South Dakota expects additional $18 million in Medicaid expansion savings due to CMS's revised IHS rules; Arizona uses procedural maneuvers to reinstate enrollment in CHIP; and comprehensive Medicaid managed care enrollment...more
CMS encourages access to Medicaid for eligible inmates transitioning to their communities, while New York seeks to extend Medicaid coverage to eligible inmates in the days prior to release; Pennsylvania seeks to shift $6...more
California's Marketplace revises its QHP contract to improve care quality and value, and announces its support for a 1332 waiver to allow undocumented immigrants to purchase Marketplace plans; Wisconsin proposes transitioning...more
Rhode Island's Medicaid reforms will save the State $75 million this year; HHS finds that Medicaid expansion improves behavioral healthcare; and California's Marketplace may exclude poor performing hospitals from its QHP...more
3/30/2016
/ Centers for Medicare & Medicaid Services (CMS) ,
Congressional Budget Office ,
Department of Health and Human Services (HHS) ,
GAO ,
Governor Vetoes ,
Healthcare.gov ,
Hospitals ,
Managed Care Contracts ,
Medicaid ,
Medicaid Expansion ,
Public Health Insurance Marketplace
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
Alabama receives federal approval for its Medicaid transformation waiver, while Michigan's Governor submits a Medicaid waiver on behalf of Flint residents; CMS announces $7.7 billion in reinsurance payments; and Vermont seeks...more
2/18/2016
/ Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Healthcare Reform ,
Hospitals ,
Medicaid ,
Medicaid Expansion ,
Public Health Insurance Marketplace ,
Qualified Health Plans ,
Reinsurance ,
SHOP Program ,
State Medicaid Programs ,
Waivers
HealthCare.gov enrolls 8.2 million; Manatt and RWJF release an open access dataset on Marketplace plans nationwide; Montana names administrator for its Medicaid expansion; and Michigan gets the green light in the nick of time...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
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
The GAO reports an increase in choice of plans both on and off Marketplaces; Hawaii submits the first 1332 waiver application, with a focus on substituting the employer mandate and SHOP provisions with pre-existing State...more
9/16/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Employer Mandates ,
GAO ,
Health Insurance Exchanges ,
Healthcare Reform ,
Healthcare.gov ,
Medicaid ,
Public Health Insurance Marketplace ,
SHOP Program ,
State Health Insurance Exchanges
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
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
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
Increased plan choice on HealthCare.gov is linked to lower premium growth; Arizona seeks changes to Medicaid expansion; and California and New York release detailed Marketplace and Medicaid enrollment reports....more
8/5/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Department of Health and Human Services (HHS) ,
Exemptions ,
Health Insurance ,
Health Insurance Exchanges ,
Health Savings Accounts ,
Healthcare ,
Healthcare Costs ,
Healthcare.gov ,
Medicaid ,
Medicaid Expansion ,
Medicare ,
Open Enrollment ,
Public Health Insurance Marketplace ,
State Health Insurance Exchanges
CMS offers a special enrollment period for HealthCare.gov enrollees whose incomes were miscalculated due to system error; California Marketplace announces two new insurers; and Connecticut’s budget reduces eligibility levels...more
7/29/2015
/ CCIIO ,
Centers for Medicare & Medicaid Services (CMS) ,
DSRIP ,
Enrollment ,
Fast Track Process ,
Health Insurance ,
Healthcare Reform ,
Healthcare.gov ,
IRS ,
Medicaid ,
Medicare ,
Public Health Insurance Marketplace ,
State Budgets ,
Tax Credits ,
Waivers