It is widely recognized that social and economic factors—such as housing, food, toxic stress and income—have a significant impact on individuals’ and communities’ health. These factors, often referred to as “social...more
Editor’s Note: The Affordable Care Act (ACA) brought sweeping changes to the Medicaid program that have had profound implications for family planning coverage, services and providers. In particular, in the 17 states with...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
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
The IRS releases guidance on resolving Form 1095 conflicts; New Hampshire's Medicaid expansion renewal clears a hurdle in the State; and New York providers get $1.5 billion in long-awaited DSRIP capital and infrastructure...more
3/16/2016
/ Centers for Medicare & Medicaid Services (CMS) ,
DSRIP ,
Health Insurance ,
Healthcare Reform ,
IRS ,
Legislative Agendas ,
Medicaid ,
Medicaid Expansion ,
Prescription Drugs ,
Public Health Insurance Marketplace ,
State and Local Government
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
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...more
Minnesota's Task Force recommends maintaining their State-based Marketplace while Oregon considers bringing back theirs; CMS narrows the criteria for special enrollment periods; and President Obama seeks an extension of full...more
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
CMS concludes no QHPs can be certified as comparable to CHIP coverage; California's Marketplace plans to connect consumers to vision coverage issuers; and states react to CMS's proposed HealthCare.gov user fee....more
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
Editor’s note: Born as an afterthought to Medicare five decades ago, Medicaid has evolved from an adjunct to state welfare programs into the nation’s largest health insurer. Medicaid’s 50th birthday is a fitting time to...more
10/27/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Eligibility ,
Enrollment ,
Health Care Providers ,
Health Information Technologies ,
Health Insurance ,
Healthcare ,
Healthcare Costs ,
Healthcare Reform ,
Medicaid ,
Medicaid Expansion ,
Medicaid Reform ,
Public Health Insurance Marketplace ,
State Medicaid Programs ,
Tax Credits ,
Value-Based Purchasing ,
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
Iowa's largest insurer joins the State's Marketplace for coverage year 2017; carrier changes are announced for Marketplaces in Kentucky, Oklahoma and Wyoming; and South Dakota's Governor convenes the Health Care Solutions...more
10/14/2015
/ Affordable Care Act ,
Blue Cross ,
Blue Shield ,
Health Care Providers ,
Health Insurance ,
Health Insurance Exchanges ,
Healthcare Reform ,
Healthcare.gov ,
HIV ,
Managed Care Contracts ,
Medicaid ,
Medicaid Expansion ,
Open Enrollment ,
Public Health Insurance Marketplace ,
Qualified Health Plans
Congress passes a bill to give states greater flexibility in defining “small businesses”; South Dakota seeks to offset Medicaid expansion costs in part with increased use of the fully federally-funded Indian Health Service;...more
10/7/2015
/ Centers for Medicare & Medicaid Services (CMS) ,
Co-Op ,
DSRIP ,
Enrollment ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Healthcare.gov ,
Medicaid ,
Medicaid Expansion ,
Medicaid Reform ,
Pending Legislation ,
Public Health Insurance Marketplace ,
Qualified Health Plans ,
Small Employers ,
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
New study shows Marketplace premiums parallel the employer market; Montana likely to select a private insurer to administer benefits to its Medicaid expansion population; and Washington’s Exchange customers will begin paying...more
9/30/2015
/ Affordable Care Act ,
Audit Reports ,
Blue Cross ,
Centers for Medicare & Medicaid Services (CMS) ,
Co-Op ,
Cost-Sharing ,
Deductibles ,
Eligibility ,
Employer Group Health Plans ,
Employer Mandates ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Hospitals ,
Medicaid ,
Medicaid Expansion ,
Medicaid Reform ,
Minimum Essential Coverage ,
NYDFS ,
OIG ,
Public Health Insurance Marketplace ,
State Health Insurance Exchanges ,
Verification Requirements
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
CMS permits states to use income information from other means-tested benefit programs for Medicaid eligibility determinations; Alaska’s Medicaid expansion is given the green light to launch today; and Washington State submits...more
9/4/2015
/ Affordable Care Act ,
Blue Cross ,
Cadillac Tax ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Co-Op ,
Comment Period ,
Eligibility ,
Essential Health Benefits ,
Federally Facilitated Exchanges ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
IRS ,
Means Test ,
Medicaid ,
Medicaid Expansion ,
Medicare ,
Payment Systems ,
Premiums ,
Reconciliation ,
SNAP Program ,
Special Assessments ,
State Health Insurance Exchanges ,
Tax Returns
Arkansas's “Private Option” is projected to have a net impact of $438 million on state funds 2017-2021; Iowa selects MCOs for proposed Medicaid managed care transition; and, the DC Marketplace launches a robust dual-language...more
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