Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

State Health Care

CMS Proposed Rule Cuts State Authority to Divert Medicaid Payments

July 10, 2018 - CMS has proposed a new rule that would eliminate a state’s authority to divert Medicaid payments away from providers. The rule is intended to ensure beneficiaries have adequate access to healthcare services through direct state-to-provider payments. In 2014, CMS allowed state governments to divert Medicaid payments from providers to specific third parties, such as in-home personal care...


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Vermont Government Plans Regulations for Association Health Plans

by Thomas Beaton

Vermont’s Department of Financial Regulation (DFR) is planning to implement emergency rules and regulations for association health plans (AHPs) following the Department of Labor’s final rule to allow AHP sales nationally. DFR said...

Aetna Takes Amerigroup Spot in Kansas Managed Medicaid Contract

by Thomas Beaton

Aetna has received a Managed Medicaid contract from the state of Kansas for plan year 2019 and will replace Amerigroup as one of the state’s three managed care payers. The state received six bids from commercial payers and determined that...

Maine Court to Force Medicaid Expansion Past LePage’s Block

by Thomas Beaton

A state-level court in Maine has forced Governor Paul LePage (R) and the Maine Department of Health and Human Services (DHHS) to uphold a ballot initiative that implements Medicaid expansion under the Affordable Care Act (ACA). Justice Michaela...

Early Health Insurance Premium Proposals Indicate Hikes for 2019

by Thomas Beaton

Significant increases to health insurance premiums are on the horizon for beneficiaries in multiple states as payers begin to share their 2019 rate plans.   A challenging regulatory landscape, complicated by policy changes that have altered...

Virginia Legislature Approves Medicaid Expansion

by Thomas Beaton

The Virginia General Assembly has passed Medicaid expansion as part of a two-year budget bill that could provide coverage to 400,000 newly eligible residents. The action would make Virginia the 33rd state in the US to expand Medicaid under the...

MN Law Allows Some Patients to Override Payers on Step Therapy

by Thomas Beaton

Minnesota Governor Mark Dayton has signed a bill into law that allows patients and providers to execute overrides on payer step therapy programs for prescription drug treatments in certain clinical situations. HF 3196 requires payers to bypass...

MD Extends All-Payer Model, Targets $1B in Medicare Savings

by Thomas Beaton

Maryland Governor Larry Hogan and CMS have announced a five year extension of the state’s All-Payer Model, targeting an additional $1 billion in Medicare savings over the coming years, according to a public statement from Hogan’s...

Experts Support Medicaid Work Requirements Lawsuit Against KY

by Thomas Beaton

A lawsuit that contends the legality of Medicaid work requirements in Kentucky has received support from 43 public health experts and 8 medical school deans who say the work requirements directly violate the Medicaid program. In an amicus brief,...

Rising Medical Costs Created Health Plan Enrollment Shifts in MN

by Thomas Beaton

The Minnesota of Council of Health Plans (MCHP) associated rising beneficiary medical costs in 2017 to irregular health plan enrollment shifts in both the private and public market. The Council said in a press release that a three percent increase...

AR Medicaid Demonstration Adds 9-Month Re-Enrollment Block

by Thomas Beaton

Arkansas received approval from CMS for a 1115 Medicaid demonstration that adds work requirements for Medicaid eligibility and adds a nine-month block on member re-enrollment if individuals don’t find work. Arkansas’ demonstration,...

Idaho’s Expansion of Association Health Plans Risks ACA Market

by Thomas Beaton

The Academy of Actuaries warned insurance officials and government leaders in Idaho that the decision to expand the sale of association health plans (AHP) will destabilize ACA individual health plan risk pools and reduce essential health protections....

AHA Makes Suggestions for In-State Insurance Market Stabilization

by Thomas Beaton

In order to stabilize in-state insurance markets, stakeholders should consider strategies including reinsurance, Medicaid-sponsored health plans, and high-risk pools, according to the AHA. Several factors are contributing to unstable state insurance...

KY Gets Approval for 1115 Medicaid Waiver with Work Requirements

by Thomas Beaton

Kentucky is the first state to receive approval for a 1115 Medicaid waiver demonstration that adds work requirements in order for able-bodied adults to be eligible for the public health insurance program. The Kentucky Health program demonstration...

CMS to Test Medicaid Waiver “Community Engagement” Incentives

by Thomas Beaton

CMS plans to support the addition of “community engagement” incentives to state 1115 Medicaid waivers that contain work eligibility requirements for able-bodied adults, the agency announced in a press release. The new policy guidance...

MI Requests Renewal of “Healthy Behaviors” 1115 Medicaid Waiver

by Thomas Beaton

Michigan is asking CMS for a renewal of its 1115 Medicaid waiver demonstration that increased the number of insured individuals in the state and led to a reduction in unhealthy behaviors. The demonstration, entitled the “Healthy Michigan...

Maine Referendum Expands Medicaid Despite Governor Opposition

by Thomas Beaton

The state of Maine has become the first state to expand Medicaid through a ballot vote that overrides Governor Paul R. LePage’s (ME-R) previous decisions to block the expansion, according to national news outlets. On Tuesday, Maine residents...

States Approve Premium Hikes after Loss of Cost Sharing Reductions

by Thomas Beaton

Several states have decided to either increase or maintain expected premium increases on individual and small group plans following the President’s decision to end the cost-sharing reductions (CSRs) that cover the cost of many Affordable...

Texas Requests Medicaid Waiver Extension for $6.2 Billion

by Jesse Migneault

Although Texas refused federal funds in the 2014 ACA Medicaid expansion, it has recently submitted documents requesting its second Medicaid waiver extension for $6.2 billion.   Originally approved in 2011, the 1115 Medicaid Waiver was...

Facing an Empty Exchange, Iowa Suggests Statewide Insurance Plan

by Jesse Migneault

If Iowa’s health insurance exchanges are completely abandoned, the state will request that the federal government allow the establishment of a state health care plan for 2018. If approved by CMS, the stopgap measure would create the Iowa...

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