Blog

Premium Assistance Programs for the Working Adult Population in Medicaid Expansion States

This week, our In Focus section comes to us from HMA Senior Consultant Erin Mathies (Indianapolis), who reviews the premium assistance programs for the working adult population in Medicaid expansion states. Medicaid programs that pay for premiums in commercial insurance for individuals eligible for Medicaid have been part of state Medicaid programs since the 1990s. Under a premium assistance program, the employer or individual market coverage is the primary plan and Medicaid supports the cost of the premium, pays for cost sharing, and provides any wrapped benefits. These programs can save money for state Medicaid agencies by leveraging the employer contribution towards premiums and holding expenditures per member to the annual out of pocket maximum amounts. Existing Health Insurance Premium Payment (HIPP) programs traditionally cover children and populations with disabilities. Individuals eligible under the Medicaid Expansions may be more likely to have access to employer sponsored-insurance (ESI) and leveraging premium assistance options for these populations represents an unrealized opportunity for many state Medicaid agencies.

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Proposed Policy Changes Affecting Health Reimbursement Arrangements

This week, our In Focus section comes to us from HMA Senior Consultant Ryan Mooney (Austin), who reviewed the proposed rule on Health Reimbursement Arrangements (HRAs). On October 29, 2018, the U.S. Department of the Treasury, the Department of Labor, and the Department of Health and Human Services published a proposed rule (83 FR 54420), the purpose of which is to expand the use of HRAs. An HRA is an employer-supported account that helps employees pay for qualified medical expenses not covered by their health plans. The proposed rule is the latest component of the President’s Executive Order 13813, which directed the federal government to expand and facilitate access to association health plans, short-term and limited-duration insurance products, and HRAs. 

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Navigating CMS’ Proposed Medicaid Managed Care Regulations

This week’s HMA Weekly Roundup features an In Focus article from HMA Senior Consultants Amber Swartzell and Stephanie Baume (Indiana), who reviewed the Centers for Medicare & Medicaid Services (CMS) proposed Medicaid managed care regulations. On November 8, 2018, CMS released a proposed rule that would update several sections of the Medicaid and Children’s Health Insurance Program (CHIP) managed care rules, which were most recently amended in 2016. This much anticipated proposal, scheduled to appear in the Federal Register on November 14, 2018, focuses on “promoting flexibility, strengthening accountability, and maintaining and enhancing program integrity.” The key provisions of the proposed regulations are summarized below.

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Florida Statewide Medicaid Managed Care (SMMC) Awards

This week, our In Focus section comes to us from Principal Elaine Peters (HMA – Florida), who reviews the recent re-procurement by the Florida Agency for Health Care Administration (AHCA) of its Statewide Medicaid Managed Care (SMMC) health and dental plans.  The SMMC program currently has two key program components:  Long-Term Care (LTC) and Managed Medical Assistance (MMA).  The new SMMC program changes the two components to: Integrated MMA and LTC and Dental.  The 2016 Legislature “carved out” dental services from MMA plans and new dental plans will be responsible for providing dental services to eligible members.

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A Deeper Look Into Highlights From the Kaiser/HMA 50-State Medicaid Director Survey

This week, our In Focus section reviews highlights and shares key takeaways from the 18th annual Medicaid Budget Survey conducted by The Kaiser Family Foundation (KFF) and Health Management Associates (HMA). Survey results were released on October 25, 2018, in two new reports: States Focus on Quality and Outcomes Amid Waiver Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2018 and 2019 and Medicaid Enrollment & Spending Growth: FY 2018 & 2019. The reports were prepared by Kathleen Gifford, Eileen Ellis, Barbara Coulter Edwards, and Aimee Lashbrook from HMA, and by Elizabeth Hinton, Larisa Antonisse, and Robin Rudowitz from the Kaiser Family Foundation. The survey was conducted in collaboration with the National Association of Medicaid Directors.

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CMS Guidance on ACA Section 1332 Waivers

This week, our In Focus section comes to us from Principal Nora Leibowitz, reviewing the Centers for Medicare & Medicaid Services (CMS) guidance on Section 1332 waivers. The State Relief and Empowerment Waivers guidance, published in the Federal Register on October 24, 2018, updates the guidance related to Section 1332 of the Patient Protection and Affordable Care Act (PPACA) and its implementing regulations. Section 1332 establishes State Innovation Waivers, the authority by which a state can make changes impacting:[1]

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CMS Section 1115 Medicaid Demonstration Evaluation Requirements: Implications for Designing Consumerism & Personal Responsibility Waivers

This week, our In Focus section highlights HMA Medicaid Market Solutions’ (MMS) efforts to support state flexibility in designing and implementing Section 1115 Demonstration Waivers promoting member engagement and personal responsibility. Over the coming weeks, HMA MMS will present a series of articles providing in-depth analyses of the many facets of these new Medicaid models. This week, we examine the implications for designing consumerism and personal responsibility waivers.

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Texas Medicaid and CHIP Managed Care Final Comprehensive Report

This week, our In Focus section comes to us from Senior Consultant Ryan Mooney, reviewing the Texas Medicaid and Children’s Health Insurance Program (CHIP) Evaluation report. The 85th Legislature of the State of Texas required the Texas Health and Human Services Commission (HHSC) to report on its findings for Rider 61, Evaluation of Medicaid Managed Care (the Report). HHSC recently published the Report, which includes the following:

  1. Rider 61(a) – A review of the current Medicaid and Children’s Health Insurance Program (CHIP) managed care delivery system and an assessment of the performance of managed care;
  2. Rider 61(b) – An assessment of Medicaid and CHIP managed care contract review and oversight;
  3. Rider 61(c) – A study of Medicaid Managed Care rate setting processes and methodologies in other states; and
  4. Rider 61(d) – An analysis of MCO administrative costs, including a survey of each MCO to determine the nature and scale of administrative resources devoted to the Texas Medicaid and CHIP programs and the identification of cost reduction opportunities.

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