The authors are grateful for insights provided by state Medicaid agency staff from the Arizona Health Care Cost Containment System, MassHealth, New York State Department of Health, Oregon Health Authority, Rhode Island...more
On October 24, 2018, North Carolina received approval from the federal Centers for Medicare & Medicaid Services (CMS) of its 1115 waiver for a five-year demonstration period. The waiver provides the North Carolina Department...more
On November 20, 2017, North Carolina submitted an amended 1115 waiver application to the Centers for Medicare & Medicaid Services (CMS) seeking authority to invest $1.2 billion over five years in a range of targeted...more
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 encourages access to Medicaid for eligible inmates transitioning to their communities, while New York seeks to extend Medicaid coverage to eligible inmates in the days prior to release; Pennsylvania seeks to shift $6...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
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
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
HealthCare.gov enrolls 8.2 million; Manatt and RWJF release an open access dataset on Marketplace plans nationwide; Montana names administrator for its Medicaid expansion; and Michigan gets the green light in the nick of time...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
CMS concludes no QHPs can be certified as comparable to CHIP coverage; California's Marketplace plans to connect consumers to vision coverage issuers; and states react to CMS's proposed HealthCare.gov user fee....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