Health and well-being require far more than medical care. Research shows that personal behaviors, physical environments and socioeconomic factors—commonly referred to as social drivers of health (SDOH)—are responsible for 80...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
Maryland becomes the first State to mandate over-the-counter contraceptive coverage; Missouri plans to increase Medicaid asset limitations by 500% by 2021; and HHS' final rule extends protections against sex discrimination to...more
5/18/2016
/ Affordable Care Act ,
Contraceptive Coverage Mandate ,
Department of Health and Human Services (HHS) ,
Health Insurance ,
Health Insurance Exchanges ,
Medicaid ,
Opioid ,
Religious Accommodation ,
SCOTUS ,
Sex Discrimination ,
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
HHS approves waiver extending Medicaid coverage to Flint residents impacted by the water crisis; SCOTUS rules that states cannot require self-insured health plans to provide claims data; and seven insurers sign on to...more
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
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
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
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
HHS announces average premium price increases of 7.5% across HealthCare.gov; Michigan and Illinois launch the country’s first joint cloud-based, real-time Medicaid information management system; and the Marketplace carrier...more
10/28/2015
/ Affordable Care Act ,
Department of Health and Human Services (HHS) ,
Eligibility ,
Enrollment ,
GAO ,
Health Insurance ,
Healthcare ,
Healthcare.gov ,
Insurance Industry ,
Medicaid ,
Premiums ,
Prescription Drugs ,
Public Health Insurance Marketplace ,
Tax Credits ,
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
Born as an afterthought to Medicare five decades ago, Medicaid has evolved from an adjunct to state welfare programs to the nation’s largest health insurer. The occasion of Medicaid’s 50th birthday is a fitting time to...more
9/30/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Department of Health and Human Services (HHS) ,
Eligibility ,
Enrollment ,
Health Insurance ,
Information Technology ,
Medicaid ,
Medicaid Expansion ,
Medicaid Reform ,
Public Health Insurance Marketplace ,
State Medicaid Programs ,
Waivers
The Massachusetts Marketplace takes steps to ease consumer confusion by reducing choice among QHPs; North Carolina appears poised to pass Medicaid reform legislation; and bipartisan support is gaining for defining businesses...more
9/23/2015
/ Affordable Care Act ,
Bundled Payments ,
Burwell v Hobby Lobby ,
Census Bureau ,
Centers for Medicare & Medicaid Services (CMS) ,
Contraceptive Coverage Mandate ,
Department of Health and Human Services (HHS) ,
GAO ,
Governor Bentley ,
Governor McCrory ,
Health Insurance ,
Health Insurance Exchanges ,
Healthcare ,
Healthcare Reform ,
Hospitals ,
Long-Term Care ,
Managed Care Contracts ,
Medicaid ,
Medicaid Expansion ,
Medicaid Reform ,
Medicaid Reimbursements ,
Medicare ,
OIG ,
Pending Legislation ,
Public Health Insurance Marketplace ,
Qualified Health Plans ,
Religious Accommodation ,
SCOTUS ,
State Budgets ,
State Medicaid Programs
Colorado’s uninsured rate is down 9 percentage points in four years; Michigan requests increased cost-sharing for its Medicaid expansion population above the federal poverty line; and, HHS’s proposed guidance strengthens...more
9/10/2015
/ Affordable Care Act ,
Anti-Discrimination Policies ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Cost-Sharing ,
Department of Health and Human Services (HHS) ,
Disability Discrimination ,
Draft Guidance ,
Federal Health Insurance Exchanges ,
Gender Discrimination ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Medicaid ,
Medicaid Expansion ,
NPRM ,
Proposed Regulation ,
Public Health Insurance Marketplace ,
Qualified Health Plans ,
Sex Discrimination ,
Sexual Orientation Discrimination ,
State Health Insurance Exchanges ,
Tax Credits ,
Transgender ,
Waivers
Ohio’s Medicaid expenditures came in $2 billion below estimates despite enrollment growth after Medicaid expansion; California extends full Medicaid benefits to more pregnant women; and nearly one million have enrolled in...more
Reductions in uninsured rates are greatest in states with Medicaid expansions and State-based or State Partnership Marketplaces; Kentucky finds increased use of preventive healthcare following Medicaid expansion; and,...more
8/12/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Insurance Commissioners ,
IRS ,
King v Burwell ,
Medicaid ,
Medicaid Expansion ,
Medicare ,
OIG ,
Open Enrollment ,
Preventive Health Care ,
Public Health Insurance Marketplace ,
SCOTUS ,
State Medicaid Programs ,
Tax Credits
Increased plan choice on HealthCare.gov is linked to lower premium growth; Arizona seeks changes to Medicaid expansion; and California and New York release detailed Marketplace and Medicaid enrollment reports....more
8/5/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Department of Health and Human Services (HHS) ,
Exemptions ,
Health Insurance ,
Health Insurance Exchanges ,
Health Savings Accounts ,
Healthcare ,
Healthcare Costs ,
Healthcare.gov ,
Medicaid ,
Medicaid Expansion ,
Medicare ,
Open Enrollment ,
Public Health Insurance Marketplace ,
State Health Insurance Exchanges
In quick succession, governors in Alaska and Utah announce Medicaid expansions this week; Iowa is transitioning its expansion away from the Marketplace to Medicaid managed care, for now; and, HHS extends its exception to...more
7/22/2015
/ Affordable Care Act ,
Burwell v Hobby Lobby ,
Centers for Medicare & Medicaid Services (CMS) ,
Contraceptive Coverage Mandate ,
Cost Allocation ,
Department of Agriculture ,
Department of Health and Human Services (HHS) ,
Eligibility ,
Employer Mandates ,
Enrollment ,
GAO ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare.gov ,
Hospitals ,
Medicaid ,
Medicaid Expansion ,
Medicare ,
OMB ,
Physicians ,
Proposed Legislation ,
Public Health Insurance Marketplace ,
Qualified Health Plans ,
SCOTUS ,
Tribal Governments
Topping the news, last week's King v. Burwell ruling preserved subsidies for the 6.7 million people receiving them through the federal marketplace.
In other news, President Obama pledged renewed efforts to work with...more
7/1/2015
/ Affordable Care Act ,
Chevron Deference ,
Department of Health and Human Services (HHS) ,
Health Insurance ,
Health Insurance Exchanges ,
King v Burwell ,
Medicaid ,
Medicaid Expansion ,
Public Health Insurance Marketplace ,
SCOTUS ,
Standard of Review ,
State Health Insurance Exchanges
Early data emerges on the impact of Medicaid expansion on states’ budgets and enrollees’ healthy behaviors. Read on for the latest in state and federal health reform updates and Manatt’s staffing announcement. ...more
Wrapping up the 2015 enrollment period, Healthcare.gov and State-based Marketplaces in seven states have announced special enrollment periods (SEPs) for people who were uninsured in 2014 and discover they owe a “shared...more
With the holiday season underway, this week the Federal government awarded $110 million in exchange establishment grants, released proposed rules to permit employees to receive employer-sponsored insurance and tax credits,...more
This week, a federal Issuer Bulletin describes how issuers in the Federally Facilitated Marketplace will identify their existing enrollees who are switching plans for 2015 coverage. The Exchange Board in New Mexico proposes a...more
12/4/2014
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Enrollment ,
Health Insurance ,
Health Insurance Exchanges ,
IRS ,
Marketplace Notice ,
Medicaid ,
Medicaid Expansion ,
SHOP Program ,
Subsidies