Manatt on Health Reform: Weekly Highlights

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 healthcare measures for public and private payers.

STATE MEDICAID EXPANSION NEWS:

Arkansas: Governor Says Federal Officials Committed to Revising State's Medicaid Expansion

Governor Asa Hutchinson (R) told legislators last week that federal officials were broadly supportive of his plan to amend the State's Medicaid expansion waiver and were committed to finding common ground on the proposed changes. The Governor's plan, called "Arkansas Works," proposes mandatory premium assistance for employer sponsored insurance, a work referral program, and premiums for beneficiaries with incomes above 100% of the federal poverty level. Hutchinson said he will call a special legislative session to consider "Arkansas Works" one week before the State's fiscal session begins in April. The Governor's plan will require three-fourths majority support in the Arkansas House and Senate to become law, after which the State will be required to submit a Medicaid waiver amendment application to the federal government.

Georgia: Legislature Holds Hearing on Coverage Expansion Bill

The State Senate Health Committee held a hearing on Senate Bill 368, legislation proposing a premium assistance program based on Arkansas's "Private Option" that would cover approximately 300,000 Georgians by permitting Medicaid to purchase qualified health plans on the Marketplace and requiring enrollees to spend up to 5% of their income towards the cost of coverage. The program would be contingent upon receiving a federal match consistent with President Obama's proposal to provide non-expansion states that take up the option the same funding algorithm as states that expanded in 2014. Governor Nathan Deal (R) has historically opposed Medicaid expansion and has not commented on the pending legislation.

Idaho: House Committee Denies Funding for Primary Care Access Program

Idaho's House State Affairs Committee rejected a bill that would have partially funded Governor C.L. "Butch" Otter's (R) Primary Care Access Program (introduced previously in a separate bill), according to local media reports. The vote effectively ends the administration's attempt to cover basic primary care services for the approximately 78,000 Idaho adults age 19-64 who earn too much to qualify for Medicaid but not enough to qualify for federal Marketplace tax subsidies. Idaho is among the 19 states that have not expanded Medicaid under the ACA. The bill would have provided $19 million for the program from the State's Millennium Fund (which is funded by a nationwide tobacco settlement) to cover a portion of the program's estimated $30 million annual cost. The source for the remainder of the funding was unclear.

Kentucky: Medicaid Expansion Cuts Low-Income Uninsurance Rate by Two-Thirds, Study Finds

A Health Affairsstudy from the University of Louisville found that that the uninsurance rate among low-income adult Kentuckians was reduced from 35% at the end of 2013 to 11% at the end of 2014, a 68% reduction. The report also found a 16-percentage-point reduction in low-income Kentuckians with unmet medical needs due to cost. The report's release comes amid recent discussion of changes to the State's Medicaid expansion program and the State's insurance Marketplace. Governor Matt Bevin (R) has already begun the process of transitioning the State-based Marketplace, kynect, to HealthCare.gov, and he has formed a committee to lead the redesign of the Medicaid expansion program through a federal waiver.

Wyoming: Senate Votes for Coverage Program for the Uninsured

The State Senate passed a bill that would direct the legislature's Management Council (or its designee) to design a program to "provide greater health status improvements" than those provided by Medicaid for individuals who cannot "afford adequate health care." The bill, sponsored by State Senator Charles Scott (R)—a vocal opponent of Medicaid expansion—allocates $20,000 for the design of the program and prohibits the State from seeking approval from the federal government to expand Medicaid expansion prior to the legislature's review of the medical assistance program design. Just last week the legislature rejected a bill that would expand Medicaid to Wyoming's estimated 20,000 uninsured.

FEDERAL & STATE HEALTH REFORM ACTIVITY:

CMS and AHIP Release Quality Metrics to Align Public and Private Payers

CMS released its first set of core quality healthcare measures intended to align quality improvement efforts across public and private payers with broadly agreed upon measures in seven categories: accountable care organizations, patient centered medical homes, and primary care; cardiology; gastroenterology; HIV and hepatitis C; medical oncology; obstetrics and gynecology; and orthopedics. The measures were developed by the Core Quality Measures Collaborative, a group representing CMS, America's Health Insurance Plans, the National Quality Forum, physician groups and other stakeholders. CMS intends to implement the quality measures in Medicare as appropriate and will work with the Office of Personnel Management, the Department of Defense, the Department of Veterans Affairs and state Medicaid agencies to do the same. According to CMS, commercial health plans have committed to implementing the core set of measures as part of their contract cycles. The Collaborative will monitor usage of the measures, modify existing measures, and select new measures as needed.

Louisiana: Analysis Estimates Millions in Medicaid Managed Care Savings

An analysis performed by an independent reviewer and paid for by Louisiana's five participating Medicaid managed care organizations (MCOs) found that the managed care program saved between $250 million and $437 million in Medicaid expenditures in 2015 compared to what costs would have been for the same members under a fee-for-service model. The estimated savings were determined by comparing the MCOs' 2015 capitation rates to a range of fee-for-service spending forecasts for the same period. The savings represent 6.7% to 11.2% of estimated fee-for-service costs.

STATE MARKETPLACE UPDATE:

Massachusetts: Marketplace Releases Detailed Report of Open Enrollment Period

The Massachusetts Health Connector added 36,000 new enrollees to the Marketplace during the 2016 open enrollment period, more than 30% of whom previously had coverage from another source, and over 40% of whom had no gap in coverage prior to enrolling on the Health Connector. Nearly 30% of new enrollees purchasing unsubsidized coverage were between 25 and 34 years old—the largest share by age group. The Health Connector also retained 94% of its enrollees between 2015 and 2016, the vast majority of whom stayed in the same metallic tier and with the same carrier. As of February 8, 201,000 individuals were enrolled in Massachusetts' qualified health plans for 2016.

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