Manatt on Health Reform: Weekly Highlights

Marylanders can shop for coverage through the Marketplace’s new mobile app; Michigan expansion enrollees report increased access to care and improved health; and survey finds states’ eligibility and enrollment systems performed well during the third open enrollment period.


Colorado: Federal Lawsuit Filed Against State Over Access to Hepatitis C Drugs

The American Civil Liberties Union of Colorado filed a federal class action lawsuit on behalf of Medicaid enrollees denied access to anti-viral hepatitis C drugs, claiming the State violates federal law by not covering “medically necessary” drugs for all Medicaid enrollees. Previously, the State covered the drugs for patients in the final two stages of liver damage but earlier this month extended coverage to patients in the final three (of four) stages of liver damage and to women of childbearing age with hepatitis C at any stage. The drugs cost approximately $40,000 for a 12-week treatment. A federal judge ruling on a separate class action lawsuit ordered Washington State’s Medicaid agency to cover hepatitis C drugs regardless of the severity of an individual's liver condition beginning in May 2016.

Kansas: Report Indicates State Has Reduced Medicaid Application Backlog

The State Department of Health and Environment (DHE) has reduced the State’s Medicaid application backlog from nearly 14,200 applications on June 1 to just under 1,700 applications on September 2, according to a report from the State’s Legislative Division of Post Audit. During this time, DHE spent $2.3 million on increased staffing and resolved technical glitches in its application tracking system that contributed to the backlog. The DHE noted key factors that contributed to the backlog, including the launch of a new eligibility system in 2015, the unexpected influx of Medicaid applications as a result of the ACA, and that DHE became responsible for all KanCare (Medicaid) eligibility determinations beginning in January 2016 (the Department of Children and Families previously made determinations for the elderly and the disabled). DHE is submitting biweekly progress reports to CMS and expects to reduce the backlog to 100-150 applications by October 2016.

Michigan: Medicaid Expansion Enrollees Report Increased Coverage and Access to Care, Improved Health

Enrollees in the Healthy Michigan Plan, the State's alternative Medicaid expansion, report having increased coverage, improved access to care and improved health status, according to a new survey conducted by the University of Michigan Institute for Healthcare Policy and Innovation. According to Modern Healthcare, 60% of surveyed enrollees reported not having coverage prior to enrolling in the Healthy Michigan Plan; 90% reported that coverage is affordable; and 86% said that their ability to pay medical bills has improved since enrollment. The results of the survey were submitted to CMS on September 15.

Washington: Medicaid Agency Releases Two-Year Budget Requests

The State’s Medicaid agency released its FY 2017-2019 funding requests, a compilation of 26 separate requests that includes $538.7 million in requested federal and State funding for projected expenditures related to the Medicaid transformation waiver proposal currently under review by CMS. If approved, the waiver would authorize: provider incentives to reduce the total cost of care; home care as an alternative to external long-term care services; and supportive housing and supported employment services for high-need populations. The agency is also requesting $113.8 million of federal and State funding for the cost of treating Medicaid enrollees with hepatitis C. In May 2016, a federal judge ordered the State's Medicaid agency to cover hepatitis C drugs regardless of the severity of an individual’s liver condition.


Surveys Find Improved Eligibility and Enrollment Systems During Third Open Enrollment

Eligibility and enrollment systems in Colorado, Connecticut, Kentucky and Washington worked well during the third open enrollment period (OEP) and system enhancements successfully improved consumers’ experiences, according to a series of case studies and focus groups conducted by the Kaiser Family Foundation. (All four study states implemented Medicaid expansion and established State-based Marketplaces (SBMs) in 2014, though Kentucky is in the process of dismantling its SBM.) Washington’s Marketplace eliminated premium aggregation, which had slowed enrollment during the second OEP, and Colorado implemented expedited enrollment using dynamic income questions to direct people to the appropriate coverage program. Colorado also added consumer decision support tools, which the study found were particularly useful to consumers with chronic conditions. Automated Medicaid renewal processes appeared to also work well, with nearly 90% of Medicaid enrollees successfully renewing coverage. Despite fewer system glitches compared to previous OEPs, the authors found that eligibility and enrollment challenges persisted for immigrants and families with mixed coverage types. Marketplace enrollment increased in all study states except for Kentucky where it was flat, which the study’s authors attribute to the exit of a CO-OP plan and confusion over whether coverage through kynect, the State’s SBM, would remain available in light of the Governor’s announced intentions to dismantle it.

Colorado: State Approves an Average 20% Rate Increase for the Individual Market

The State Division of Insurance has approved a 20.4% average rate increase for the 2017 individual market, ranging from a 0.5% decrease to a 46.2% increase across carriers. Approximately 7.7% of the State’s population has coverage through the individual market. More than 92,000 of the nearly 450,000 individual market enrollees will need to select a different insurer for 2017 following carrier exits from the Marketplace, and 14 of Colorado’s 64 counties will only have one carrier option. The State also approved a 2.1% average rate increase for the small group market.

Maryland: Marketplace Launches Mobile App for Enrollment, Other Functions

The Maryland Health Benefits Exchange (MHBE) has launched a mobile app that consumers can use to apply for coverage, compare plan prices and ratings, view notices and upload documents for verification using the camera on their device. The app, called "Enroll MHC," will also indicate preliminary eligibility for federal tax credits and cost-sharing for Marketplace coverage and eligibility for Medicaid and CHIP. Enroll MHC will be linked to the Marketplace's desktop website, so users can save and complete applications across devices. Development of the app was spurred by MHBE consumer research indicating that one-third of visitors accessed the State's Marketplace using mobile devices. The app currently provides 2016 plan information and will be fully functional with 2017 plan information by late October.


CDC Publishes Annual National Health Statistics Report

The Centers for Disease Control and Prevention's National Center for Health Statistics published its 39th annual report on the health status of the country, providing detailed statistics on health status and determinants, utilization of healthcare services, healthcare resources, expenditures and payers, and a special feature on racial and ethnic health disparities. The many findings in the report include: the percentage of adults aged 18–64 who were uninsured decreased 20% between 2013 and 2014 and by another 22% between 2014 to June 2015, though 2015 data is preliminary. The percentage of adults aged 18–64 who reported delaying or not receiving needed medical care in the preceding 12 months fell from 14.7% in 2010 to 11.2% in 2014. The percentages for accessing prescription drugs fell from 11.2% to 7.6%.


Florida: Agency for Health Care Administration Secretary Retires

Liz Dudek, secretary of the Agency for Health Care Administration (AHCA), will retire on October 3 after five years in the role and more than 40 years in State government. As secretary of the AHCA, Dudek oversees operations for the Medicaid program, the Division of Health Quality Assurance, and the Center for Health Information and Policy Analysis. She also co-chaired the Commission on Healthcare and Hospital Funding. Justin Senior, the deputy secretary for the Division of Medicaid, will serve as interim secretary.

Nevada: Board Appoints New Marketplace Executive Director

The Silver State Health Insurance Exchange board named Heather Korbulic, the current chief operations officer, as the Exchange’s new executive director. Korbulic will replace current Executive Director Bruce Gilbert, who is stepping down to join TriHealth, an Ohio non-profit health system.

Wisconsin: Selection of New Medicaid Director Announced

Michael Heifetz will become the State’s next Medicaid director beginning on October 3. Heifetz most recently served as the State’s budget director and spent 10 years in the executive and legislative branches of State government. Heifetz will be taking over for Kevin Moore, who served as Medicaid director since early 2015 and is leaving to pursue opportunities in the private sector.



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