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.
MEDICAID EXPANSION & REFORM NEWS:
Kansas: Three Members of House Committee Ousted Due to Support of Medicaid Expansion
Kansas House Speaker Ray Merrick (R) has removed three moderate GOP members from the House Health and Human Services Committee due to their support of Medicaid expansion. The debate over Medicaid expansion has been gaining attention in the wake of a rural hospital closure. According to Representative Merrick, the members' removal was “in the best interests of our caucus and state.” Representative Barbara Bollier (R), a retired physician and one of the three members removed, said that while she would continue to participate in the debate as actively as possible, she was saddened that “three of the most knowledgeable people on health care issues are being removed from all of the policymaking decisions.” The other two legislators pulled from the committee are Representative Susan Concannon (R), the former director of the Mitchell County Regional Medical Foundation, and Representative Don Hill (R), a practicing pharmacist.
Montana: Enrollment in Medicaid Expansion Exceeds Expectations
In the first week after CMS approved Montana's expanded Medicaid program, approximately 5,500 Montanans applied and were approved to enroll in the program, representing nearly one-quarter of the total number of Montanans that Governor Steve Bullock (D) estimated would enroll during the first six months. The Governor stated, "High enrollment in the plan in its first week shows just how critical the need for quality, affordable health care is for Montanans." Coverage through the expansion is set to begin January 1, 2016.
Nebraska: Health Department Moves Toward Integration of Medicaid Services with Managed Care RFP
The Nebraska Department of Health and Human Services released a Request for Proposals for the integration of physical health, behavioral health, and pharmacy services under a new Medicaid managed care initiative called Heritage Health. The State currently works with three insurance companies that manage enrollees’ physical health and two separate entities for behavioral health and pharmacy services. Heritage Health is intended to streamline the delivery model for Medicaid beneficiaries by providing them with a simple, comprehensive package of healthcare benefits. Approximately 230,000 enrollees will be served by Heritage Health, including 41,000 who were previously excluded from the managed physical health care program. Proposals are due December 22, 2015, and Heritage Health is scheduled to begin operations on January 1, 2017.
Virginia: Up to $38 Million in Medicaid Benefits Provided to Ineligible Recipients
An audit by the State’s Joint Legislative Audit and Review Commission found that up to $38 million in Medicaid payments were made in 2014 for services provided to individuals determined Medicaid ineligible during the renewal process whose renewals were processed after payments were made. The audit pointed to overburdened eligibility workers and recommended revising how administrative funds were distributed to regional Medicaid offices to reflect caseloads. Linda Nablo, the Chief Deputy Director for the Department of Medical Assistance Services said new policies to address issues discovered in the audit are expected to be in place by the end of the year.
Over 70% of Medicaid Beneficiaries Are in Managed Care, According to New Report
More than 51 million Americans receive Medicaid benefits through a private managed Medicaid plan, an increase from last year of 7.8 million beneficiaries, according to a new report by PwC. In addition, the number of Medicaid beneficiaries enrolled in fee for service or public managed care programs decreased by 1.4 million over the past year. Forty-one states currently provide coverage through private managed Medicaid, though the proportion of states’ Medicaid populations in these plans ranges from 100% of the Medicaid population in Hawaii and Tennessee to 1% in Idaho. Private managed Medicaid plans are highly local and increasingly consolidated: 90% of the 194 total plans operate in only one state, and of those, the largest 12 plans account for 56% of total membership.
MORE STATE MEDICAID & MARKETPLACE NEWS:
Massachusetts: Consideration of 1332 Waiver Underway
The Massachusetts Health Connector, in response to a directive from the Governor, has identified potential policy areas of interest for a Section 1332 waiver and begun engaging waiver stakeholders. The Health Connector plans to further explore such policy areas as: streamlining the federal individual mandate to better align with the State’s individual mandate; refining employers’ and employees’ choices in the Small Business Health Options Program; streamlining eligibility and income rules between MassHealth and the Health Connector; modifying its subsidy mechanism to buffer enrollees from complexities of premium tax credits and reconciliation; incorporating the total cost of family coverage when measuring affordability of employer sponsored insurance; and modifying the approach to “grace periods” for enrollees receiving premium tax credits to prevent retroactive terminations of coverage. Contingent on support and interest from stakeholders, the Connector aims to submit a waiver application to CMS by March 2016.
