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Author: Yvonne Villante (page 1 of 12)

Does the Healthy Indiana Plan 2.0 have national aspirations?

For the last six years, the Healthy Indiana Plan (HIP) has delivered quality care, encouraged the use of preventive services, and received measurable results. By incorporating the essence of a high deductible health plan and health savings account (HSA), the Medicaid expansion project became the first in the nation to adopt – and successfully demonstrate – the linkage of personal responsibility with subsided health protection to low-income individuals.

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10 States move to impose Medicaid work requirements; Kentucky HEALTH becomes first to implement

Earlier this week, we examined a major shift involving states’ proposals to impose work requirements for Medicaid recipients through Section 1115 waivers. The move, which was announced by the Trump Administration on January 11, would affect nearly 70 million low-income people receiving benefits.

According to CMS, ten states – Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin – have already sent in proposals to add work requirements for Medicaid. On January 12, Kentucky became the first to gain CMS approval. Mississippi has also submitted a waiver proposal to CMS, but it has not yet been certified as complete.

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Alex Azar on track to become next HHS Secretary

Following yesterday’s Senate Finance Committee hearing, it appears Alex Azar, the former head of Pharmaceutical company Eli Lilly’s U.S. operation, is on track to be confirmed as the Head of the Department of Health and Human Services (HHS). If confirmed, Azar will replace Thomas Price M.D., a former congressman who served as the HHS secretary for seven months before resigning. 

Despite a probe by Democrats, including that from Sen. Ron Wyden (D-Oregon), on his drug industry ties, Republicans have focused on the fact that Azar would come to the job with greater working knowledge of the sprawling agency, with its budget of more than $1.1 trillion and far-flung staff of nearly 80,000, than many of his predecessors, according to the Washington Post 

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What’s new for SHOP in 2018

The Small Business Health Options Program (SHOP) will remain open for small businesses with 1-50 employees in 2018, and will boast new features that’ll impact how small employers and their employees enroll in and manage their coverage for SHOP plans starting on or after January 1, 2018.

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1115 Waivers Signal a Bright Future for Medicaid

Whether through analyzing social determinants, increasing engagement, or creating patient-centered approaches, it’s clear that the key to health issuers’ future success lies with the people they serve and the future of Medicaid Expansion.

The Affordable Care Act (ACA) opened the door to an improved Medicaid Managed Care system. With over 74,550,529 Medicaid and CHIP beneficiaries across the country, Medicaid programs have evolved to become highly complex, multibillion-dollar enterprises. Today, some states are implementing a wide range of initiatives to coordinate and integrate care beyond traditional care. One such method is the Section 1115 waiver, which focuses on improving care for populations with chronic and complex conditions, align payment incentives with goals, and drive accountability for quality care and coverage.

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At a Glance: Kentucky’s Medicaid Managed Care System

The Affordable Care Act (ACA) opened the door to an improved Medicaid Managed Care system. However, while the health law fundamentally transformed the health insurance policy landscape, the Commonwealth Fund concludes that state Medicaid programs still carry a heavy burden, since the Medicaid population is poorer and faces high health risks. Because of these risks, the likelihood for challenges such as reaching medically underserved communities, unstable eligibility and enrollment, developing effective payment incentives, organizing coverage, aligning managed care with health, education, and social services, as well as those relating to information technology (IT) is likely. In this blog, we examine the impact of Medicaid Expansion in the state of Kentucky, its current reform initiatives (e.g. 1115 Waivers), and recommendations to resolve common challenges faced by MCOs across the country.  

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Senate Hearings Day 3: Advocates Shed Light on State Flexibility

The Senate Committee on Health, Education, Labor, and Pensions (HELP) conducted its third hearing today, offering testimony of 5 advocates for state flexibility: Governor Michael O. Leavitt (R-Utah), Allison Leigh O’Toole, CEO at MNsure, Tarren Bragdon, CEO at the Foundation for Government Accountability, Bernard J. Tyson, Chairman and CEO at Kaiser Foundation Hospitals and Health Plan, Inc., and Tammy Tomczyk, Senior Principal and Consulting Actuary at Oliver Wyman.

With extensive experience in helping states offer insurance and addressing concerns around rising costs and healthcare accessibility, each witness shed light into innovate ways of addressing concerns within the individual health insurance market.

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Senate Hearings Day 2: U.S. Governors Offer Recommendations

The Senate Committee on Health, Education, Labor, and Pensions (HELP) kicked off their hearings on stabilizing the individual health insurance market on Wednesday. With the testimonials of 5 insurance commissioners,  it collectively suggested that resolving the market’s challenges would require added state flexibility via 1332 Waivers and the continuation of CSR payments.

During yesterday’s hearing (Day 2), members of the Committee heard from 5 Governors; Governor Steve Bullok (D-Mont.), Governor Charlie Baker (R-Mass), Governor John Hickenlooper (D-Col), and Governor Gary Herbert (R-Utah):

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Senate Hearings Day 1: State Insurance Commissioners Testify

The Senate Committee on Health, Education, Labor, and Pensions kicked off their hearings on stabilizing the individual health insurance market yesterday. These bipartisan discussions aim at strengthening our healthcare system for American families, or nearly 18 Million consumers. The first of four hearings, committee members heard from 5 insurance commissioners: Julie Mix McPeak (Tennessee), Mike Kreidler (Washington),  Lori Wing-Heier of Alaska, Teresa Miller (Pennsylvania), John Doak (Oklahoma):

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August Round Up: CMS Announces OEP Procedures; Senate Schedules Hearings; Navigator Funding; Bare Counties

On August 28, 2017, the Centers for Medicare and Medicaid Services released information providing insight into the procedures that it intends to follow for the 2018 open enrollment period. There are some new policies in place for the 2018 plan year, many of which have been introduced by the market stabilization rule:

Payments Rule

CMS has announced a new rule which will permit payments for new enrollees to be applied for past-due premiums owed to the insurer or an insurer in the same group. According to the released information, if payment of applicable past-due premiums and a new binder is not received for the new coverage, the insurer may refuse to effectuate coverage. The rule will allow a look-back period of up to 1 year, however the look-back period for 2018 coverage cannot extend beyond June 19, 2017. Insurers must have described its nonpayment policy in its application materials and in any notice of nonpayment of premiums. The policy may only be applied to enrollees that have received notice before failing to pay their premium that has become past-due, and only to enrollees who were contractually responsible for the nonpayment.

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