Category: All Posts

Health Policy News December Edition

Introduction As in years past, the primary focus of the December edition is highlighting some of the important topics we wrote about in 2018, while also foreshadowing policy trends that we believe will be of particular importance to states in 2019. Before many of you take a break to spend time with family and friends, ...

A Look at Two States’ Responses to the Association Health Plan Final Rule

Implementation of the new Federal Association Health Plan (AHP) Rule—and new options for associations seeking to offer health insurance coverage—is well underway. The new rule became effective for all fully-insured AHPs seeking to operate under the new rule in September, and will go into effect for existing self-insured AHPs seeking to operate under the new ...

Two Insurance Markets, Similar Stories to Tell

Massachusetts and New Hampshire held public meetings this past fall aimed at providing insights into the factors affecting health care costs in their respective states. The Massachusetts Health Policy Commission (HPC) held its sixth annual Cost Trend Hearing on October 16th and 17th. The New Hampshire Health Insurance Department (NHID) held its annual hearing at ...

A Preliminary Decision in the Newest Lawsuit Challenging the Affordable Care Act

On December 14th, a decision was published in the Texas v. U.S. case that challenged the validity of the Affordable Care Act (ACA). The case – which was brought by 20 states (“plaintiff states”) and later joined by two individual plaintiffs – contends that the “zeroing out” of the shared responsibility penalty through the 2017 ...

2018 Retrospective & Looking Forward to 2019

This past year brought increased flexibility for states related to both public health care programs and commercial health plans, with the Federal administration announcing numerous policies to give states more control over the design / regulation of the coverage offered to consumers. We saw first-of-their-kind waivers approved at the Federal level, including community engagement / ...

Early Lessons Learned from Implementing Community Engagement Requirements

Sixteen states have submitted Section 1115 Waivers to the Center for Medicare and Medicaid Services (CMS), requesting that a person’s eligibility to receive Medicaid be contingent on their participation in community engagement activities (also referred to as “work requirements”). States have flexibility to define the activities that would meet community engagement or work requirements, and ...

CMS Proposes Changes to the Regulations Governing Medicaid and CHIP Managed Care

On November 14, 2018, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule making changes to the Medicaid and Children’s Health Insurance Program (CHIP) Managed Care regulations. CMS had notified states in March 2017 that it was doing a thorough review of Medicaid and CHIP Managed Care regulations, which were last overhauled ...

CMS Issues Guidance on Medicaid Behavioral Health Delivery System Reform

On November 13, 2018, the Centers for Medicare and Medicaid Services (CMS) released a letter to State Medicaid directors outlining a wide range of opportunities for states to design innovative delivery systems for adults and children with serious mental health conditions. The CMS letter offers guidance on strategies to improve care for such individuals using ...

1115 Waiver Decisions issued by CMS

As we addressed in our report this past Spring, the use of Section 1115 Medicaid Waivers to address rising drug costs was a notable feature of the Federal administration’s recent drug proposal, and is an emerging policy trend.[1] The Federal administration’s 2019 budget proposes providing five states with Medicaid demonstration authority to test “drug coverage ...

Health Policy News October Edition

 Introduction This month’s edition of Health Policy News focuses on recent developments relative to drug policy, which has been an ever-growing focus at the State and Federal level. We continue our coverage of efforts relative to drug cost control with short summaries of recent decisions on Section 1115 Waivers submitted by Massachusetts and Oklahoma, and ...