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Category: State & Federal Insurance Exchanges (page 1 of 4)

Trump Administration releases guidance on Medicaid work requirements

Matt Cummings

Solutions Architect at Softheon
Matthew is a Solutions Architect at Softheon. He works closely with Product and Development teams to design products and solutions to help Health Plans and other entities to excel in the marketplace. He received his bachelor's degree in Applied Psychology and Business Management from Stony Brook University in Stony Brook, New York.

What happened?  

In a major shift that could affect millions of low-income people receiving benefits, The Trump Administration announced Thursday, January 11, that it will open the door for states to require work requirements for Medicaid recipients.  

The guidance was published in a letter from CMS Deputy Administrator Brian Neale to State Medicaid Directors Thursday morning. In the letter, Deputy Administrator Neale stated that the move would help “improve Medicaid enrollee health and well-being through incentivizing work and community engagement.” 

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Alex Azar on track to become next HHS Secretary

Yvonne Villante
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Yvonne Villante

Director of Marketing at Softheon
Yvonne Villante is the Director of Marketing at Softheon. Before this, Yvonne held several roles within the organization including Senior Research Manager, Corporate Research Manager, and Marketing Research Analyst. She holds a MBA in healthcare administration from Ohio University and a BS in business management from SUNY Stony Brook. During her undergraduate studies, she graduated within the top 10% of her class.
Yvonne Villante
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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

Yvonne Villante
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Yvonne Villante

Director of Marketing at Softheon
Yvonne Villante is the Director of Marketing at Softheon. Before this, Yvonne held several roles within the organization including Senior Research Manager, Corporate Research Manager, and Marketing Research Analyst. She holds a MBA in healthcare administration from Ohio University and a BS in business management from SUNY Stony Brook. During her undergraduate studies, she graduated within the top 10% of her class.
Yvonne Villante
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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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CMS signals support for Medicaid work requirements

Sean Kirschner

Sean is a Business Analyst at Softheon. His objective is to provide insight into the current state of the healthcare landscape through research on both business and policy. He is also responsible for assisting the research team through creating and maintaining research briefings on various industry topics. He earned his bachelor’s degree in economics from Boston College.

Latest posts by Sean Kirschner (see all)

Earlier this month, the head of the Centers for Medicare and Medicaid Services (CMS), Seema Verma, made an announcement conveying that CMS would approve waiver applications from states that would require Medicaid enrollees to participate in “community engagement” activities, otherwise known as work requirements. This follows a letter co-authored by Verma that encouraged state Medicaid directors to use these waivers to modify their Medicaid programs to empower consumers. To advocates, work requirements are a way to empower Medicaid enrollees by encouraging them to be independent, self-sufficient consumers of healthcare.

Here’s what you should know about the proposed work requirements for Medicaid:

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Major changes to 1332 waivers could be coming

Sean Kirschner

Sean is a Business Analyst at Softheon. His objective is to provide insight into the current state of the healthcare landscape through research on both business and policy. He is also responsible for assisting the research team through creating and maintaining research briefings on various industry topics. He earned his bachelor’s degree in economics from Boston College.

Latest posts by Sean Kirschner (see all)

1332 waivers, or state innovation waivers, allow states to apply to the federal government to waive certain provisions of the Affordable Care Act (ACA) and pursue innovative strategies for providing residents with access to quality, affordable insurance while retaining the law’s basic protections. However, there are two developments currently in motion that could make significant changes to these waivers.

One is the Alexander-Murray bill, which is indirectly connected to the Congressional tax bill currently in the process of reconciliation between the Senate and the House. The other is a bill currently being drafted by Senators Orrin Hatch (R-UT) and Mike Crapo (R-ID) that would overhaul the 1332 process, altering many of the original stipulations laid out by the ACA.

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Repealing individual mandate: not as bad as once feared?

Matt Cummings

Solutions Architect at Softheon
Matthew is a Solutions Architect at Softheon. He works closely with Product and Development teams to design products and solutions to help Health Plans and other entities to excel in the marketplace. He received his bachelor's degree in Applied Psychology and Business Management from Stony Brook University in Stony Brook, New York.

Background

On Wednesday, December 13th, leaders from both the House and Senate will meet in Washington to finalize the Tax Cuts and Jobs Bill. If they decide to include removing the individual mandate, this will undoubtedly have an impact on healthcare in America – but it may be not as extreme as originally thought.