Kentucky: Outgoing Governor Urges Continuation of Medicaid Expansion and State-Based Marketplace
Governor Steve Beshear (D) encouraged Governor-elect Matt Bevin (R) to maintain Medicaid expansion and kynect, the State’s health insurance Marketplace, pointing to the economic and health benefits derived from the programs as demonstrated in a progress report on kyhealthnow, the Governor’s wellness initiative. During the gubernatorial campaign, Governor-elect Bevin had pledged to repeal Medicaid expansion and to dismantle kynect, though in more recent interviews he expressed openness to maintaining expansion through an 1115 Medicaid waiver. In his speech, Governor Beshear also cited a new report by the Kentucky Center for Economic Policy, which found that over 73,800 working Kentuckians received coverage through Medicaid expansion, with the restaurant industry, construction industry, and temp agencies seeing the greatest number of individuals covered. The Cabinet for Health and Family Services and the Office of the State Budget Director have said it would cost at least $300 million over the next two years to roll back Medicaid expansion.
New Mexico: Legislative Finance Committee Highlights Decline in Uncompensated Care After ACA
Upon request by the Legislature, the New Mexico Legislative Finance Committee released a report studying the effect of the ACA on uncompensated care in the State's hospitals. The Committee found that "by all measures, the costs of uncompensated care have dropped in New Mexico" since 2013. Alongside a 4.1% drop in the share of New Mexicans without insurance, uncompensated care as a percent of hospital expenses dropped 12.5% and uncompensated care in CMS hospital cost reports dropped 3.6% from 2013 to 2014. In addition, applications for reimbursement from the State's Safety Net Care Pool dropped 30.4% from 2014 to 2015.
FEDERAL ACTIVITY:
Final ACA Health Plan Regulations Released
Interim health insurance regulations in effect since the Affordable Care Act’s 2010 enactment—including the requirement that health plans provide internal appeal and external review processes, cover dependent children to age 26, and the prohibition on lifetime and annual benefit limits—were finalized this week. The insurance reforms became applicable six months after the ACA’s enactment, leaving little time for public comment and requiring the regulations to be issued as interim final regulations. Clarifications in the final rules released this week include: plans cannot require dependent children to live in a plan’s service area to be eligible for dependent coverage; states may not impose new filing fee requirements for external review of an adverse coverage determination; states may continue to use existing external review processes that do not fully meet National Association of Insurance Commissioners standards through 2017; and pediatric subspecialists can be designated as a child’s primary care provider. Federal officials also indicated that they are evaluating options for preventing out-of-network providers from balance billing patients when they are treated for emergency services at an in-network hospital. Any changes in the final rules will go into effect beginning 2017.
More than 500,000 HealthCare.gov Plans Selected in First Week of Open Enrollment
In the first week of the 2015 open enrollment period, nearly 544,000 individuals selected an insurance plan through HealthCare.gov, according to CMS, an increase of approximately 17% from the number of selections made in the first week of 2014 open enrollment. Thirty-four percent of 2015 plan selections were made by consumers enrolling in a HealthCare.gov plan for the first time, while the remaining 66% were renewing coverage. The previous year, plan selections were split almost evenly between new and returning enrollees. As noted in a Health Affairs blog, this year’s proportions may reflect that there are fewer people remaining to newly enroll in Marketplace plans and that the message to current enrollees to actively renew is working. To effectuate enrollment, those who have selected a plan must pay their first premium. Further demonstrating a strong first week of open enrollment, more than 3 million users visited HealthCare.gov and over 1 million applications for coverage were submitted.
STATE STAFFING UPDATES:
Hawaii: Health Connector Executive Director Steps Down
Hawaii Health Connector’s Executive Director Jeff Kissel will resign on December 4, 2015, having held the position since October 2014. He was the Connector's third Executive Director. Kissel will join the Energy Policy Research Foundation, Inc. (EPRINC) as an EPRINC Distinguished Fellow. The announcement comes as Hawaii transitions the Connector’s plan management and consumer assistance functions to state agencies and begins utilizing HealthCare.gov for eligibility and enrollment functions for 2016 open enrollment.
Texas: New Health Services Commissioner Named
Dr. John Hellerstedt was named the new Commissioner of the Department of State Health Services, effective January 1, 2016. Dr. Hellerstedt previously served as Medical Director for the Medicaid and Children’s Health Insurance Program Division before assuming his current position as Chief Medical Officer at the Seton Family of Hospitals. Dr. Hellerstedt's appointment comes a week after Gary Jessee was named the new State Medicaid Director.