Health Policy News Hosts Round Table Discussion of Public Option Programs

On October 9th, Health Policy News held the second event in our 2018 Fall Webinar Series. This webinar featured a round table discussion on the history of public options, and the various design and programmatic options available to states crafting such programs. The webinar summarized and updated information included in the HPN report released this past summer entitled “Revisiting the Public Option- Medicaid Buy-Ins.” The HPN team was joined by a buy-in expert from the PCG Health team, Ms. Lisa Lee, former Kentucky Medicaid Commissioner and CHIP Director. Ms. Lee brought decades of on-the-ground expertise to the round table discussion, and offered key insights and lessons learned to attendees.

If you were unable to attend or want to revisit the information presented, please review the slides here, and the State and Federal legislative activity chart below.

State Program Date Introduced Legislation Status
CT The HUSKY E Plan 3/7/2019 Raised Bill 5463 Referred to Committee on Human Services
An Act Concerning the Study of Health Insurance Options for Individuals Ineligible for Medicaid 5/3/2017 File No. 202
& HB 5463
Study Underway
MD Maryland Health Insurance Coverage Protection Commission – Medicaid Buy-in 2/18/2018 SB 878 Study Underway
MA Public Health Insurance Option 1/23/2017 S.618 Accompanied a study order
MN MinnesotaCare 1/9/2017 SF 58 Failed
NV Nevada Care Plan 3/20/2017 AB 374 Bill vetoed, study underway
NM Medicaid Buy-In Study 2/8/2018 SM003 Passed
WI BadgerCare Public Option 7/5/2017 AB 449 Failed

The presentation frequently referenced the work underway in the state of Nevada. In 2017, Nevada authorized a study of a public option buy-in program (SB 394) entitled the Nevada Care Plan. In April 2018, the workgroup released a Request for Information (RFI) asking health insurance issuers operating in Nevada to weigh in on their proposed ideas, as well as offer insights into benefits, costs, and other administrative considerations. The two options the state presented for input were:

  • Option A: Utilizing the collective purchasing power of the state to develop a product that all three state programs (Medicaid, Corrections and the Public Employees Benefit Program) could use;
  • Option B: Implementing a Medicaid buy-in for non-Medicaid eligible individuals, and individuals not eligible for federal subsidies through the state exchange.

The responses directed the state to consider how the design of any program would impact the market, including the impact on the risk pool. Issuers recommended that the state simplify the Medicaid eligibility determinations process and allow for longer eligibility periods in an effort to reduce churn, utilize federal waivers where applicable to support program innovation, and contain high cost drivers—including prescription drug costs. The insights from the statewide listening sessions and RFI responses will be used to draft a bill request highlighting legislative changes deemed necessary to support and establish the Nevada Care Plan. For those seeking to follow along with the progress to date or be notified of updates, Nevada is tracking and posting information on nvcareplan.com.

The HPN discussion of buy-in and public option programs was timely, as CMS announced new guidance on Children’s Health Insurance Program (CHIP) buy-in programs programs on October 5th. The State Health Official (SHO) letter was issued to outline the key provisions of the CHIP funding extension mechanisms: the Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act (“HEALTHY KIDS”) and the Advancing Chronic Care, Extenders and Social Services Act (“ACCESS”), hereinafter “the Acts.” This letter clarifies that state-funded, qualified CHIP look-alike programs must include a benefit package identical to or more generous than those provided by the state plan or waiver, and those claims may be included in a single or blended risk pool. As background, the letter restates that any state that funds CHIP buy-in programs without federal funding does not need to comply with certain Federal CHIP standards.

The Acts clarified that qualified CHIP look-alike programs will be considered Minimum Essential Coverage (MEC), applicable to taxable years beginning after December 31, 2017. With this change, states now must only demonstrate that coverage in the CHIP buy-in program is identical to coverage under the CHIP state child health plan for it to be considered MEC, whereas previously, coverage had to be commensurate with private health plans.

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