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Federal and State Health Care Reform

8/20/19 - The Facts on Medicare Spending and Financing

By: Juliette Cubanski, Tricia Neuman and Meredith Freed

Medicare, the federal health insurance program for more than 60 million people ages 65 and over and younger people with long-term disabilities, helps to pay for hospital and physician visits, prescription drugs, and other acute and post-acute care services. This issue brief includes the most recent historical and projected Medicare spending data published in the 2019 annual report of the Boards of Medicare Trustees from the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary (OACT) and the 2019 Medicare baseline and projections from the Congressional Budget Office (CBO).
 

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07/09/19 - Kaiser Family Foundation - Federal Appeals Court Takes Up Case that Could Upend U.S. Health System

By Julie Rovner

The fate of the Affordable Care Act is again on the line Tuesday, as a federal appeals court in New Orleans takes up a case in which a lower court judge has already ruled the massive health law unconstitutional.

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7/3/19 – ICRC – Tips to Improve Medicare-Medicaid Integration Using D-SNPs: Integrating Medicaid Managed Long-Term Services and Supports into D-SNP Models of Care

By Rebecca Lester

Dual Eligible Special Needs Plans (D-SNPs) must develop a model of care (MOC) that describes their enrollees’ characteristics and health and service needs as well as the plan’s care coordination and health risk assessment processes. Despite the importance of Medicaid services to dually eligible enrollees, D-SNPs are only required to describe Medicare services in their MOCs. However, states may require D-SNPs to develop an integrated MOC that describes not just how Medicare services will be provided, but also how the plan will provide and/or coordinate Medicaid benefits. This tip sheet outlines the benefits of integrated MOCs, lists the steps in developing and implementing an integrated MOC, and provides examples of state-specific elements that Massachusetts and Minnesota require D-SNPs to include in their MOCs.

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7/3/19 – ICRC – Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, June 2018 – June 2019

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7/3/19 – Kaiser Family Foundation – Explaining Texas v. U.S.: A Guide to the 5th Circuit Appeal in the Lawsuit Challenging the Affordable Care Act

By MaryBeth Musumeci

On July 9, 2019, the U.S. Court of Appeals for the 5th Circuit will hear oral argument in Texas v. U.S., the next round of litigation challenging the Affordable Care Act (ACA). The appeals court is reviewing a federal trial court’s decision that the ACA’s minimum essential coverage provision (known as the individual mandate) is unconstitutional and, as a result, requires the entire ACA to be overturned. The individual mandate provides that most people must maintain a minimum level of health insurance coverage; those who do not do so must pay a financial penalty (known as the shared responsibility payment) to the IRS. The individual mandate was upheld as a constitutional exercise of Congress’ taxing power by a five member majority of the U.S. Supreme Court in NFIB v. Sebelius in 2012.

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Click here to view press release


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7/1/19 – Kaiser Family Foundation – HHS’s Proposed Changes to Non-Discrimination Regulations Under ACA Section 1557

By MaryBeth Musumeci, Jennifer Kates, Lindsey Dawson, Alina Salganicoff, Laurie Sobel, and Samantha Artiga

On June 14, 2019, the Department of Health and Human Services (HHS) proposed what it describes as “substantial revisions” to its regulations implementing Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination based on race, color, national origin, sex, age, and disability in health programs and activities receiving federal financial assistance. Notably, it is the first federal civil rights law to prohibit discrimination in health care based on sex. The 60-day public comment period on the proposed changes closes on August 13, 2019. The proposal cannot change Section 1557’s protections in the law enacted by Congress but would significantly narrow the scope of the existing HHS implementing regulations.

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6/25/19 – Kaiser Family Foundation – New Budget Boosts Health Coverage for Low-Income Californians

By Ana B. Ibarra

Ann Manganello survives entirely off her Social Security stipend: $1,391 a month.  That doesn’t amount to much in the pricey desert enclave of Palm Springs, Calif. — especially for someone who contends with a host of expensive medical problems, including a blood vessel disorder, complications from a recent stroke and frequent bouts of colitis.

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6/11/19 – The Commonwealth Fund – State Healthcare Scorecard Finds Deaths from Suicide, Alcohol, Drugs are a Regional Epidemic; Impact Varies Widely across States

Hawaii, Massachusetts, Minnesota, Washington, Connecticut, and Vermont rank at the top of the Commonwealth Fund’s 2019 Scorecard on State Health System Performance. The scorecard assesses all 50 states and the District of Columbia on 47 health care measures, covering access, quality, service use and costs of care, health outcomes, and income-based health care disparities. Arkansas, Nevada, Texas, Oklahoma, and Mississippi rank at the bottom in the report.

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Click here to view the full report


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5/24/19 – Kaiser Health News – The Opioid Epidemic and Medicaid’s Role in Facilitating Access to Treatment

By Kendal Orgera and Jennifer Tolbert

In 2017, nearly two million nonelderly adults in the United States had an opioid use disorder (OUD), and of these adults, nearly four in ten were covered by Medicaid. This brief examines Medicaid’s role in facilitating access to treatment for OUD.

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5/17/19 – Office of Inspector General – Four States Did Not Comply With Federal Waiver and State Requirements in Overseeing Adult Day Care Centers and Foster Care Homes

The four States did not comply with Federal waiver and State requirements in overseeing centers and homes. Our reviews found violations of health and safety and administrative requirements at 96 of the 100 centers and homes reviewed. Specifically, we found 1,141 instances of noncompliance with health and safety and administrative requirements.

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Click here to view report in brief


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5/16/19 – Office of Inspector General – Using Health IT for Care Coordination: Insights from Six Medicare Accountable Care Organizations

Overall, health information technology (health IT) tools have enabled the six Medicare accountable care organizations (ACOs) we visited to better coordinate patient care. (An ACO is a network of doctors, hospitals, or other healthcare providers that come together voluntarily to coordinate high-quality care for their patients.) ACOs that used a single electronic health record (EHR) system across their provider networks were able to share data in real time, enhancing providers’ ability to coordinate care. A small number of ACOs had access to robust health information exchanges, which give ACOs access to patient data even when patients see providers outside the ACOs’ networks. Most of the ACOs we visited used data analytics to inform their care coordination by identifying and grouping patients according to the potential severity and cost of their health conditions.

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5/13/19 Kaiser Family Foundation – Status of State Medicaid Expansion Decisions: Interactive Map

To date, 37 states (including DC) have adopted the Medicaid expansion and 14 states have not adopted the expansion. Current status for each state is based on KFF tracking and analysis of state expansion activity.

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Click here to view information in a table format


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5/09/19 – ASPE - Loss of Medicare-Medicaid Dual Eligible Status: Frequency, Contributing Factors and Implications

By Zhanlian Feng, Alison Vadnais, Emily Vreeland, Micahsegel, Abigail Ferrell, Joshua M. Weiner, and Bob Baker

This paper seeks to document the frequency of Medicaid coverage loss among full-benefit dual eligible beneficiaries and identify potential causes for coverage loss. For dual eligible beneficiaries, the loss of full-benefit Medicaid coverage is of concern because most of them do not have an alternative source of health insurance for the services covered by full-benefit Medicaid. For providers involved in the care of dual eligible beneficiaries, discontinuity in full-benefit Medicaid coverage may lead to disruption in care and adverse health outcomes.

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5/02/19 The Commonwealth Fund – States Step Up to Protect Insurance Markets and Consumers from Short-Term Health Plans

By Dania Palanker, Maanasa Kona and Emily Curran

Short-term health insurance plans are expected to siphon healthy individuals away from the ACA-compliant insurance market, causing higher premium rates in the individual market and leaving millions enrolled in coverage that excludes key services and financial protections.

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5/01/19 CHCS – Accelerating Value-Based Payment in California’s Federally Qualified Health Centers: Options for Medicaid Plans

By Greg Howe, Tricia McGinnis and Rob Houston

Leading-edge federally qualified health centers (FQHCs) and health plans in California are demonstrating interest in advanced payment models (APMs) aimed at providing greater flexibility for FQHCs to deliver care in innovative ways. Their joint goal is to improve quality and decrease the health care costs of their patients. With support from the California Health Care Foundation and Blue Shield of California Foundation, CHCS conducted interviews with 28 stakeholders in California and around the country to inform this report.

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4/30/19 – Kaiser Family Foundation – From Ballot Initiative to Waivers: What is the Status of Medicaid Expansion in Utah?

By MaryBeth Musumeci and Robin Rudowitz

Like Idaho and Nebraska, Utah voters supported a November 2018 ballot measure to adopt the full Medicaid expansion as set out in the Affordable Care Act (ACA). Utah voters approved a full ACA expansion to cover nearly all adults with income up to 138% of the federal poverty level (FPL, $17,236/year for an individual in 2019), an April 1, 2019 implementation date, and a state sales tax increase as the funding mechanism for the state’s share of expansion costs. By implementing a full ACA expansion, Utah would qualify for the substantially enhanced (93% in 2019 and 90% in 2020 and thereafter) federal matching funds. The expansion population in Utah includes childless adults ages 19-64 with income from 0 to 138% FPL and parent/caretakers ages 19-64 with income from 60% to 138% FPL. The fiscal note from the ballot initiative estimated that approximately 150,000 newly eligible individuals would enroll in Medicaid in fiscal year 2020. However, Utah is one of 11 states (out of the 21 states that allow state laws to be adopted via a ballot initiative) that have no restrictions on how soon or with what majority state legislators can repeal or amend voter initiated statutes.

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4/26/19 – Kaiser Family Foundation – Status of State Medicaid Expansion Decisions: Interactive Map

To date, 37 states (including DC) have adopted the Medicaid expansion and 14 states have not adopted the expansion. Current status for each state is based on KFF tracking and analysis of state expansion activity.

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Click here to view data in a table format


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4/15/19 – Kaiser Family Foundation – Uninsured Adults in States that Did Not Expand Who Would Become Eligible for Medicaid Under Expansion

Prior to the Affordable Care Act, Medicaid eligibility was limited to specific low-income groups, such as the elderly, people with disabilities, children, pregnant women, and some parents. The ACA expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($17,236 for an individual in 2019). As of April 2019, 14 states have not adopted the ACA Medicaid expansion. Across all non-expansion states, 4.4 million uninsured nonelderly adults would become eligible for Medicaid if all opted to expand their programs. The two-page fact sheets provide a snapshot with key data for those who would become eligible for Medicaid under expansion in non-expansion states.