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Tax bill takes toll on individual mandate

Matt Cummings

Solutions Architect at Softheon
Matthew is a Solutions Architect at Softheon. He works closely with Product and Development teams to design products and solutions to help Health Plans and other entities to excel in the marketplace. He received his bachelor's degree in Applied Psychology and Business Management from Stony Brook University in Stony Brook, New York.

Background

On Saturday, December 2nd, the U.S. Senate passed The Tax Cuts and Jobs Act, which was drafted in a Republican effort to reform the U.S. tax code. This follows the passage of Congress’ version of the bill, which took place on November 16th. One of the key differences between the two bills is that the Senate’s version includes a provision that effectively removes the Affordable Care Act’s individual mandate, which requires all individuals to purchase health insurance.

As leaders from the Senate and Congress meet to discuss how to reconcile the two versions of the bill, the healthcare industry is waiting to see if the mandate will be removed and what some of the ramifications could be.

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Hidden benefits of medicaid expansion

Sean Kirschner

Sean is a Business Analyst at Softheon. His objective is to provide insight into the current state of the healthcare landscape through research on both business and policy. He is also responsible for assisting the research team through creating and maintaining research briefings on various industry topics. He earned his bachelor’s degree in economics from Boston College.

Latest posts by Sean Kirschner (see all)

Although there is still an ongoing debate in many states over whether or not to expand Medicaid, in the 33 states that have, unexpected benefits are starting to surface.

When the Patient Protection and Affordable Care Act (ACA) laid the framework for Medicaid Expansion, it allowed states to expand the income level needed to qualify for Medicaid. This gave a large number of Americans access to coverage. But it turns out this wasn’t the only benefit.

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A Victory for Maine Medicaid Could Be an Inspiration to Others

Sean Kirschner

Sean is a Business Analyst at Softheon. His objective is to provide insight into the current state of the healthcare landscape through research on both business and policy. He is also responsible for assisting the research team through creating and maintaining research briefings on various industry topics. He earned his bachelor’s degree in economics from Boston College.

Latest posts by Sean Kirschner (see all)

What happened?

In a first-of-its-kind vote, Maine residents elected to expand the state’s Medicaid program through a state-wide referendum on Tuesday, November 7.

The expansion easily passed with 59% of voters in favor. These results place a majority of Maine residents in opposition to the stance of their Governor, Paul LePage, who has vetoed five bills to expand Medicaid.

Maine was one of 19 states that did not initially expand Medicaid in reaction to the Patient Protection and Affordable Care Act (ACA) in 2010. The state previously expanded the program in 2003, increasing the eligible population and subsidizing private coverage, but LePage dismantled much of this framework when he took office in 2011.

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Three States Bar Issuers from Increasing Rates

Sean Kirschner

Sean is a Business Analyst at Softheon. His objective is to provide insight into the current state of the healthcare landscape through research on both business and policy. He is also responsible for assisting the research team through creating and maintaining research briefings on various industry topics. He earned his bachelor’s degree in economics from Boston College.

Latest posts by Sean Kirschner (see all)

UPDATE: On October 26th, North Dakota’s insurance commissioner announced that Sanford Health Plan will return to ND’s individual exchange for 2018, but only in 5 counties. Sanford’s Executive Vice President, Kirk Zimmer stated that the move was due to the Trump administration’s decision to cut off insurer subsidies.

Though the start of the 2018 Open Enrollment Period (OEP) is only a week away, there is unprecedented uncertainty around the Exchanges and federal funding established by the Patient Protection and Affordable Care Act (ACA). Despite this, three states have decided to hold their ground and block issuers from increasing member premiums for 2018.  

With rumors that the White House was considering ending cost-sharing reduction payments, many health insurance carriers increased their 2018 premium rates to account for the loss of government funding. Since the official decision to end the payments on October 12, even more health plans have raised their rates through an informal offer by the Department of Health and Human Services (HHS), allowing carriers to adjust their premium rates right up until OEP 2018 on November 1st (1).  

While insurers in all 50 states, plus D.C., have requested the approval of rate hikes, the insurance commissioners of Minnesota, North Dakota, and Vermont have unilaterally declared that they will deny any such request by insurers participating in their exchanges. They reason that the effect would be too severe with such little time until OEP 2018 begins on November 1st, justifying that their purpose is to protect consumers though whatever measures they can take. 

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