Waiver Program to Offer States Increased Flexibility

On October 22, 2018, the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Treasury jointly announced new guidance overhauling the 1332 Waiver process, which will take effect in 2020. With modification of the 1332 waiver process, the new policy will address states’ request for greater flexibility. It will also permit states to use waivers to increase choice and competition within their insurance markets, use subsidies to help consumers afford health coverage, and introduce new flexibilities.  

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Section 1115 Waivers: The effects of Medicaid expansion under the Affordable Care Act

To date, 33 states and the District of Columbia have expanded their programs, 8 utilizing a Section 1115 Waiver.  Another 17 are not currently expanding, however, their interest will soon be measured on ballots this Fall.   

Overall, the impacts have been significant; coverage, access to care, and delivery system reform have all seen changes. Medicaid expansion has positively affected utilization of services, the affordability of care, and financial security among the low-income population. According to Kaiser Family Foundation (KFF), Medicaid expansion states have also experienced significant coverage gains and reductions in uninsured rates – among the low-income population broadly and within specific vulnerable populations.  

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MESC 2018 Recap: Day 1

The annual Medicaid Enterprise Systems Conference (MESC) kicked off with a boom. Set in beautiful Portland, Oregon, the event welcomed the who’s who of Medicaid. Nearly 100 sessions are packed into 4 days of fun- filled announcements and discussions about Medicaid and where the industry is headed.

Day 1 rang in with an overarching theme: “What’s your next big idea in Medicaid?” If you weren’t able to attend, check out our MESC recap of key takeaways:

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CMS restores Affordable Care Act risk-adjustment transfers for 2017 benefit year

Yesterday, the Centers for Medicare and Medicaid Services (CMS) released a final rule designed to allow and reissue payments under the Affordable Act risk-adjustment program to balance the insurance market. According to CMS Administrator Seema Verma, “This rule will restore operation of the risk adjustment program and mitigate some of the uncertainty caused by the New Mexico litigation.”  

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Preparing for 2019 Open Enrollment: Softheon Enhanced Direct Enrollment (EDE) delivers a better consumer experience and enables new consumer self-service policy management capabilities

As health plans consider implementing and launching an EDE solution for ACA 2019 Open Enrollment, it’s become clear that EDE is much more than an improvement to the Marketplace (or on-exchange) enrollment process and post- enrollment policy management for consumers – it’s the beginning of a real-time, API driven service to promote an improved healthcare consumer insurance benefit shopping experience with online self-service updates.

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Virginia Senate passes Medicaid Expansion

400,000 Virginians will soon benefit, following Wednesday’s decision by state legislature, to expand its Medicaid program.  

Virginia joins 32 states and the District of Columbia in expanding its public health insurance program under the Affordable Care Act. The new health care law, which is slated to take effect on January 1, would introduce changes to Virginia’s Medicaid program, which, according to reports, is one of the most “restrictive” in the nation.  

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Addressing Social Determinants of Health (SDoH) through Medicaid

Affecting a broad range of health and quality-of-life outcomes, socioeconomic, and environmental factors constitute what is known as Social Determinants of Health (SDoH). These factors can be used to create social and physical environments that promote good health.

To achieve better outcomes, states and managed care organizations (MCO) must first understand what determines and impacts their members’ health. These stakeholders must be able to “assess risk, identify trends, stratify member risk, and proactively intervene.” To this notion, there is a clear demand for predictive accuracy of risk associated with healthcare and related costs.

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Enhanced direct enrollment eliminates ‘double redirect’, establishes new policy management strategy

In June 2018, the Federally-Facilitated-Marketplace (FFM) is expected to launch new technology known as Enhanced Direct Enrollment (EDE) – which will allow consumers and agent/brokers to shop, enroll, and manage policy changes to Marketplace health products, without ever having to create an application on Healthcare.gov or contact Marketplace Customer Service. 

EDE is a unified enrollment experience that contains an updated, easy-to-use, portal for Marketplace members. EDE will eliminate the current “double redirect” to HealthCare.gov, using a series of CMS-based APIs to process eligibility and changes behind the scenes. This new portal will allow issuers and agent/brokers to establish and maintain relationships with members from initial enrollment, through mid-year changes, and into renewal. The goal of EDE is to provide consumers and health insurance brokers with alternatives to shop for and enroll in coverage, providing the data and tools needed to effectuate and maintain policies.  

In our new whitepaper former Executive Director for Aetna’s Exchange program and Founder, JGood Advisors, Jane Good discusses Enhanced Direct Enrollment (EDE) and this new policy strategy.

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1332 State Innovation Waivers: Current status & potential opportunities

Section 1332 waivers, or state innovation waivers, allow states to apply to the federal government to waive certain provisions of the Affordable Care Act (ACA). This can allow the states to pursue innovative strategies for providing residents with access to quality, affordable insurance, while retaining the law’s basic protections. In this blog we evaluate state’s waiver approval statuses. 

Below is our analysis for states with approved, pending, and withdrawn requests.

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Does the Healthy Indiana Plan 2.0 have national aspirations?

For the last six years, the Healthy Indiana Plan (HIP) has delivered quality care, encouraged the use of preventive services, and received measurable results. By incorporating the essence of a high deductible health plan and health savings account (HSA), the Medicaid expansion project became the first in the nation to adopt – and successfully demonstrate – the linkage of personal responsibility with subsided health protection to low-income individuals.

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