South Dakota expects additional $18 million in Medicaid expansion savings due to CMS's revised IHS rules; Arizona uses procedural maneuvers to reinstate enrollment in CHIP; and comprehensive Medicaid managed care enrollment...more
CMS's sweeping final rule aligns Medicaid and CHIP managed care with QHP and Medicare Advantage regulations; New York's DSRIP is enabling change in the State's Medicaid delivery system; and Medicaid expansion reduces...more
California's Marketplace revises its QHP contract to improve care quality and value, and announces its support for a 1332 waiver to allow undocumented immigrants to purchase Marketplace plans; Wisconsin proposes transitioning...more
Oklahoma proposes Medicaid coverage for 175,000 currently uninsured; a report finds State-based Marketplaces boost Medicaid enrollment growth rates; and CMS issues a final rule on mental health parity in Medicaid and CHIP....more
4/6/2016
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Contraceptive Coverage Mandate ,
Employer Mandates ,
Enrollment ,
Medicaid Expansion ,
Mental Health ,
SCOTUS ,
State Health Insurance Exchanges ,
Zubik v Burwell
Rhode Island's Medicaid reforms will save the State $75 million this year; HHS finds that Medicaid expansion improves behavioral healthcare; and California's Marketplace may exclude poor performing hospitals from its QHP...more
3/30/2016
/ Centers for Medicare & Medicaid Services (CMS) ,
Congressional Budget Office ,
Department of Health and Human Services (HHS) ,
GAO ,
Governor Vetoes ,
Healthcare.gov ,
Hospitals ,
Managed Care Contracts ,
Medicaid ,
Medicaid Expansion ,
Public Health Insurance Marketplace
Oklahoma seeks federal approval for premium assistance program targeted to American Indians/Alaska Natives; Louisiana estimates $100 million in net savings from Medicaid expansion; and Vermont becomes the first state to...more
3/23/2016
/ 1332 Waiver ,
Co-Op ,
Department of Health and Human Services (HHS) ,
Drug & Alcohol Abuse ,
GAO ,
Health Insurance ,
Medicaid ,
Medicaid Expansion ,
Mental Health ,
Native American Issues ,
Premium Assistance ,
Public Health Insurance Marketplace ,
SHOP Program
The IRS releases guidance on resolving Form 1095 conflicts; New Hampshire's Medicaid expansion renewal clears a hurdle in the State; and New York providers get $1.5 billion in long-awaited DSRIP capital and infrastructure...more
3/16/2016
/ Centers for Medicare & Medicaid Services (CMS) ,
DSRIP ,
Health Insurance ,
Healthcare Reform ,
IRS ,
Legislative Agendas ,
Medicaid ,
Medicaid Expansion ,
Prescription Drugs ,
Public Health Insurance Marketplace ,
State and Local Government
STATE STAFFING UPDATES:
Nevada: New Insurance Commissioner Appointed -
The Director of Nevada's Department and Industry announced Barbara Richardson as the Commissioner of the Division of Insurance. Richardson...more
3/2/2016
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Department of Health and Human Services (HHS) ,
GAO ,
Healthcare Reform ,
Healthcare.gov ,
Managed Care Contracts ,
Medicaid ,
Medicaid Expansion ,
Native American Issues ,
OIG ,
State Health Insurance Exchanges
Medicaid expansion cuts the number of low-income adults without health insurance in Kentucky by nearly 70%; the Georgia legislature considers a "Private Option" coverage expansion bill; and CMS and AHIP collaborate on quality...more
Alabama receives federal approval for its Medicaid transformation waiver, while Michigan's Governor submits a Medicaid waiver on behalf of Flint residents; CMS announces $7.7 billion in reinsurance payments; and Vermont seeks...more
2/18/2016
/ Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Healthcare Reform ,
Hospitals ,
Medicaid ,
Medicaid Expansion ,
Public Health Insurance Marketplace ,
Qualified Health Plans ,
Reinsurance ,
SHOP Program ,
State Medicaid Programs ,
Waivers
CMS details requirements for Kentucky's transition to HealthCare.gov; a new special enrollment period is established for subsidy-eligible individuals who failed to file their 2014 taxes; and President Obama sends his final...more
Virginia submits a $1 billion DSRIP application; Michigan's Governor will request authority to extend Medicaid coverage to Flint residents aged 21 and under; and Hawaii reinstates small business tax credits in its updated...more
Louisiana's Governor pushes ahead on Medicaid expansion, while expansion is blocked by Wyoming's Legislature; Massachusetts plans to submit a 1332 waiver application to preserve its merged markets; and CBO lowers its 2016...more
1/28/2016
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Healthcare Reform ,
Healthcare.gov ,
Medicaid ,
Medicaid Expansion ,
Medicare ,
Prescription Drugs ,
State Budgets ,
State Health Insurance Exchanges ,
Tax Credits
Minnesota's Task Force recommends maintaining their State-based Marketplace while Oregon considers bringing back theirs; CMS narrows the criteria for special enrollment periods; and President Obama seeks an extension of full...more
Louisiana's Governor signs an executive order on his first day in office to expand Medicaid; Kentucky's Governor opts to replace, rather than repeal, its Medicaid expansion program; and New York and Missouri make it easier...more