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4/04/19 – The Commonwealth Fund – The Role of Medicaid Expansion in Care Delivery at Community Health Centers

By Corinne Lewis, Akeiisa Coleman, Melinda K. Abrams, and Michelle M. Doty

Community health centers provide comprehensive primary care to medically underserved communities, regardless of patients’ insurance status or ability to pay. Health centers have enjoyed bipartisan support for decades, because they provide affordable, cost-effective care for millions of Americans while saving the overall health care system money. When people gained insurance coverage under the Affordable Care Act (ACA), it was expected that reliance on health centers would increase. As a result, Congress doubled federal grant funding for centers and created incentives for clinicians to practice in them.

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4/03/19 – CHCS – Promising State Innovation Model Approaches for High-Priority Medicaid Populations: Three State Case Studies

By Anna Spencer, Maia Crawford and Colin Planalp

The State Innovation Models (SIM) initiative within the Center for Medicare and Medicaid Innovation is partnering with states to advance multi-payer health care payment and delivery system reform models. States participating in the SIM initiative have focused mainly on testing large-scale, statewide health care delivery and payment reform. Yet many states are also designing and testing smaller, more focused initiatives for high-need population subsets. This brief, coauthored by CHCS and the State Health Access Data Assistance Center, describes three promising, smaller-scale SIM initiatives: (1) Massachusetts Child Psychiatry Access Program; (2) Tennessee’s Quality Improvement in Long-Term Services and Supports initiative; and (3) Ohio’s Opioid Performance Measures approach. These pockets of state innovation can serve as valuable models for states looking to improve a particular aspect of their health systems.

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3/15/19 – Kaiser Family Foundation – Broker Websites Expand Health Plan Shopping Options While Glossing Over Details

By Julie Appleby

Some websites consumers use to buy their own health insurance don’t provide full information on plan choices or Medicaid eligibility, and appear to encourage selection of less comprehensive coverage that provides higher commissions to brokers, according to a report released Friday by the left-leaning Center on Budget and Policy Priorities.

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3/11/19 – The Commonwealth Fund – Where do U.S. Health Reform Proposals Fall on the Medicare-for-All Continuum?

The health care debate in the 2020 presidential campaign so far has largely focused on Democratic candidates' support for "Medicare for all," or a national health insurance program.

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3/01/19 – Kaiser Family Foundation – KFF Health Tracking Poll: The Public’s Views on the ACA

The public has remained deeply divided on the health reform law since it was passed in March 2010. Click below to examine how specific groups feel about the law and how those opinions have changed or not changed over time.

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2/27/19 – ASPE - Assessing the Impact of Parity in the Large Group Employer-Sponsored Insurance Market: Final Report

This study assessed the impact of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) on the private, large group employer-sponsored insurance market. The impact of MHPAEA on mental health (MH) and substance use disorder (SUD) utilization and spending outcomes was assessed using interrupted time series regression analysis, focusing on outpatient services. In lieu of a control group, we compared MH and SUD services with non-behavioral health services. MHPAEA had significant and positive effects on any use of SUD services and the frequency of SUD services used. Increases in insurer and enrollee spending on SUD outpatient services were driven by increased utilization, and not enrollee cost sharing. When examined separately, similar effects were found for both opioid use disorder (OUD) and non-OUD SUD services, supporting the conclusion that effects can be attributed to parity and not to general trends related to the OUD crisis. Although MHPAEA had similar positive impacts on utilization of and spending on MH outpatient services, these effects were more moderate. MHPAEA led to a dramatic shift toward out-of-network spending for SUD outpatient services. In secondary analyses, we examined the impact of parity on three subgroups: individuals with serious mental illness, those with OUD, and high utilizers of behavioral health services. The effects on use and spending outcomes in these secondary analyses were consistent with overall findings. Sensitivity analyses were conducted by including only continuously contributing employers, which produced very similar results. Finally, the analyses provide evidence that the effects of parity on outpatient services were continuing up until the study end date of September 30, 2015, particularly for SUD services.

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2/19/19 – CHCS – Using Health Homes to Integrate Care for Dually Eligible Individuals: Washington State’s Experiences

By Nancy Archibald, Kathy Moses and Lauren Rava

To provide more integrated, coordinated care for its residents who are dually eligible for Medicare and Medicaid, Washington State is operating a demonstration under the Financial Alignment Initiative offered by the Centers for Medicare & Medicaid Services. This case study describes: (1) the demonstration’s structure; (2) results achieved to date; and (3) insights on the demonstration’s implementation from the state and other stakeholders.

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2/12/19 – ASPE – Use of Medication-Assisted Treatment for Opioid Use Disorders in Employer-Sponsored Health Insurance: Final Report

This project assessed changes in Opioid Use Disorder (OUD) treatment utilization and expenditures in the employer-sponsored private health insurance market at two timepoints, 2006-2007 and 2014-2015, that mark the periods before and after implementation of the Mental Health Parity and Addiction Equity Act, the Patient Protection and Affordable Care Act, and the introduction and expanded use of new opioid treatment medications.

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2/7/19 – The Commonwealth Fund – Health Insurance Coverage Eight Years after the ACA

Fewer Uninsured Americans and Shorter Coverage Gaps, But More Underinsured

By Sara R. Collins, Herman K. Bhupal and Michelle M. Doty

What does health insurance coverage look like for Americans today, more than eight years after the Affordable Care Act’s passage? In this brief, we present findings from the Commonwealth Fund’s latest Biennial Health Insurance Survey to assess the extent and quality of coverage for U.S. working-age adults. Conducted since 2001, the survey uses three measures to gauge the adequacy of people’s coverage.

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2/06/19 – ICRC – Monthly Enrollment in Medicare-Medicaid Plans by Plan and State, January 2018 to January 2019

This resource reports data on the most recent 12 months of enrollment in the capitated model financial alignment demonstrations.

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1/04/19 – Kaiser Family Foundation – Status of State Medicaid Expansion Decisions: Interactive Map

To date, 37 states (including DC) have adopted the Medicaid expansion and 14 states have not adopted the expansion. Current status for each state is based on KFF tracking and analysis of state expansion activity.

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Click here to view data in a table format


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1/03/19 – Kaiser Family Foundation – Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State

This page aggregates tracking information on pending and approved Section 1115 Medicaid waivers. Scroll down or click on the links below to jump to resources such as an overview map and figure, detailed waiver topic tables, and explanatory briefs.

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12/11/18 – Kaiser Family Foundation – 4.2 Million Uninsured People Could Get a Bronze Plan in the ACA Marketplace with $0 Premiums After Tax Credits

But High Deductibles Mean Consumers Might Be Better Off Paying More in Premiums for a Silver Plan That Offers Cost-Sharing Help

As the Affordable Care Act’s open enrollment period nears an end in most areas this week, a new analysis from KFF (the Kaiser Family Foundation) finds that 4.2 million currently uninsured people could get a bronze-level plan for 2019 and pay nothing in premiums after factoring in tax credits.

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Click here to view the analysis


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12/10/18 – Kaiser Family Foundation – New Rules for Section 1332 Waivers: Changes and Implications

By Jennifer Tolbert and Karen Pollitz

On October 22, 2018, the Trump administration released new guidance on Section 1332 waivers established by the Affordable Care Act (ACA). This replaced earlier guidance released in 2015 and substantially changed the standards for evaluating waiver applications. While waiver activity to date has been limited and mostly used to implement state reinsurance programs to help reduce the cost of ACA-compliant individual market policies, the new guidance may encourage states to use 1332 waiver authority to make broader changes to insurance coverage for their residents, including to promote the sale of, and apply subsidies to, ACA non-compliant policies. On November 29, 2018, the Centers for Medicare and Medicaid Services (CMS) released a discussion paper outlining a set of waiver concepts designed to provide states with a roadmap for developing waiver applications that use the flexibility granted under the new guidance. This issue brief describes the new guidance, highlighting key changes from the 2015 guidance, describes how state waiver activity may change, particularly in light of the waiver concepts put forward by CMS, and discusses possible implications of the changes.

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12/07/18 – The Commonwealth Fund – New State-by-State Report: Employer Health Insurance Costs Are Growing Burden for Families, Especially in the South; Workers’ Premium Contributions and Deductibles Grew in 2017

Commonwealth Fund Shows Eliminating ACA’s Family Insurance Glitch and Other Measures, Could Reduce Cost Burden for Millions

Key findings from the Commonwealth Fund report The Cost of Employer Insurance Is a Growing Burden for Middle-Income Families, released today.

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11/26/18 – Kaiser Family Foundation - Some Can Get Marketplace Plans With No Premiums,Though With Higher Deductibles and Cost-Sharing

Many low-income consumers who are eligible for federal financial help under the Affordable Care Act can get a bronze-level plan and pay nothing out-of-pocket in premiums in more than 2,000 counties next year, depending on their annual income, according to a new analysis from KFF (the Kaiser Family Foundation). Such plans come with higher deductibles and out-of-pocket maximums, however.

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Click here to view analysis


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11/23/18 – Kaiser Family Foundation - Health Insurance Wastelands, Rosier Options Crop Up For 2019

By Jordan Rau

In recent years, places such as Memphis and Phoenix had withered into health insurance wastelands as insurers fled and premiums skyrocketed in the insurance marketplaces set up by the Affordable Care Act. But today, as in many parts of the country, these two cities are experiencing something unprecedented: Premiums are sinking and choices are sprouting.

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10/30/18 – Kaiser Family Foundation - With One Hand, Administration Boosts ACA Marketplaces, Weakens Them With Another

By Julie Appleby

In the span of less than 12 hours last week, the Trump administration took two seemingly contradictory actions that could have profound effects on the insurance marketplaces set up by the Affordable Care Act.

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10/1/18 – The Commonwealth Fund – The Affordable Care Act’s Impact on Small Business

By David Chase and John Arensmeyer

Small-business owners have seen significant gains in health care coverage for themselves and their employees thanks to the Affordable Care Act. Though efforts to repeal the law failed in 2017, the current administration continues to take steps that undermine the law’s progress. In recent months, new rules have been announced that allow more groups to establish association health plans and extend the length of short-term health insurance plans. These changes are likely to impact the stability of the marketplaces and coverage rates for the small-business community.

