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Brief & Report

Governors’ Proposed Budgets for FY 2019: Focus on Medicaid and Other Health Priorities

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This issue brief provides Medicaid highlights from governors’ proposed budgets for state fiscal year (FY) 2019 (July 1, 2018 through June 30, 2019 in most states). Proposed budgets reflect the priorities of the governor and are often blueprints for the legislature to consider. In total, 39 proposed state budgets and text from 46 state of the state speeches were reviewed. This review revealed that while state revenue collections improved in 2017 compared to 2016, considerable economic and regional variation persists, many states are facing significant budget challenges unrelated to Medicaid such as unfunded pension liabilities or falling oil prices, and the outlook for 2018 remains uncertain due, in part, to the impacts of the 2017 Federal Tax Reform Act.

Contributors

Larisa Antonisse, Policy Analyst, Program on Medicaid and the Uninsured, Kaiser Family Foundation
Robin Rudowitz, Associate Director, Program on Medicaid and the Uninsured, Kaiser Family Foundation
Kathleen Gifford, Principal, Health Management Associates

Brief & Report

Four Briefs Examine New Home and Community-Based Services Settings Rules

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The federal Center for Medicaid and Medicare Services (CMS) promulgated regulations in 2014 which established standards for the settings in which Medicaid-reimbursed home and community-based services (HCBS) may be provided (42 C.F.R. § 441.301). These regulations also pertain to the settings in which individuals who receive HCBS may reside, even if the Medicaid HCBS are provided in a different setting. The federal regulations focus on community integration, individual choice and privacy, and other factors that relate to an individual’s experience of the setting as being home-like and not institution-like. These regulations set a floor for Medicaid reimbursement, but states may elect to set more stringent requirements. States have been charged with developing a transition plan to ensure that state Medicaid programs come into compliance with the new HCBS expectations by March 2022. As of November 2017, seven states (Arkansas, Delaware, Kentucky, Oklahoma, Tennessee, Washington, and the District of Columbia) have received final CMS approval of their Transition Plans.

The four briefs below examine new settings rules for HCBS:

An Effective Person-Centered Planning Process Is Key for Memory Care Units

Community Integration Options and Resident Choice Are Key in Assessment of Co-Located Assisted Living Communities and Inpatient Facilities

Ensuring Individual Choice and Privacy

Resolving Differences Between State Assisted Living Licensure Requirements and HCBS Settings Rule

Brief & Report

Preliminary Look at Key Healthcare Proposals in 32 States from Governors’ Proposed Budgets for SFY 2019

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The preliminary report presents key healthcare proposals from governors’ proposed state budget documents for state fiscal year (SFY) 2019, state-of-the-state speeches, news reports, and other budget-related documents, based on a review of these materials by the Kaiser Family Foundation and Health Management Associates. Proposed budgets reflect the priorities of the governor and are often blueprints for the legislature to consider, however, the level of detail presented in governors’ proposed budget documents varies significantly and in most cases does not capture all of the activity in a given state. As of the time of this publication, the table includes information from 32 governors’ proposed budgets and will be updated periodically as additional budgets are released and reviewed. The table captures proposals that fall into six categories:

  • Medicaid spending cuts
  • Medicaid enhancements
  • Medicaid work requirements
  • Other major Medicaid proposals
  • Opioid/behavioral health proposals (both within and outside of Medicaid)
  • Other major non-Medicaid healthcare proposals

Read more: http://kaiserf.am/2HkH8GK

Brief & Report

Report Examines Emerging Innovations in Managed Long-Term Services and Supports for Family Caregivers

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The paper—co-written by the AARP Public Policy Institute and Health Management Associates—highlights examples of how progressive managed care plans are supporting family caregivers who are caring for plan members with LTSS needs. The purpose of this paper is for plan administrators, policymakers, and community-based organizations to learn from one another and ultimately adopt these practices, resulting in better care for members and their family caregivers.

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Brief & Report

Annual Survey Finds Medicaid Enrollment Growth Slowing, Uptick in Spending Growth

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Medicaid Moving Ahead in Uncertain Times: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2017 and 2018

Medicaid enrollment continues to slow in FY 2017 and FY 2018; however, states project an uptick in spending in FY 2018. This is just one finding in the 17th annual 50-state Medicaid Budget Survey conducted by The Kaiser Family Foundation and in collaboration with Health Management Associates (HMA) and the National Association of Medicaid Directors.

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Brief & Report

Hospital Charges and Reimbursement for Drugs: Analysis of Markups Relative to Acquisition Cost

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Analyses of prescription drug spending trends may not always include the role various parts of the pharmaceutical supply chain play in those trends. This analysis examines hospital charges and reimbursement for 20 drugs for which hospital reimbursement data is provided in the Magellan Rx Management Medical Pharmacy Trend Report™: 2016 Seventh Edition (the Magellan report). Charges were calculated from claims data, as described in the methodology at the end of this report. Magellan reports that prescriptions in the hospital outpatient setting account for 52% of spending on medical-benefit drugs (drugs, typically physician-administered, that are reimbursed under health plans’ medical benefit rather than the pharmacy benefit) for commercial payers.

