Insurance Coverage and Medical Care

At the same time the federal government has announced a new emphasis on reviewing how well states enforce Medicaid eligibility rules, it has offered a new tool to help states improve accuracy and speed up the eligibility determination process.
In June 2018, the Trump administration announced new initiatives to increase Medicaid program integrity. These initiatives include assuring that states effectively enforce Medicaid beneficiary eligibility rules. The Government Accountability Office (GAO) estimates that improper Medicaid payments totaling $11.3 billion were made in 2017 because of state errors in eligibility determinations.

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In March, ADAPT Pharma, a subsidiary of Emergent BioSolutions and CSG Associate, announced the expansion of its program offering free NARCAN Nasal Spray – the leading community use naloxone – to U.S. high schools and eligible colleges and universities. NARCAN Nasal Spray 4mg is the only FDA-approved, needle-free formulation of naloxone for the emergency treatment of a known or suspected opioid overdose. As part of this effort, ADAPT Pharma will:

• Expand free NARCAN Nasal Spray availability by eliminating the prior 20,000 cartons cap for eligible colleges and universities
• Double the allocation to high schools from one free carton (two 4mg doses) to two free cartons (four 4mg doses)
• Extend the term of the free NARCAN Nasal Spray offer until it is in every high school and eligible college and university in the United States

CSG Midwest
In October, the Trump Administration adopted new rules for short-term (or “skinny”) health insurance plans. Since then, some states have weighed in by adopting new rules of their own, while also reminding insurers that they must still comply with state-level regulations.

While a federal district court struck down the Affordable Care Act as unconstitutional on December 14, the Act and the litigation will continue. The judge didn’t issue a nationwide injunction which would have had the effect of immediately ceasing all aspects of law.

Unsurprisingly, the states defending the law have stated they will appeal this ruling to the Eleventh Circuit. Particularly if the Eleventh Circuit agrees with the lower court the Supreme Court is likely to hear this case though not until its next term beginning October 2019.

The Affordable Care Act individual mandate required uninsured who didn’t purchase health insurance to pay a so-called shared-responsibility payment. In 2012 the Supreme Court held the individual mandate is a constitutional “exercise of Congress’s Tax Power because it triggered a tax.” The Tax Cuts and Jobs Act of 2017 reduced the tax to $0 as of January 1, 2019.

CSG Midwest
Wisconsin has received federal approval of changes to its Medicaid program that include requiring work for some enrollees and charging higher premiums based on the results of a health risk assessment. The approved waiver centers on childless adults applying for and receiving coverage through the public health insurance program. According to The Washington Post, Wisconsin also had originally sought to become the first state in the nation to impose drug tests on some of its Medicaid population. This requirement did not receive federal approval.

Ballot measures to expand Medicaid eligibility in Idaho, Nebraska and Utah passed in the mid-term elections. Montana voters rejected a measure to continue the expansion in their state.

On Oct. 22, the federal government issued new draft regulations concerning 1332 waivers. In a call to CSG from the Centers for Medicare and Medicaid Services (CMS), officials explained the new regulations would provide more flexibility to states, revising the “guardrails” set in the 2012 regulations. Plans previously considered non-ACA compliant could be sold on the marketplaces and could qualify for federal subsidies. 

CSG Midwest
By 2022, every hospital emergency room in Illinois must have staff that can provide specialized care to victims of sexual assault. This new requirement is the result of HB 5245, a bill passed unanimously by the General Assembly and signed into law this summer. Under the law, a trained provider will have to be present in the emergency room within 90 minutes of the patient arriving in the hospital. According to the Illinois attorney general’s office, few hospitals currently provide specialized care for sexual assault victims.
CSG Midwest
Residents living in more than half of the nation’s counties have only one insurer to choose from on their state’s Affordable Care Act health insurance exchange. This lack of options is most prevalent in rural areas: 41 percent of enrollees in non-metro counties vs. the overall rate of 21 percent, according to the Kaiser Family Foundation.
Could the creation of agricultural cooperative health plans help fill insurance gaps, offer more choices for consumers and lower costs?

Yesterday, the U.S. Census Bureau released a report with 2017 data on health insurance status in each state. In 2017, 28.5 million people (or 8.8 percent) did not have health insurance at any point during the year. The uninsured rate and number were not statistically different from 2016. In some states the uninsured rate change between 2016 and 2017 was statistically significant. In three states – California, Louisiana, and New York—the percentage of people without insurance decreased, but in 14 states the percentage increased. The states where the uninsured rates increased are Connecticut, Florida, Georgia, Illinois, Iowa, Massachusetts, Minnesota, Ohio, Oregon, South Carolina, Tennessee, Texas, Vermont and West Virginia.

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