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10/1/18 – ICRC - Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, September 2017 to September 2018

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9/18/18 – The Commonwealth Fund - Study: State-Level Individual Mandates Would Reduce Number of Uninsured by Nearly 4 Million in 2019; Health Plan Premiums Would Fall 12 Percent

Montana, West Virginia, North Dakota, and Kentucky would see the largest percentage increases in coverage

Close to 4 million Americans would gain health insurance, and premium costs would drop an average of nearly 12 percent, if every state joined Massachusetts and New Jersey in enacting state-level individual mandates. These mandates would replace the Affordable Care Act’s (ACA) penalty for not having health insurance, a fee that Congress eliminated, effective 2019. That’s according to a new Commonwealth Fund/Urban Institute report by the Urban Institute’s Linda Blumberg, Matthew Buettgens, and John Holahan examining what would happen if all states adopted their own individual insurance mandates.

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Click here to view full article


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9/4/18 – Kaiser Health News – A Texas Lawsuit Being Heard This Week Could Mean Life or Death for the ACA

By Julie Rovner

Wednesday is looking like yet another pivotal day in the life-or-death saga that has marked the history of the Affordable Care Act.

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8/30/18 – MedPAC Comment on CMS’s Proposed Rule on the CY 2019 Home Health PPS Update and 2020 Case Mix Refinements

The Medicare Payment Advisory Commission (MedPAC) appreciates the opportunity to submit comments on the Centers for Medicare & Medicaid Services’ (CMS) proposed rule entitled “Medicare and Medicaid Programs; CY2019 home health prospective payment system rate update and 2020 case-mix adjustment methodology refinements; home health value-based purchasing model; home health quality reporting requirements; home infusion therapy requirements; and training requirements for surveyors of national accrediting organizations,” Federal Register, vol. 83, no. 134, p. 32340 (July 12, 2018). We appreciate your staff’s efforts to administer and improve the Medicare program for beneficiaries and providers, particularly given the considerable demands on the agency. 

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8/17/18 – Kaiser Family Foundation – Tracking Section 1332 State Innovation Waivers

Through Section 1332 of the Affordable Care Act (ACA), states may apply for innovation waivers to alter key ACA requirements in the individual and small group insurance markets. States can use the flexibility granted by 1332 waiver authority to shore up fragile insurance markets, address unique state insurance market issues, or experiment with alternative models of providing coverage to state residents. As states explore ways to address access and affordability issues in their individual and small group markets, they are increasingly turning to 1332 waivers.

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8/7/18 – ICRC - Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, July 2017 to July 2018

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8/6/18 – Kaiser Health News – Medicaid Expansion Making Diabetes Meds More Accessible to Poor, Study Shows

By Pauline Bartolone

Low-income people with diabetes are better able to afford their medications and manage their disease in states that expanded Medicaid under the Affordable Care Act, a new study suggests.

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7/31/18 – Kaiser Family Foundation – Enrollment in the Individual Insurance Market Continued to Fall in the First Quarter of 2018, With the 12 Percent Overall Decline Concentrated in Off-Exchange Plans

Enrollment in the individual insurance market continued to shrink in the first quarter of 2018, declining by 12 percent compared to the first quarter of 2017, according to a new analysis from the Kaiser Family Foundation. The decline was concentrated in off-exchange plans where enrollees are not eligible for Affordable Care Act subsidies and have had to pay the full cost of recent premium increases.

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Click here to view the analysis


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7/19/18 – Kaiser Health News – California’s ACA Rates to Rise 8.7% Next Year

By Chad Terhune and Pauline Bartolone

Premiums in California’s health insurance exchange will rise by an average of 8.7 percent next year, marking a return to more modest increases despite ongoing threats to the Affordable Care Act.

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06/20/18 – ICRC - Tips to Improve Medicare-Medicaid Integration Using D-SNPs: Designing an Integrated Summary of Benefits Document

By Erin Weir Lakhmani

States are increasingly contracting with Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) to better integrate Medicare and Medicaid benefits for dually eligible enrollees in order to increase care coordination and improve beneficiaries’ experience of care. D-SNPs whose enrollees are also enrolled in aligned Medicaid managed care (MMC) or managed long-term services and supports (MLTSS) plans can receive their Medicare and Medicaid benefits in a seamless, coordinated manner.1 In these arrangements, member materials that describe both Medicare and Medicaid benefits in an integrated, understandable way are an important component in improving the beneficiary experience. States can start to improve member materials by using contractual requirements to ensure that Medicare and Medicaid benefit information for aligned plans is incorporated into a single, streamlined Summary of Benefits (SB) document.

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06/20/18 – ICRC - Facilitating Access to Medicaid Durable Medical Equipment for Dually Eligible Beneficiaries in the Fee-for-Service System: Three State Approaches

By Paul Montebello

Beneficiaries who are dually eligible for Medicare and Medicaid often experience difficulties accessing durable medical equipment (DME), such as wheelchairs, in a timely manner. Whether Medicare or Medicaid covers a specific item may be unclear. Medicaid usually is the “payer of last resort,” which means that DME suppliers generally must obtain a Medicare denial before Medicaid will pay. For higher cost items, waiting for a Medicare denial can create an access problem, especially for lower-income beneficiaries. To address this issue, some states, such as Illinois, California, and Connecticut, have developed procedures for provisional prior authorization from Medicaid for such items. States may supplement these procedures by posting lists of DME items that Medicare consistently denies as non covered, and allow DME suppliers to bill Medicaid directly for these items without first billing Medicare. This can make it more likely that suppliers will provide DME to dually eligible beneficiaries in a timely way, with less confusion and uncertainty about who will pay and when.

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06/05/18 – ICRC - How States Can Better Understand their Dually Eligible Beneficiaries: A Guide to Using CMS Data Resources

By Danielle Chelminsky

The Centers for Medicare & Medicaid Services (CMS) Medicare-Medicaid Coordination Office (MMCO) regularly reports data on Medicare-Medicaid dually eligible beneficiary demographics, service utilization, spending, and other characteristics that can give states a more comprehensive view of this population. States can use these data to design, develop, monitor, and improve programs in their state to better meet the specific needs of dually eligible beneficiaries. This technical assistance tool shows states how to use these data to create tables, graphs, and figures and interpret their meaning for a wider audience of stakeholders. Using data effectively can help state decision makers and external stakeholders to better understand dually eligible beneficiaries in their state and improve the programs that serve them.

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06/05/18 – ICRC - Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, May 2017 to May 2018

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05/09/18 – ICRC - Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, April 2017 to April 2018

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05/09/18 – ICRC – Tips to Improve Medicare-Medicaid Integration Using D-SNPs: Promoting Aligned Enrollment

By Erin Weir Lakhmani, Mathematica Policy Research and Alexandra Kruse, Center for Health Care Strategies

States are increasingly seeking ways to better integrate care for people dually eligible for Medicare and Medicaid, who are among the highest need and most expensive populations in either program due to a high prevalence of multiple chronic conditions, physical and behavioral health disabilities, and need for long-term services and supports (LTSS).1 A good option for states looking to integrate care for dually eligible beneficiaries is to use contracting strategies that maximize the opportunity for Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) and Medicaid managed care (MMC) plans to have aligned
enrollment—the beneficiary is enrolled in a D-SNP and MMC offered by the same parent company in the same geographic area (aligned plans).
 

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05/08/18 – Kaiser Health News - How The Farm Bill Could Erode Part Of The ACA

By Julie Appleby

Some Republican lawmakers continue to try to work around the federal health law’s requirements. That strategy can crop up in surprising places. Like the farm bill.

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03/29/18 – Kaiser Family Foundation – State and Federal Contraceptive Coverage Requirements: Implications for Women and Employers

By Laurie Sobel, Alina Salganicoff and Ivette Gomez

Contraceptive Coverage under the Affordable Care Act (ACA) has made access to the full range of contraceptive methods affordable to millions of women. Since it was first issued in 2012, this provision has been controversial and has been the focus of two major cases that have reached the Supreme Court. Following the Hobby Lobby ruling, the Obama Administration took the stand that almost all women had an entitlement to the contraceptive benefit and developed an “accommodation” to assure they would still get coverage, even if their employer had religious objections to contraception. The Trump Administration, in contrast, has prioritized the rights of employers, and in October 2017, issued regulations that significantly broadened the exemption to nearly any employer with a religious or moral objection. The new regulations have been challenged by 8 states and have been blocked from being implemented pending the outcome of the litigation.

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03/28/18 – Kaiser Family Foundation – The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review

By Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artiga

A substantial body of research has investigated effects of the Medicaid expansion under the Affordable Care Act (ACA) on coverage; access to care, utilization, affordability, and health outcomes; and various economic measures. This issue brief summarizes findings from 202 studies of the impact of state Medicaid expansions under the ACA published beginning in January 2014 (when the coverage provisions of the ACA went into effect) and updates earlier versions of this brief with studies through February 2018.1 More recent studies continue to support earlier findings but provide additional findings in key areas, including expansion’s effects on health outcomes, access to services and medications for behavioral health and other needs, and providers’ financial stability.

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Click here to view appendix


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03/21/18 – The Commonwealth Fund – How Did State-Run Health Insurance Marketplaces Fare in 2017

By Justin Giovannelli and Emily Curran

Issue: Sixteen states and the District of Columbia manage their own health insurance marketplaces under the Affordable Care Act. These states, which were broadly supportive of health reform, chose to run their marketplaces to exert greater control over their insurance markets and tailor the portals to suit local needs. Though federal policy changes and political uncertainty around the ACA in 2017 have posed challenges across the country, states that operate their own marketplaces had greater flexibility than others to respond.
 
Goal: To understand how states on the forefront of health reform perceived and responded to federal policy changes and political uncertainty in 2017.
 
Methods: Structured interviews with the leadership staff of 15 of the 17 state-run marketplaces.
 
Findings and Conclusions: Respondents unanimously suggested that federal administrative actions and repeal efforts have created confusion and uncertainty that have negatively affected their markets. The state-run marketplaces used their broader authority to reduce consumer confusion and promote stable insurer participation. However, their capacity to deal with federal uncertainty has limits and respondents stated that long-term stability requires a reliable federal partner.
 

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03/14/18 – The Commonwealth Fund – Do Medicare Advantage Plans Respond to Payment Changes? A Look at the Data from 2009 to 2014

By Stuart Guterman, Laura Skopec and Stephen Zuckerman

Issue: Medicare Advantage (MA) enrollment has grown significantly since 2009, despite legislation that reduced what Medicare pays these plans to provide care to enrollees. MA payments, on average, now approach parity with costs in traditional Medicare.
 