Brief & Report

Report Provides Analysis and Technical Assistance on Oklahoma’s Section 1332 Waiver

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This report was prepared by HMA and Leavitt Partners for the Oklahoma State Department of Health.

During the 2016 session, Oklahoma’s legislature enacted Senate Bill (SB) 1386, which authorized the development of a Section 1332 State Innovation Waiver. The goals of the legislation were to improve healthcare quality and access in the state while reducing costs, and to meet the needs of Oklahomans by developing a system that provides more affordable health care options. A Section 1332 Waiver, which allows states to obtain flexibility within selected requirements of the Affordable Care Act (ACA), represents an opportunity for Oklahoma to develop its own unique program that is responsive to the needs of the state’s residents.

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Brief & Report

Medicaid and Social Determinants of Health: Adjusting Payment and Measuring Health Outcomes

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With the support of State Health and Value Strategies, Ellen Breslin and Anissa Lambertino of Health Management Associates, in partnership with Dennis Heaphy of the Disability Policy Consortium and Tony Dreyfus, prepared a recently released issue brief “Medicaid and Social Determinants of Health: Adjusting Payment and Measuring Health Outcomes.”

This brief answers two key questions for state policy makers:

  1. Why should Medicaid programs account for social determinants of health (SDOH) in setting payments and in measuring quality?
  2. What methods can Medicaid programs use to examine SDOH and account for them in their payment and/or quality improvement policies?

Case studies from Medicaid agency efforts in both Massachusetts and Minnesota will be used to answer these questions.

This brief was prepared to accompany the recent State Health and Value Strategies webinar “Using Social Determinants of Health Data in Medicaid Managed Care.”

Brief & Report

Report Examines State Medicaid Coverage of Perinatal and Maternal Benefits

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Medicaid Coverage of Pregnancy and Perinatal Benefits: Results from a State Survey

This report, authored by the Kaiser Family Foundation and Health Management Associates (HMA), analyzes the status of Medicaid benefit policies for perinatal and family planning services in 40 states and the District of Columbia.

While inpatient and outpatient hospital care must be covered for pregnant women under the federal scope of Medicaid, it is up to the discretion of states to define which other maternal benefits are included. Most states cover a broad range of perinatal services such as ultrasounds and prenatal vitamins. Other services are less likely to be covered by the states, including parenting classes and breastfeeding education.

Key findings in the report are presented in the areas of:

  • Perinatal services
  • Counseling and support services
  • Delivery and postpartum care
  • Breastfeeding services

HMA’s Kathleen Gifford co-authored the report along with Usha Ranji, Alina Salganicoff and Ivette Gomez of the Kaiser Family Foundation and Jenna Walls. This report serves as a companion report to Medicaid Coverage of Family Planning Benefits: Results from a State Survey, released in September 2016 by the same authors.

Brief & Report

Report Shares Lessons as Affordable Housing Providers, MMC Programs Forge Partnerships

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A growing body of literature continues to validate the importance of addressing the social and structural determinants of health to improve health outcomes, and promote opportunity and economic mobility. Affordable, service-enriched housing plays a vital role in this work, with a growing momentum to collaborate across the health and housing sectors through lessons learned from research and demonstration projects across the nation.

Stewards of Affordable Housing for the Future (SAHF) members are experienced nonprofit housing providers that have collaborated with healthcare stakeholders for many years. However, few have had direct partnerships with insurers. Beginning in 2014, SAHF engaged its members in efforts to “match-make” business relationships with Medicaid payers to implement joint initiatives that would demonstrate and assess the contributions of service-enriched housing to the healthcare system.

On April 24, SAHF, in partnership with Health Management Associates (HMA), and with support from the Kresge Foundation, released its report, The Path to Partnership: Lessons Learned in the Pursuit of Joint Initiatives between Affordable Housing Providers and Medicaid Managed Care Programs. SAHF members who participated in this matchmaking activity included Mercy Housing, Volunteers of America (VOA) and National Church Residences. HMA worked with SAHF members on market scans, and HMA initiated outreach to potential health plan partners, which resulted in joint initiatives in Atlanta, Denver and Pittsburgh.

The report identifies the following lessons learned from the efforts to date:

  • Joint initiatives must address the problem of scale;
  • Housing providers must be willing to adapt services to meet the requirements of the healthcare system;
  • Housing providers must present a business case to potential health plan partners that includes primary and secondary benefits;
  • HIPAA compliance needs to be addressed as a potential barrier; and
  • Healthcare partners and housing providers need to be realistic about joint initiative resource requirements.