Guidance from HHS and Treasury sets a high bar for 1332 waiver approvals; Kentuckians support Medicaid expansion and their State Marketplace despite plans to change course; and South Dakota's executive budget includes funds...more
12/16/2015
/ Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Co-Op ,
Department of Health and Human Services (HHS) ,
Health Insurance ,
IRS ,
Managed Care Contracts ,
Medicaid Expansion ,
Public Health Insurance Marketplace ,
Shared Responsibility Rule ,
State Health Insurance Exchanges ,
U.S. Treasury ,
Waivers
A flurry of support for Medicaid expansion this week…with Virginia hospitals backing a provider assessment, Wyoming's Governor putting forth a budget initiative, and Arkansas announcing plans to extend its waiver. Meanwhile,...more
12/10/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Conflicts of Interest ,
Enrollment ,
Governor Pence ,
Healthcare Costs ,
Healthcare Reform ,
Medicaid ,
Medicaid Expansion ,
State Budgets ,
Waivers
HHS proposes significant new network adequacy standards and surprise billing protections for 2017 QHPs; Louisiana's Governor-elect reiterates his intent to expand Medicaid on "Day One"; and California considers pursuing a...more
Kansas legislators supportive of Medicaid expansion are pulled from committee; Montana’s Medicaid expansion is off to a strong start; and New Mexico sees declines in uncompensated care since ACA implementation....more
11/18/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Healthcare.gov ,
Legislative Committees ,
Managed Care Contracts ,
Medicaid Expansion ,
Medicaid Reform ,
Request for Proposals ,
State Health Insurance Exchanges ,
Waivers
With the election of a new Governor, the future of Kentucky’s Marketplace and Medicaid expansion is uncertain; CMS questions Iowa on its Medicaid managed care transition timeline; and the Supreme Court agrees to hear a case...more
11/11/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Co-Op ,
Contraceptive Coverage Mandate ,
Hepatitis C ,
Medicaid ,
Medicaid Expansion ,
Medicaid Reform ,
Pharmaceutical Industry ,
SCOTUS ,
State Health Insurance Exchanges
Montana receives approval to expand Medicaid beginning 2016; California’s $6.2 billion Medicaid waiver receives pre-approval; and HHS proposes broadening circumstances under which states receive enhanced federal matching...more
11/5/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Co-Op ,
Comment Period ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare.gov ,
Medi-Cal ,
Medicaid ,
Medicaid Expansion ,
Medicaid Reform ,
Native American Issues ,
Open Enrollment ,
Proposed Amendments ,
Public Health Insurance Marketplace ,
State Health Insurance Exchanges ,
Waivers
Editor’s note: Born as an afterthought to Medicare five decades ago, Medicaid has evolved from an adjunct to state welfare programs into the nation’s largest health insurer. Medicaid’s 50th birthday is a fitting time to...more
10/27/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Eligibility ,
Enrollment ,
Health Care Providers ,
Health Information Technologies ,
Health Insurance ,
Healthcare ,
Healthcare Costs ,
Healthcare Reform ,
Medicaid ,
Medicaid Expansion ,
Medicaid Reform ,
Public Health Insurance Marketplace ,
State Medicaid Programs ,
Tax Credits ,
Value-Based Purchasing ,
Waivers
Arizona seeks Medicaid Waiver to implement new coverage restrictions for Medicaid expansion enrollees and delivery system reform; Tennessee’s uninsured rate continues to drop; and Louisiana gubernatorial candidates line up...more
10/21/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Co-Op ,
Co-payments ,
Cost-Sharing ,
Department of Health and Human Services (HHS) ,
DSRIP ,
Enrollment ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Hospitals ,
Medicaid ,
Medicaid Expansion ,
Medicaid Reform ,
OIG ,
Public Health Insurance Marketplace ,
Qualified Health Plans ,
State Health Insurance Exchanges ,
Tax Credits ,
Waivers
Iowa's largest insurer joins the State's Marketplace for coverage year 2017; carrier changes are announced for Marketplaces in Kentucky, Oklahoma and Wyoming; and South Dakota's Governor convenes the Health Care Solutions...more
10/14/2015
/ Affordable Care Act ,
Blue Cross ,
Blue Shield ,
Health Care Providers ,
Health Insurance ,
Health Insurance Exchanges ,
Healthcare Reform ,
Healthcare.gov ,
HIV ,
Managed Care Contracts ,
Medicaid ,
Medicaid Expansion ,
Open Enrollment ,
Public Health Insurance Marketplace ,
Qualified Health Plans
Congress passes a bill to give states greater flexibility in defining “small businesses”; South Dakota seeks to offset Medicaid expansion costs in part with increased use of the fully federally-funded Indian Health Service;...more
10/7/2015
/ Centers for Medicare & Medicaid Services (CMS) ,
Co-Op ,
DSRIP ,
Enrollment ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Healthcare.gov ,
Medicaid ,
Medicaid Expansion ,
Medicaid Reform ,
Pending Legislation ,
Public Health Insurance Marketplace ,
Qualified Health Plans ,
Small Employers ,
Waivers