Goal: Examine changes in per enrollee costs between 2009 and 2014 to better understand how MA plans have continued to thrive even as payments decreased.
 
Methods: Analysis of Medicare data on MA plan bids, net of rebates.
 
 

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03/13/18 – Kaiser Family Foundation - Overview: 2017 Kaiser Women’s Health Survey

By Usha Ranji, Caroline Rosenzweig, Ivette Gomez, and Alina Salganicoff

Health care is a central component of women’s lives, affecting their ability to care for themselves and their families, play a part in their communities, and participate in the workforce and earn a living. Access to comprehensive, affordable, and high quality care is essential for women to address their health care needs – which change across their lifespans. Women’s access to care is shaped by a wide range of factors, including federal and state health care policies. The passage of the Affordable Care Act (ACA) in 2010 marked a significant change in the availability and affordability of coverage and care for millions of formerly uninsured women and men.

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Click here to view methodology


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03/07/18 – The Commonwealth Fund – Medicaid Payment and Delivery Reform: Insights from Managed Care Plan Leaders in Medicaid Expansion States

By Sara Rosenbaum, Rachel Gunsalus, Maria Velasquez, Shyloe Jones, Sara Rothenberg, and J. Zoe Beckerman

 
Issue: Managed care organizations (MCOs) are integral to Medicaid payment and delivery reform efforts. In states that expanded Medicaid eligibility under the Affordable Care Act, MCOs have experienced a surge in enrollment of adults with complex needs.
 
Goal: To understand MCO experiences in Medicaid expansion states and learn about innovations related to access to care, care delivery, payment, and integration of health and social services to address nonmedical needs.
 
Methods: Interviews with leaders of 17 MCOs in 10 states that have seen large Medicaid enrollment growth and have undertaken payment and delivery reforms.
 

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03/06/18 – The Commonwealth Fund – Competition and Premium Costs in Single-Insurer Marketplaces: A Study of Five Rural States

By Jon R. Gabel, Heidi Whitmore, Matthew Green, and Sam Stromberg

Issue: In 2017, five states — Alabama, Alaska, Oklahoma, South Carolina, and Wyoming — had only one issuer participating in their health care marketplaces, limiting consumer choice and competition among insurers.
 
Goal: Examine the history of participation in the individual market from 2010 (before the Affordable Care Act was enacted) to 2017, and analyze premium changes among marketplace plans.
 
Methods: Robert Wood Johnson Foundation’s HIX Compare, which provides national data on the marketplaces from 2014 to 2017.
 

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03/01/18 – The Commonwealth Fund - Americans’ Views on Health Insurance at the End of a Turbulent Year

By Sara A. Collins, Munira Z. Gunja, Michelle M. Doty, and Herman K. Bhupal

The Affordable Care Act’s 2018 open enrollment period came at the end of a turbulent year in health care. The Trump administration took several steps to weaken the ACA’s insurance marketplaces. Meanwhile, congressional Republicans engaged in a nine-month effort to repeal and replace the law’s coverage expansions and roll back Medicaid.

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Click here to view chartpack

Click here to review press release


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03/01/18 – Kaiser Health News – Tens of Thousands of Medicaid Recipients Skip Paying New Premiums

By Phil Galewitz

When Arkansas lawmakers debated in 2016 whether to renew the state’s Medicaid expansion, many Republican lawmakers were swayed only if some of the 300,000 adults who gained coverage would have to start paying premiums.

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02/28/18 – ICRC – Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, February 2017 to February 2018 

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01/31/2018 - ICRC – How States Can Better Understand their Medicare-Medicaid Enrollees: A Guide to Using CMS Data Resources

By Danielle Chelminsky

This technical assistance tool presents an overview of the various data sources available on the CMS Medicare-Medicaid Coordination Office (MMCO) website that may be useful to states in designing, developing, and refining programs that serve Medicare-Medicaid enrollees. CMS regularly publishes data collected from states, health plans, and other sources on its website. The data include Medicare-Medicaid enrollee eligibility categories, demographics, service utilization, and spending that states can use to better understand the specific needs and characteristics of this population as they develop, operate, monitor, and refine programs that serve Medicare-Medicaid enrollees in their state.

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01/31/2018 - ICRC – How States Can Monitor Dual Eligible Special Needs Plan Performance: A Guide to Using CMS Data Resources

By Danielle Chelminsky

This resource guide presents an overview of the various data sources available on the Centers for Medicare & Medicaid Services (CMS) website that may be useful to states in designing, developing, refining, and monitoring programs that use contracts with D-SNPs to coordinate Medicare and Medicaid services for Medicare-Medicaid enrollees. CMS regularly reports data collected from health plans and other sources, and publishes guidance documents on its website. The data include health plan enrollment, quality measures, compliance information, payment information and other useful information that states can use as to monitor performance of the D-SNPs with which they contract.

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01/31/18 – ICRC – Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State,  January 2017 – January 2018  

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01/18/18 – MedPAC – January 2018 MedPAC and MACPAC Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid

This data book is a joint project of the Medicaid and CHIP Payment and Access Commission (MACPAC) and the Medicare Payment Advisory Commission (MedPAC). The data book presents information on the demographic and other personal characteristics, expenditures, and health care utilization of individuals who are dually eligible for Medicare and Medicaid coverage. Dual-eligible beneficiaries receive both Medicare and Medicaid benefits by virtue of their age or disability and low incomes. This population is diverse and includes individuals with multiple chronic conditions, physical disabilities, and cognitive impairments such as dementia, developmental disabilities, and mental illness. It also includes some individuals who are relatively healthy.

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01/18/18 – CHCS – Medicaid Accountable Care Organizations: State Update

Many states have begun to implement Medicaid accountable care organizations (ACOs) that align provider and payer incentives to focus on value instead of volume, with the goal of keeping patients healthy and costs manageable. Currently, 11 states have active Medicaid ACO programs, and at least 11 more are pursuing them.

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01/17/18 – Kaiser Family Foundation – Medicaid: What to Watch in 2018 from the Administration, Congress, and the States

By Robin Rudowitz

Medicaid provides health insurance coverage for about one in five Americans and is the largest payer for long-term care services in the community and nursing homes. Efforts in 2017 to repeal and replace the Affordable Care Act (ACA) and cap federal financing for Medicaid were unsuccessful but help to set the stage for 2018. As 2018 begins, there is a focus on administrative actions using Medicaid Section 1115 demonstration waivers, state actions on Medicaid expansion, and funding for the Children’s Health Insurance Program (CHIP) and other federal health care priorities.  Medicaid in 2018 is also likely to continue to be part of both federal and state budget deliberations. Pressures to control the federal deficit may reignite efforts to reduce or cap federal Medicaid spending.  In addition, Governors will soon release proposed budgets for state FY 2019 that will need to account for uncertainty around CHIP and Medicaid, changes in the economy and the effects of the recent tax legislation as well as funding for rising prescription drugs and initiatives to combat the opioid epidemic. This brief examines these issues.

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01/05/18 – The Commonwealth Fund – Using Community Partnerships to Integrate Health and Social Services for High-Need, High-Cost Patients

By Ruben Amarasingham, Bin Xie, Albert Karam, Nam Nguyen, and Bianca Kapoor 

Issue: Our health care and social services delivery systems are not well-equipped to effectively manage patients with multiple chronic diseases and complex social needs such as food, housing, or substance abuse services. Community-level efforts have emerged across the nation to integrate the activities of disparate social service organizations with local health care delivery systems. Evidence on the experiences and outcomes of these programs is emerging, and there is much to learn about their approaches and challenges.
 
Goal: Profile and classify burgeoning initiatives, understand common challenges, and surface solutions to address those challenges.
 
Methods: Mixed-methods approach, including literature search, surveys, semistructured interviews with program leaders, and consultation with expert panels.
 
Findings and Conclusions: We categorized cross-sector community partnerships in four dimensions. We also identified five common challenges: inadequate strategies to sustain cost-savings, improvement, and funding; lack of accurate and timely measurement of return on investment; lack of mechanisms to share potential savings between health care and social services providers; lack of expertise to integrate multiple data sources during health care or social services provision; and lack of a cross-sector workflow evidence base.
 
 

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01/05/18 – The Commonwealth Fund – How Medicare Could Provide Dental, Vision, and Hearing Care for Beneficiaries

By Amber Willink, Cathy Schoen and Karen Davis

Issue: The Medicare program specifically excludes coverage of dental, vision, and hearing services. As a result, many beneficiaries do not receive necessary care. Those that do are subject to high out-of-pocket costs.
 
Goal: Examine gaps in access to dental, vision, and hearing services for Medicare beneficiaries and design a voluntary dental, vision, and hearing benefit plan with cost estimates.
 
Methods: Uses the Medicare Current Beneficiary Survey, Cost and Use File, 2012, with population and costs projected to 2016 values.
 
Findings and Conclusions: Among Medicare beneficiaries, 75 percent of people who needed a hearing aid did not have one; 70 percent of people who had trouble eating because of their teeth did not go to the dentist in the past year; and 43 percent of people who had trouble seeing did not have an eye exam in the past year. Lack of access was particularly acute for poor beneficiaries. Because few people have supplemental insurance covering these additional services, among people who received care, three-fourths of their costs of dental and hearing services and 60 percent of their costs of vision services were paid out of pocket. We propose a basic benefit package for dental, vision, and hearing services offered as a premium-financed voluntary insurance option under Medicare. Assuming the benefit package could be offered for $25 per month, we estimate the total coverage costs would be $1.924 billion per year, paid for by premiums. Subsidies to reach low-income beneficiaries would follow the same design as the Part D subsidy.
 

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01/02/18 – ICRC – Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, December 2016 to December 2017 

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12/20/17 – CHCS – Strengthening Medicaid Long-Term Services and Supports in an Evolving Policy Environment: A Toolkit for States

By Stephanie Anthony, Arielle Traub, Sarah Lewis, Cindy Mann, Alexandra Kruse, Michelle Herman Soper, and Stephen A. Somers

Long-term services and supports (LTSS) enable more than 12 million people to meet their personal care needs and live with dignity and independence in a variety of community and institutional settings. With Medicaid LTSS expenditures of more than $140 billion annually and the aging population projected to grow 18 percent by 2020, the increasing demand for LTSS is putting more pressure on Medicaid at both the federal and state levels.

