in January and will be assessing additional options to make health insurance for small businesses more affordable.
  • Pennsylvania – Governor Tom Wolf announced the incoming leadership of the Pennsylvania Health Insurance Exchange Authority, the state-affiliated entity that will create, manage, and maintain Pennsylvania’s state-based health insurance marketplace. Four voting members are appointed by the governor, while one voting member each is appointed by the speaker of the house, the house minority leader, the senate pro tempore, and the senate minority leader.
  • Rhode Island
    • The state was notified by CMS that its Section 1332 application to create a reinsurance program was approved, bringing the total to 13 states with approved Section 1332 waivers, 12 of which are to support reinsurance programs.  
    • Zach Sherman, Director of HealthSource RI since 2015, is leaving the state’s health insurance marketplace and has accepted the position of Executive Director of the recently established Pennsylvania Health Insurance Exchange Authority.
  • Virginia
    • Governor Ralph Northam announced that Dr. Jennifer Lee, the Director of the Virginia Department of Medical Assistance Services, will step down effective Oct. 9 after leading the agency through the expansion of Medicaid. Governor Northam also announced Karen Kimsey, currently Chief Deputy Director, will serve as the new Director.
    • Virginia’s Framework for Addiction Analysis and Community Transformation (FAACT), a data-sharing platform designed to help the Commonwealth address the opioid crisis, will expand to the Roanoke Valley. FAACT began in 2017 as a collaboration between the Virginia Departments of Criminal Justice Services and Behavioral Health and Developmental Services to develop and implement a platform to share data across government agencies and local organizations.


Final Public Charge Rule: Analysis and Potential Implication

SHVS will host a webinar on the final public charge rule, facilitated by experts at Manatt Health, on Tuesday, Sept. 3 from 1:00-2:00 p.m. EST. Released on Aug. 12 by the Department of Homeland Security (DHS), the rule will go into effect beginning Oct. 15 and will change how DHS determines whether immigrants—when seeking admission to the U.S., an extension of their stay, or status change to become a legal permanent resident—are “likely at any time to become a public charge” (i.e., dependent on the government for financial support). The webinar will review the final rule, highlight changes from the proposed rule, and explore the rule’s potential impacts on consumers, states and providers. Speakers will highlight the key ways the proposed rule departs from current guidance, with a particular focus on the implications for Medicaid and other health-related public benefits.

Registration (required) at the following link: 


Drivers of Health: A Review of the Literature

Drivers of Health, the one-year research and education project aimed at improving understanding of the social determinants of health, funded by the Robert Wood Johnson Foundation, released a literature review of scholarly work on the drivers of health. The literature review provides an historical background on the work done in the last forty years to quantify the contributions of various factors to health and includes efforts to decompose health outcomes into several key determinants.


Paying for Episodes: Lessons from TennCare

Catalyst for Payment Reform’s podcast, Listening In (With Permission), features a discussion between Brooks Daverman, Chief Operating Officer of TennCare (Tennessee’s Medicaid program) and Catalyst for Payment Reform’s Suzanne Delbanco on the need for standard bundled payment definitions. During the podcast, Daverman and Delbanco draw on lessons learned from the Tennessee experience to explore how the payment method could be scaled nationwide. Spanning providers from small rural practices to large health systems and covering everything from maternity care to behavioral health conditions, TennCare’s episodes-of-care program serves as a national model for purchasers, vendors, and health plans alike.