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Click here to view the full toolkit


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12/15/17 – Michigan Retirement Research Center – The Effect of Affordable Care Act Medicaid Expansion on Post-Displacement Labor Supply among the Near-Elderly

By Chichun Fang 

Expanded health-insurance coverage under the Affordable Care Act (ACA) provides alternative channels to obtain health-insurance coverage outside employment, which in theory may affect whether people want to work, how much they work, and the sorting of individuals into jobs.
Although health insurance exchanges are available in all states, ACA Medicaid expansion is only available in states that chose to expand Medicaid coverage. The state-level variation in timing of
Medicaid expansion provides a quasi-experiment setting that can be used to examine how health insurance coverage affected labor supply. In this paper, I study how Medicaid expansion affects the labor supply and re-employment outcomes of displaced (involuntarily unemployed) workers who are near-elderly, low-income, nonmarried, childless, and nondisabled. Data from 2011-2016 waves of monthly Current Population Survey (CPS) as well as 2010-2016 waves of Displaced
Workers Survey (DWS) are used. Results from a discrete-choice model using the CPS suggest that, some displaced workers in expansion states became less likely to exit unemployment to employment while some others became more likely to exit unemployment to not-in-labor-force immediately following Medicaid expansion. While robustness tests suggest this may partly be attributed to state-level idiosyncrasies, my results reject large and persistent effect of Medicaid expansion on unemployment exits. The DWS does not have enough statistical power to identify the difference in re-employment outcomes between displaced workers in expansion and nonexpansion states.
 

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12/14/17 – The Commonwealth Fund – What’s at Stake: States’ Progress on Health Coverage and Access to Care, 2013-2016

By Susan L. Hayes, Sara R. Collins, David Radley, and Douglas McCarthy 

Issue: Given uncertainty about the future of the Affordable Care Act, it is useful to examine the progress in coverage and access made under the law.
 
Goal: Compare state trends in access to affordable health care between 2013 and 2016.
 
Methods: Analysis of recent data from the U.S. Census Bureau and the Behavioral Risk Factor Surveillance System.
 
Findings and Conclusions: Between 2013 and 2016, the uninsured rate for adults ages 19 to 64 declined in all states and the District of Columbia, and fell by at least 5 percentage points in 47 states. Among children, uninsured rates declined by at least 2 percentage points in 33 states. There were reductions of at least 2 percentage points in the share of adults age 18 and older who reported skipping care because of costs in the past year in 36 states and D.C., with greater declines, on average, in Medicaid expansion states. The share of at-risk adults without a recent routine checkup, and of nonelderly individuals who spent a high portion of income on medical care, declined in at least of half of states and D.C. These findings offer evidence that the ACA has improved access to health care for millions of Americans. However, actions at the federal level — including a shortened open enrollment period for marketplace coverage, a failure to extend CHIP funding, and a potential repeal of the individual mandate’s penalties — could jeopardize the gains made to date.
 
 
 
 

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12/06/17 – The Commonwealth Fund – Is the Affordable Care Act Helping Consumers Get Health Care?

Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, March-June 2017

By Munira Z. Gunja, Sara R. Collins and Herman K. Bhupal

With the Affordable Care Act (ACA)’s open enrollment period for marketplace plans under way, most attention has focused on the cost of this coverage. But what about consumers’ views about the doctors covered by their insurance and their ability to get timely care from primary care physicians and specialists?

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Click here to view the chartpack


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12/06/17 – CHCS – Advancing Medicare and Medicaid Integration: Key Program Features and Factors Driving State Investment

By Alexandra Kruse, Stephanie Gibbs and Leah Smith

Today, there are more than 11 million individuals who receive services from both Medicare and Medicaid. For these dually eligible beneficiaries, care is often fragmented across a wide array of medical, behavioral health, and long-term care providers. All of these services and supports need to be coordinated effectively to improve care for this population, yet Medicare and Medicaid offer otherwise uncoordinated systems of care with different eligibility criteria, benefits, provider networks, and enrollment processes.

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Click here to view the infographic


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11/30/17 – Avalere – Plans with More Restrictive Networks Comprise 73% of Exchange Market

Deductibles Remain High, Nearing $4,000 on Average for Silver Plans

By Caroline F. Pearson and Elizabeth Carpenter

New analysis from Avalere finds that plans with more restrictive networks, including health maintenance organizations (HMOs) and exclusive provider organizations (EPOs), continue to dominate the exchange market, with 73% of the 2018 market comprised of restrictive network plans, up from 68% in 2017 and 54% in 2015. Only 27% of plans are Preferred Provider Organizations (PPO) or Point of Service (POS) plans, which typically cover care with a broader network.

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11/21/17 – The Commonwealth Fund – Comparing the Affordable Care Act’s Financial Impact on Safety-Net Hospitals in States That Expanded Medicaid and Those That Did Not

By Allen Dobson, Joan Da Vanzo, Randy Haught, and Phap-Hoa Luu

Issue: Safety-net hospitals play a vital role in delivering health care to Medicaid enrollees, the uninsured, and other vulnerable patients. By reducing the number of uninsured Americans, the Affordable Care Act (ACA) was also expected to lower these hospitals’ significant uncompensated care costs and shore up their financial stability.
 
Goal: To examine how the ACA’s Medicaid expansion affected the financial status of safety-net hospitals in states that expanded Medicaid and in states that did not.
 
Methods: Using Medicare hospital cost reports for federal fiscal years 2012 and 2015, the authors compared changes in Medicaid inpatient days as a percentage of total inpatient days, Medicaid revenues as a percentage of total net patient revenues, uncompensated care costs as a percentage of total operating costs, and hospital operating margins.
 
Findings and Conclusions: Medicaid expansion had a significant, favorable financial impact on safety-net hospitals. From 2012 to 2015, safety-net hospitals in expansion states, compared to those in nonexpansion states, experienced larger increases in Medicaid inpatient days and Medicaid revenues as well as reduced uncompensated care costs. These changes improved operating margins for safety-net hospitals in expansion states. Margins for safety-net hospitals in nonexpansion states, meanwhile, declined.
 

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Kaiser Family Foundation – Explaining Health Care Reform: Questions About Health Insurance Subsidies

Health insurance can be expensive, and is therefore often out of reach for lower and moderate income families, particularly if they are not offered health benefits at work. To make coverage obtainable for families that otherwise could not afford it and to encourage broad participation in health insurance, the Affordable Care Act (ACA) includes provisions to lower premiums and out-of-pocket costs for people with low and modest incomes. The adequacy of this assistance will be a key determinant of how many people ultimately gain coverage and whether or not lower-income people will be able to use the health insurance they obtain.

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Kaiser Family Foundation

Estimates of Eligibility Coverage for ACA Coverage Among the Uninsured in 2016

By Rachel Garfield, Anthony Damico, Julia Foutz, Gary Claxton, and Larry Levitt

Despite historic coverage gains under the Affordable Care Act (ACA), more than 27 million people in the United States remain without insurance coverage.1 Recent debate over the future of the ACA has led to uncertainty about whether and how ACA coverage will be maintained. The public reports confusion about the future of the law, and outreach to help inform people about coverage options is more limited than in past years. Still, millions of currently uninsured people are eligible for ACA coverage under current law, and given upcoming open enrollment, it is helpful to understand how many people could potentially gain ACA coverage. In addition, the administration has indicated to states that it is open to state Medicaid waiver proposals, which may lead some states that have not yet expanded Medicaid under the ACA to develop Medicaid expansion waivers and further extend coverage. Understanding how many people might be eligible for coverage under the ACA or could be reached with policy changes can inform these policy discussions.

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Click here to view Technical Appendix A

Click here to view Technical Appendix B

Click here to view Technical Appendix C


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10/25/2017 – Kaiser Health News – Federal Judge Denies Bid to Force Feds to Resume ACA Subsidies

By Ngoc Nguyen

A federal judge Wednesday denied a petition to immediately reinstate Affordable Care Act subsidies that President Donald Trump suspended earlier this month.

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10/25/2017 – The Commonwealth Fund – Medicaid Payment and Delivery System Reform: Early Insights from 10 Medicaid Expansion States

By Sara Rosenbaum, Sara Schmucker, Sara Rothenberg, Rachel Gunsalus, and J. Zoe Beckerman  

Issue: Expanded Medicaid enrollment under the Affordable Care Act has heightened the importance of states’ roles as principal purchasers of health care for low-income and medically vulnerable populations. Concurrently, the federal government has augmented states’ purchasing tools.
 
Goal: To examine the evolution of payment and delivery system reform in 10 ACA Medicaid expansion states.
 
Methods: Analysis of state managed care policies, including a detailed review of purchasing documents as well as interviews with senior agency officials in 10 states.
 
Findings and Conclusions: States have made health system reform a core element of their Medicaid expansions, with the aim of improving access, quality, efficiency, and population health. States have sought to incorporate evidence-based practice and payment strategies, with an emphasis on populations likely to benefit from improved care management and on better integration of treatment for physical and behavioral health problems. Seven of 10 are directly engaged in provider payment and delivery system reform. Agencies noted the importance of experienced provider networks in addressing complex health and social needs, along with managed care’s role in quality improvement and payment reform. States embrace their roles as payers and health care innovators, identifying stability of both coverage and the underlying federal policy environment as key factors.
 
 

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10/24/2017 – The Commonwealth Fund – Assessing Changes to Medicaid Managed Care Regulations: Facilitating Integration of Physical and Behavioral Health Care

By Elizabeth Edwards 

Issue: As states consider how to effectively control Medicaid costs, many are looking to integrate behavioral and medical care, including long-term services and supports, particularly for individuals with complex needs.
 
Goal: To summarize how recent federal regulations are encouraging an integrated approach to behavioral and physical health care.
 
Findings and Conclusions: Two recent federal rules issued in 2016 are facilitating the transition to integrated care models: the Medicaid managed care rule and the Medicaid managed care mental health parity rule. These changes may not spell the end of fragmented systems, but they certainly do not support a status quo approach to care. While the regulations do not specifically address integrated care, they should facilitate and, in some instances, encourage, state movement to integrated care for Medicaid participants.
 

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10/11/2017 – Kaiser Health News – California Slaps Surcharge on ACA Plans as Trump Remains Coy on Subsidies

By Chad Terhune

California’s health exchange said Wednesday it has ordered insurers to add a surcharge to certain policies next year because the Trump administration has yet to commit to paying a key set of consumer subsidies under the Affordable Care Act.

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10/11/2017 – The Commonwealth Fund – How Have Health Insurers Performed Financially under the ACA’s Market Rules?

By Michael J. McCue and Mark A. Hall

The Affordable Care Act (ACA) transformed the market for individual health insurance, so it is not surprising that insurers’ transition was not entirely smooth. Insurers, with no previous experience under these market conditions, were uncertain how to price their products. As a result, they incurred significant losses. Based on this experience, some insurers have decided to leave the ACA’s subsidized market, although others appear to be thriving.

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10/11/2017 – Kaiser Family Foundation – Survey: Adjusting to Sudden Reduction in Federal Funds, ACA Navigators Expect to Decrease Services

New Report Compares Navigator Funding Changes with Their Reported Performance Metrics – Many navigator organizations responsible for helping consumers understand and sign up for health coverage in 2018 Affordable Care Act (ACA) marketplaces say steep federal funding reductions that recently took effect will likely force them to limit their geographic service area, cut back outreach and public education, lay off staff members, and curtail other assistance, according to a new Kaiser Family Foundation survey of such programs.

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Click here to view data note


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10/11/2017 – The Commonwealth Fund – Cuts to the ACA’s Outreach Budget Will Make It Harder for People to Enroll

By Shanoor Seervai

At a recent concert in Clearwater, Florida, Jodi Ray was proud to recognize the lead singer — a previously uninsured man in his forties, whom she helped get health coverage. Ray, who directs a navigator program that helps individuals enroll in health insurance in Florida, guided him through the process of buying a plan through the Affordable Care Act’s (ACA) health insurance marketplace.

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09/28/2017 – ICRC – Key Medicare Advantage Dates and Action Items for States Contracting with Dual Eligible Special Needs Plans

Many states are exploring strategies to integrate the financing and delivery of services for individuals dually eligible for Medicare and Medicaid. Through their Medicaid agency contracts with Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs), states have the opportunity to integrate care for dually eligible beneficiaries.

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09/26/2017 – Avalere – Updated Analysis: Revised Graham-Cassidy Bill Would Reduce Federal Funding to States by $205B

By Chris Sloan and Richard Kane

This version of the bill would lead to a reduction in federal funding to states by $205B through 2026 and more than $4T over a 20-year period.

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09/25/2017 – Kaiser Family Foundation – Public Opinion on ACA Replacement Plans: Interactive

This interactive tracks the public’s views of the Affordable Care Act replacement plans over the past several months. By collecting data from various surveys of adults in the U.S. conducted by Kaiser and others, we show how the public’s views have changed or remained stable as Congress considers major changes to the U.S. health care system and details of the plans have emerged from the House and the Senate. The interactive nature of the tool also allows users to explore how views vary by party identification, a key factor in people’s views of the ACA and plans to replace it, as well as among supporters of President Trump.  Access a downloadable table of the poll results.

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Click here to view a downloadable table of the poll results


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09/25/2017 – Kaiser Family Foundation – The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review

By Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artigo

A substantial body of research has investigated effects of the Medicaid expansion under the Affordable Care Act (ACA) on coverage, access to care, and various economic measures. These findings can inform understanding of the broader effects of the ACA and ongoing debate over ACA repeal, including the Medicaid expansion.

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Click here to view the Appendix


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09/13/2017 – Kaiser Family Foundation – Section 1115 Medicaid Demonstration Waivers: A Look at the Current Landscape of Approved and Pending Waivers

By Elizabeth Hinton, MaryBeth Musumeci, Robin Rudowitz, and Larisa Antonisse

Section 1115 Medicaid demonstration waivers provide states an avenue to test new approaches in Medicaid that differ from federal program rules. Waivers can provide states considerable flexibility in how they operate their programs, beyond what is available under current law, and can have a significant impact on program financing. While there is great diversity in how states have used waivers over time, waivers generally reflect priorities identified by states and the Centers for Medicare and Medicaid Services (CMS) (see Appendix A). As of September 2017, there are 33 states with 41 approved waivers1 and 18 states with 21 pending waivers (see Appendix B and C for detailed tables).2 3 This brief answers basic questions about Section 1115 waiver authority and discusses the current landscape of approved and pending demonstration waivers (Figure 1).

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09/07/2017 – The Commonwealth Fund - Following the ACA Repeal-and-Replace Effort, Where Does the U.S. Stand on Insurance Coverage?

Findings from the Commonwealth Funds Affordable Care Act Tracking Survey, March-June 2017

By Sara R. Collins, Munira Z. Gunja and Michelle M. Doty

Issue: After Congress’s failure to repeal and replace the Affordable Care Act, some policy leaders are calling for bipartisan approaches to address weaknesses in the law’s coverage expansions. To do this, policymakers will need data about trends in insurance coverage, reasons why people remain uninsured, and consumer perceptions of affordability.
Goal: To examine U.S. trends in insurance coverage and the demographics of the remaining uninsured population, as well as affordability and satisfaction among adults with marketplace and Medicaid coverage.
Methods: Analysis of the Commonwealth Fund Affordable Care Act Tracking Survey, March–June 2017.
Findings and Conclusions: The uninsured rate among 19-to-64-year-old adults was 14 percent in 2017, or an estimated 27 million people, statistically unchanged from one year earlier. Uninsured rates ticked up significantly in three subgroups: 35-to-49-year-olds, adults with incomes of 400 percent of poverty or more (about $48,000 for an individual), and adults living in states that had not expanded Medicaid. Half of uninsured adults, or an estimated 13 million, are likely eligible for marketplace subsidies or the Medicaid expansion in their state. Four of 10 uninsured adults are unaware of the marketplaces. Adults in marketplace plans with incomes below 250 percent of poverty are much more likely to view their premiums as easy to afford compared with people with higher incomes. Policies to improve coverage include a federal commitment to supporting the marketplaces and the 2018 open enrollment period, expansion of Medicaid in 19 remaining states, and enhanced subsidies for people with incomes of 250 percent of poverty or more.
 
 
 
 
 

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09/05/2017 – The Commonwealth Fund – A Glimmer of Bipartisanship on the ACA

By David Blumenthal, M.D.

With the eclipse of Republican efforts to repeal and replace the Affordable Care Act (ACA), bipartisan approaches to improving the law are having a moment in the sun. This week, Senators Lamar Alexander (R-Tenn.) and Patti Murray (D-Wash.) are cosponsoring hearings before the Senate Health, Education, Labor and Pensions (HELP) committee on bipartisan solutions to stabilizing private health insurance markets. The Problem-Solvers — a new caucus of House Democrats and Republicans — are similarly at work on a cross-party package of reforms. Eight governors have released a bipartisan plan, as has a group of health policy experts with mixed party affiliations.

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08/30/2017 – ICRC – Technical Assistance Tool – August 2017

Integrating Behavioral and Physical Health for Medicare-Medicaid Enrollees: Lessons for States Working With Managed Care Delivery Systems

By Melanie Au, Claire Postman and James Verdier

A growing number of states are integrating physical and behavioral health services for beneficiaries dually eligible for Medicare and Medicaid. These beneficiaries not only have complex needs, but must also navigate between separate programs (Medicare and Medicaid) and care delivery systems (physical and behavioral health) for their services. This brief explores the experience of six states that have achieved varying levels of behavioral health and physical health integration or collaboration for dually eligible beneficiaries within a managed care environment. States are implementing their models of integration (e.g., comprehensive carve-in models, specialty plans for beneficiaries with serious mental illness, hybrid models, and coordinated carve-out models) through contracts with Medicare-Medicaid Plans or Medicaid managed care plans that are aligned with Medicare Advantage Dual Eligible Special Needs Plans.
 

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08/16/2017 – Kaiser Family Foundation - Section 1115 Medicaid Expansion Waivers: A Look at Key Themes and State Specific Waiver Provisions

By MaryBeth Musumeci, Elizabeth Hinton, and Robin Rudowitz

Seven states currently are implementing the Affordable Care Act’s (ACA) Medicaid expansion to low income adults up to 138% of the federal poverty level (FPL, $16,643 per year for an individual in 2017) in ways that extend beyond the flexibility provided by the law through Section 1115 demonstration waivers. While the future of federal legislation affecting the Medicaid expansion is unclear at this time, Section 1115 Medicaid expansion waiver activity continues as states submit amendments, extensions, and new waivers. While no decisions on expansion waivers have been issued under the new Administration to date, the Administration’s March, 2017 letter to state governors signaled some potential policy changes beyond what has been approved in the past. This issue brief focuses on approved (Arizona, Arkansas, Indiana, Iowa, Michigan, Montana, and New Hampshire) and pending (Arkansas, Kentucky, Indiana, Iowa, and Massachusetts) Section 1115 waivers that implement the ACA’s Medicaid expansion. 

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08/11/2017 – Kaiser Family Foundation - Kaiser Health Tracking Poll – August 2017: The Politics of ACA Repeal and Replace Efforts

By Ashley Kirzinger, Bianca DiJulio, Bryan Wu, and Mollyann Brodie

The August Kaiser Health Tracking Poll finds that the majority of the public (60 percent) say it is a “good thing” that the Senate did not pass the bill that would have repealed and replaced the ACA. Since then, President Trump has suggested Congress not take on other issues, like tax reform, until it passes a replacement plan for the ACA, but six in ten Americans (62 percent) disagree with this approach, while one-third (34 percent) agree with it.

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Click here to read the topline and methodology


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08/10/2017 – Kaiser Family Foundation - An Early Look at 2018 Premium Changes and Insurer Participation on ACA Exchanges

By Rabah Kamal, Cynthia Cox, Care Shoaibi, Brian Kaplun, Ashley Semanskee, and Larry Levitt

Each year insurers submit filings to state regulators detailing their plans to participate on the Affordable Care Act marketplaces (also called exchanges). These filings include information on the premiums insurers plan to charge in the coming year and which areas they plan to serve. Each state or the federal government reviews premiums to ensure they are accurate and justifiable before the rate goes into effect, though regulators have varying types of authority and states make varying amounts of information public.

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07/28/2017 – CHCS - Medicaid Accountable Care Organization Shared Savings Programs: Options for Maximizing Provider Participation and Program Sustainability

By Rachael Matulis

Many states that have successfully launched Medicaid accountable care organization (ACO) programs in recent years have adopted a shared savings payment model. A general issue with shared savings programs is that they typically use a total cost of care (TCoC) benchmark that is based at least in part on an ACO’s historical spending, which means that health systems with higher costs and more waste may be more likely to share in savings than more efficient providers. A related concern is that as ACOs achieve cost savings, there may be a threat of payment cuts down the road, given that payment rates are often based on historic costs and use.

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07/25/2017 – The Kaiser Family Foundation - Using Medicaid to Wrap Around Private Insurance: Key Questions to Consider

By MaryBeth Musumeci, Robin Rudowitz, and Rachel Garfield

The Senate is currently considering the Better Care Reconciliation Act (BCRA). This bill goes beyond repeal and replacement of the Affordable Care Act (ACA) to make major changes in Medicaid program financing that would reduce federal funding by $756 billion from 2017-2026 and lead to 15 million fewer people covered by Medicaid by 2026, according to the latest Congressional Budget Office estimate.  Most of this reduction is due to changing federal Medicaid financing to a per capita cap beginning in 2020 and eliminating the enhanced federal matching funds for the ACA’s Medicaid expansion by 2024.

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07/19/2017 – Kaiser Family Foundation - Better Care Reconciliation Act (BCRA): State-by-State Estimates of Reductions in Federal Medicaid Funding

By Rachel Garfield, Robin Rudowitz, and Allison Valentine

The Senate recently considered legislation called the Better Care Reconciliation Act of 2017 (BCRA), proposed on June 22, 2017 and revised on July 13, 2017. This bill differs in some ways from the American Health Care Act (AHCA) that passed in the House in May 2017 but maintains a similar overall framework in its treatment of Medicaid. While referred to as legislation to repeal and replace the Affordable Care Act (ACA), both the BCRA and the AHCA make more fundamental changes to Medicaid by phasing out the enhanced federal matching funds for the ACA Medicaid expansion and by setting a limit on federal funding through a per capita cap or, at state option, a block grant for some enrollees.

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07/19/2017 – Kaiser Family Foundation - State-by-State Estimates of Reductions in Federal Medicaid Funding Under Repeal of the ACA Medicaid Expansion

By Rachel Garfield and Robin Rudowitz

The Senate is currently considering the Obamacare Repeal Reconciliation Act of 2017. While there are a number of provisions that affect Medicaid, the primary change would be the elimination of the statutory authority to cover childless adults up to 138% FPL ($16,643 for an individual in 2017) as well as an elimination of the enhanced match rate for the Medicaid expansion.

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07/11/2017 – ICRC - Preventing Improper Billing of Medicare-Medicaid Enrollees in Managed Care: Strategies for States and Dual Eligible Special Needs Plans

By Claire Postman and James Verdier

Medicaid provides some degree of coverage for Medicare deductibles, copayments, and coinsurance amounts for about 85 percent of dually eligible beneficiaries. The vast majority of these Medicare-Medicaid enrollees are Qualified Medicare Beneficiaries and are protected from billing by any providers for unpaid Medicare cost-sharing. Although providers are prohibited from billing these protected beneficiaries for cost-sharing, improper billing continues to be an issue. The complexity of processing Medicare claims for cost-sharing, state policies concerning Medicare cost-sharing payments, and lack of provider awareness about billing prohibitions may contribute to the persistence of this issue. This brief explores strategies that states and Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) can use to streamline claims processing and communicate with providers and members in order to prevent instances of improper billing.

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07/06/2017 – Kaiser Family Foundation - What Are the Implications for Medicare of the American Health Care Act and the Better Care Reconciliation Act?

By Juliette Cubanski and Tricia Neuman

An important question in the debate over proposals to repeal and replace the Affordable Care Act (ACA) is what might happen to the law’s many provisions affecting the Medicare program. The American Health Care Act (AHCA), which was passed by the House of Representative on May 4, 2017, and the Better Care Reconciliation Act (BCRA), released by Senate Republicans on June 22, 2017, would leave most ACA changes to Medicare intact, including the benefit improvements (no-cost preventive services and closing the Part D coverage gap), reductions to payments to health care providers and Medicare Advantage plans, the Independent Payment Advisory Board, and the Center for Medicare and Medicaid Innovation.

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06/26/2017 – Congressional Budget Office - H.R. 1628, Better Care Reconciliation Act of 2017

The Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have completed an estimate of the direct spending and revenue effects of the Better Care Reconciliation Act of 2017, a Senate amendment in the nature of a substitute to H.R. 1628. CBO and JCT estimate that enacting this legislation would reduce the cumulative federal deficit over the 2017-2026 period by $321 billion. That amount is $202 billion more than the estimated net savings for the version of H.R. 1628 that was passed by the House of Representatives.

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06/26/2017 – Kaiser Family Foundation - Premiums Under The Senate Better Care Reconciliation Act

By Gary Claxton, Anthony Damico, Larry Levitt, and Cynthia Cox

The Senate Better Care Reconciliation Act (BCRA) would make significant changes to the amounts that people pay for nongroup coverage and for the care they receive under the Affordable Care Act (ACA). The tables below provide estimates of how premiums after taking into account tax credits would change for people currently enrolled in the federal and state marketplaces.

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06/26/2017 – CHCS - Medicaid Managed Long-Term Services and Supports Programs: State Update

Medicaid is the nation’s largest payer of long-term services and supports (LTSS), funding these services for nearly five million Americans. An increasing number of state Medicaid agencies — 22 as of July 2017 — are providing LTSS through capitated contracts with managed care organizations, with roughly 1.2 million individuals enrolled in comprehensive managed care plans that include LTSS or managed LTSS-only plans. These managed LTSS (MLTSS) programs cover services like personal care, home-delivered meals, and transportation that are used by children and adults with functional limitations and/or chronic illnesses who need assistance with bathing, dressing, shopping, and housework, as well as other activities.

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06/14/2017 – The Commonwealth Fund - The American Health Care Act: Economic and Employment Consequences for States

By Leighton Ku, Erika Steinmetz, Erin Brantley, Nikhil Holla, Brian Bruen

The American Health Care Act (AHCA), passed by the U.S. House of Representatives, would repeal and replace the Affordable Care Act. The Congressional Budget Office indicates that the AHCA could increase the number of uninsured by 23 million by 2026.

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Click here to read the Appendices

Click here to read the State Fact Sheet


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06/13/2017 – CHCS - Medicaid Accountable Care Organizations: State Update

Across the country, states are exploring the viability of Medicaid accountable care organizations (ACOs) that align provider and payer incentives to focus on value instead of volume, with the goal of keeping patients healthy and costs manageable. Currently, 10 states have active Medicaid ACO programs, and at least 13 more are pursuing them.

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06/12/2017 – CHCS - Medicaid Health Homes: Implementation Update

Medicaid health homes, made possible under Section 2703 of the Affordable Care Act, provide states with a mechanism to support better care management for people with complex health needs with the goal of improving health outcomes and curbing costs. As of June 2017, 21 states and the District of Columbia have 32 approved Medicaid health home models in operation. 

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06/11/2017 – Integrated Care Resource Center - State and Health Plan Strategies to Grow Enrollment in Integrated Managed Care Plans for Dually Eligible Beneficiaries

By James Verdier and Danielle Chelminsky, Mathematica Policy Research

States and health plans that provide Medicare and Medicaid services to dually eligible beneficiaries can work together to achieve the levels of enrollment that are needed to support effective health plan coordination of these services. States can support enrollment growth through program design decisions, marketing support, and beneficiary education. Health plans have an especially important role in retaining and growing their enrollment in an environment in which enrollment for Medicare services is voluntary. They must consistently demonstrate that they can provide better access to and coordination of Medicare and Medicaid services than other alternatives and ensure enrollees’ timely and appropriate care. Plans’ ability to retain enrollment can be monitored through a standardized measure of voluntary disenrollment from the plan that is reported each year in the Centers for Medicare & Medicaid Services star ratings system for Medicare managed care plans.

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06/05/2017 – Kaiser Family Foundation - How ACA Repeal and Replace Proposals Could Affect Coverage and Premiums for Older Adults and Have Spillover Effects for Medicare

By Tricia Neuman, Karen Pollitz, and Larry Levitt

Now that the House has passed its bill to repeal and replace the Affordable Care Act (ACA), Senate negotiators face a number of policy decisions that could be of particular interest to older adults who are not quite old enough for Medicare.  Prior to the ACA, adults in their fifties and early 60s were arguably most at risk in the private health insurance market.  They were more likely than younger adults to be diagnosed with certain conditions, like cancer and diabetes, for which insurers denied coverage.  They were also more likely to face unaffordable premiums because insurers had broad latitude (in nearly all states) to set high premiums for older and sicker enrollees.

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05/31/2017 – Kaiser Family Foundation - Poll: Public Views the ACA More Favorably Than Congress’ Plan to Replace It, Though Republicans Favor the Replacement

Majority Says the Senate Either Should Make Major Changes or Not Pass The House Bill At All, While About a Third Want the Senate to Pass It As Is or With Only Minor Changes

Most (55%) of the public holds an unfavorable view of the Congressional plan that would repeal and replace the Affordable Care Act, and the same share (55%) want the Senate either to make major changes to the House-passed bill or not pass it all, finds the latest Kaiser Health Tracking Poll.

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Click here to read the Kaiser Health Tracking Poll


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05/30/2017 – The Commonwealth Fund - High-Risk Pools: An Illusion of Coverage That May Increase Costs for All in the Long Term

By Deborah Lorber

The American Health Care Act (AHCA), recently passed by the U.S. House of Representatives, would segregate people with preexisting health conditions from the broader insurance pool and place these potentially costly patients into high-risk pools. Prior to the Affordable Care Act, 35 states had high-risk pools, but these programs were not effective in making insurance affordable or accessible. In a commentary for Annals of Internal Medicine, Commonwealth Fund grantee Jean P. Hall, Ph.D., considers the problems of high-risk pools and why restoring them would be “a huge step backward for American health care policy.” 

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05/24/2017 – Congressional Budget Office – Cost Estimate H.R. 1628 American Health Care Act of 2017

The Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have completed an estimate of the direct spending and revenue effects of H.R. 1628, the American Health Care Act of 2017, as passed by the House of Representatives. CBO and JCT estimate that enacting that version of H.R. 1628 would reduce the cumulative federal deficit over the 2017-2026 period by $119 billion. That amount is $32 billion less than the estimated net savings for the version of H.R. 1628 that was posted on the website of the House Committee on Rules on March 22, 2017, incorporating manager’s amendments 4, 5, 24, and 25. (CBO issued a cost estimate for that earlier version of the legislation on March 23, 2017.)

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05/17/2017 – Kaiser Family Foundation - Data Note: Medicaid’s Role in Providing Access to Preventive Care for Adults

By Leighton Ku, Julia Paradise, and Victoria Thompson

Medicaid, the nation’s public health insurance program for people with low income, covers 74 million Americans today, including millions of low-income adults. The Affordable Care Act (ACA) expanded Medicaid to nonelderly adults with income up to 138% of the federal poverty level (FPL), and, in the 32 states (including DC) that implemented the expansion, more than 11 million adults have gained Medicaid as a result. Chronic illness is prevalent in the adult Medicaid population. Preventive care, including immunizations and regular screenings that permit early detection and treatment of chronic conditions, improves the prospects for better health outcomes. This Data Note focuses on Medicaid’s role in providing access to preventive care for low-income adults.

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05/12/2017 – CHCS - Demonstrating the Value of Medicaid Managed Long-Term Services and Supports Programs

By Camille Dobson, Stephanie Gibbs, Adam Mosey, and Leah Smith

States are increasingly implementing Medicaid managed long-term services and supports (MLTSS) programs to accomplish goals including rebalancing spending from institutional care to home- and community-based services, improving beneficiary experience, and better managing costs. But there is relatively limited evidence of the value of these efforts.

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05/10/2017 – CHCS - Quality Measurement Approaches of State Medicaid Accountable Care Organization Programs

States interested in using an accountable care organization (ACO) model for Medicaid populations must think critically about which metrics are best-suited to promote enhanced access and care coordination and encourage provider accountability for these outcomes. There is considerable variety in state Medicaid ACO measurement approaches related to access, quality, clinical, and cost goals. Quality measure requirements for ACOs can range from simple collection and reporting to advanced expectations involving achievement thresholds, benchmark comparisons, and/or rates of improvement over time. Methodologies to calculate performance-based payments can range similarly in complexity.

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04/27/2017 – The Commonwealth Fund - Medicaid Provides Equal- Or Better-Quality Health Insurance Coverage Than Private Plans As Well As More Financial Protection

Commonwealth Fund’s Biennial Health Insurance Survey Finds People with Medicaid Have Better Access to Health Care Than the Uninsured and Fewer Medical Bill Problems

Having Medicaid is not only substantially better than being uninsured, but it provides enrollees with health insurance that on most measures is as good as or, in some cases, better than private coverage, according to new a Commonwealth Fund report. Medicaid is currently the nation’s largest health insurer, covering more than 70 million people, about 12 million of whom enrolled when 31 states and the District of Columbia expanded eligibility for the program under the Affordable Care Act (ACA).

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Click here to veiw the issue brief.

Click here to view the chartpack.

Click here to view Appendix Table 1.


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04/26/2017 – Kaiser Family Foundation - Poll: Majority Opposes Hard-Ball Negotiating Tactics to Replace the Affordable Care Act, But Republicans Support It

Three Quarters of Public, Including Half of Trump Backers, Want President and Congress to Make the Law Work

With President Trump and Congress continuing to discuss repealing and replacing the Affordable Care Act, a majority of the public opposes using hard-ball tactics as a way to force Democrats in Congress to negotiate a replacement, the latest Kaiser Health Tracking Poll finds.  President Trump recently suggested that his administration and Congress could push Democrats to negotiate a replacement to the Affordable Care Act by stopping payments for the law’s cost-sharing reductions, which experts say would likely cause insurers to raise premiums or stop offering coverage through the ACA’s marketplaces.

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Click here to view the Kaiser Health Tracking Poll.


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04/25/2017 – Kaiser Family Foundation - Federal Government Could See Net Increase of $2.3 Billion in Costs in 2018 if ACA Cost-Sharing Reduction Payments Eliminated

On Average, Premiums for Silver Plans Would Need to Rise 19% to Offset Lack of Funding for Cost-Sharing Reductions, Triggering Tax Credit Increases

Ceasing payments for the Affordable Care Act’s (ACA) cost-sharing reduction program could save $10 billion, but cost an additional $12.3 billion in premium tax credits – an estimated net increase of $2.3 billion, or 23 percent, in federal spending on marketplace subsidies – in 2018, if insurers continue to participate in ACA marketplaces, according to a new analysis from the Kaiser Family Foundation.

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Click here to view the issue brief


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04/24/2017 – Kasier Family Foundation - Data Note: Medicaid Managed Care Growth and Implications of the Medicaid Expansion

By Julia Paradise

The Medicaid program covers more than 74 million Americans, or 1 in 5, including low-income pregnant women, children, and parents, seniors, people with disabilities, and, in Medicaid expansion states, nearly all low-income nonelderly adults. Most states today rely heavily on risk-based managed care organizations to serve Medicaid beneficiaries. This Data Note discusses the current role of managed care in Medicaid and addresses differences in managed care growth between states that expanded Medicaid to low-income adults under the Affordable Care Act (ACA) and states that did not expand Medicaid.

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04/21/2017 – Kaiser Family Foundation - Analysis: Insurer Financial Indicators Show Signs of Stabilizing After Transition to ACA Marketplaces

A new Kaiser Family Foundation analysis of key insurer financial indicators suggests that the individual insurance market showed signs of stabilizing in 2016, although profitability remained below the level of performance prior to the opening of the Affordable Care Act’s insurance marketplaces.  The new analysis tracks insurer financial performance in the individual market through two key indicators: average medical loss ratios (the share of health premiums paid out as claims) and average gross margins per member per month (the average amount by which premium income exceeds claims costs per enrollee in a given month).

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Click here to view that data note


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04/20/2017 – Avalere - Medicaid Per Capita Caps Could Cut Funding for Dual Eligible Beneficiaries

Capping Medicaid Funding Could Also Shift Costs To Medicare

By Caroline F. Pearson and Tiernan Meyer

New modeling from Avalere finds that proposals to limit per capita federal Medicaid funding growth based on medical inflation could lead to a $44 billion spending cut for dual eligible beneficiaries—or people who qualify for both Medicaid and Medicare—over the next 10 years. Capped funding proposals have been included as part of recent Affordable Care Act (ACA) repeal conversations in Congress. While the future of these legislative initiatives remains uncertain, policymakers are expected to continue considering Medicaid reforms, which could have a significant effect on beneficiaries, states, and Medicare.

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Click here to view the full analysis


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04/19/2017 – The Commonwealth Fund - Essential Facts About Health Reform Alternatives: Continuous Coverage Requirement

Proposed alternatives to the Affordable Care Act (ACA) would require Americans to continuously carry health insurance coverage or be penalized with higher premiums. Under the American Health Care Act (AHCA)—the Republican bill introduced in the U.S. House of Representatives and subsequently withdrawn—people whose insurance coverage lapsed for more than 63 days would be charged a 30 percent premium surcharge every month for 12 months when they repurchase coverage. This penalty was intended to encourage people to maintain coverage and ensure the stability of insurance markets.

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04/12/2017 – The Commonwealth Fund - Substantial Physician Turnover and Beneficiary “Churn” in a Large Medicare Pioneer ACO

A study of one of the nation’s largest Medicare accountable care organizations (ACOs) found that participating physicians see a relatively small number of patients who are actually part of the ACO population: less than 5 percent of a typical patient panel consists of ACO patients. The ACO also experiences substantial physician turnover. And when physicians leave the ACO, most of their attributed beneficiaries leave as well.

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04/11/2017 – The Commonwealth Fund - Essential Facts About Health Reform Alternatives: Medicaid Per Capita Caps

To lower government spending on Medicaid, some conservatives have proposed limiting the federal contribution to each enrollee’s health coverage. The American Health Care Act, the Republican-backed bill recently introduced into the U.S. House of Representatives as a replacement for the Affordable Care Act (ACA), includes a provision that would transition federal Medicaid funding to a per person basis by 2020. 

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04/06/2017 - Kaiser Family Foundation - Governor’s Proposed Budgets for FY 2018: Focus on Medicaid and Other Health Priorities

By Larisa Antonisse, Elizabeth Hinton, Robin Rudowitz, Kathleen Gifford, and Nicole McMahon

This report provides Medicaid highlights from governors’ proposed budgets for state fiscal year (FY) 2018, which runs from July 1, 2017 through June 30, 2018 in most states. Proposed budgets reflect the priorities of the governor and are often blueprints for the legislature to consider. As of the 2017 legislative session, 31 governors are from the same party as their legislatures (24 Republican and 7 Democratic states) and 18 governors are from different parties than their legislatures. As governors were issuing proposed budgets for FY 2018, federal lawmakers were debating the American Health Care Act (AHCA) which included major changes to the ACA as well as fundamental reforms for the structure and funding of the Medicaid program. While the AHCA failed to pass in the House, discussions on Medicaid reform are likely to continue at the federal level.

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04/04/2017 – Kaiser Family Foundation - Three Quarters of the Public, Including a Majority of Trump Supporters, Want President Trump to Try to Make the Affordable Care Act Work 

Most Say President Trump and Republicans Are Responsible for the ACA Now, Not President Obama and Democrats

Despite divided views about the Affordable Care Act, three-fourths of the public (75%) say President Trump and his administration should do what they can to make the law work, while one in five (19%), including 38 percent of Republicans, say the Administration should do what it can to make the law fail so they can replace it later, the latest Kaiser Health Tracking Poll finds.  Fielded after the U.S. House cancelled its March 24 vote on a plan to repeal and replace the Affordable Care Act supported by President Trump and House Speaker Paul Ryan, the poll finds majorities of Democrats (89%) and independents (78%), and half of Republicans (51%) want the Trump Administration to make the law work, as do a majority of President Trump’s supporters (54%).

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Click here to view the Kaiser Health Tracking Poll


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04/03/2017 – CHCS - Practice Transformation Assistance in State Innovation Models

By Katherine Heflin and Anna Spencer

The federal State Innovation Model (SIM) initiative is striving to achieve statewide multi-payer care delivery and payment reforms for roughly 80 percent of the population within participating states. To realize this goal, SIM states and territories are helping health care providers transform their practices to be more patient-centered, while improving patient outcomes and reducing health care spending.

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03/20/2017 – CHCS - Update on Medicare-Medicaid Integration

Over 11 million individuals across the United States are eligible for both Medicare and Medicaid. These people, known as Medicare-Medicaid enrollees or dually eligible beneficiaries, often have significant health and social service needs, making them among the nation’s highest-need, highest-cost populations.  As of March 2017, over 750,000 dually eligible beneficiaries are enrolled in programs that integrate Medicare and Medicaid.
 

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