CSG Midwest
Under managed care, states do not pay health care providers on a fee-for-service basis. Instead, MCOs are paid an agreed-upon amount for each member’s health care expenses. Adjustments can be made to the per-member fee based on the health status of the member. Savings are shared between the states and the...

Two years ago, Colorado reported success in dramatically reducing the state’s teen birth and abortion rates by 48 percent from 2009 to 2014 through a privately funded initiative that provided long-acting reversible contraception, known as LARCs. LARCs—intrauterine devices, or IUDs, and subdermal contraceptive implants—are highly effective forms of birth control, with a pregnancy rate of less than 1 percent within the first year according to the Centers for Disease Control and Prevention. For comparison, oral contraceptive pills have a pregnancy rate of 9 percent and male condoms have a pregnancy rate of 18 percent in the first year. The LARC devices are effective for three to 10 years. In the last days of budget negotiation in Colorado in early April, legislators approved $2.5 million in state funding to provide LARCs to low-income women.

From economic and workforce development, to infrastructure and education, any number of items could have dominated discussions during the winter meeting of the National Governors Association, or NGA, in February. Yet, as the governors began to immerse themselves in committee reports and assemble a list of priorities for their meeting with President Barack Obama at the White House, it was the issue of opioid abuse and overdose deaths that dominated the agenda.

The U.S. Food and Drug Administration announced yesterday it will require “black box” warnings on all immediate-release opioid pain medications. The target of the warning is prescribers.

Despite pushing the federal government to provide 100 percent of the cost for health care for American Indians, what South Dakota Gov. Daugaard has characterized as a longstanding treaty obligation, on Feb. 29 Daugaard ruled out Medicaid expansion during this legislative session.

Last week, two states rejected Medicaid expansion, another is continuing negotiations with Washington and one is studying whether and how to continue expansion already in place and reduce the numbers of people eligible. Currently 31 states and the District of Columbia have expanded income eligibility for Medicaid as provided for by the Affordable Care Act. Sixteen states remain firmly in the non-expansion column.

On Tuesday, Jan. 12, John Bel Edwards signed his first executive order as Louisiana’s new governor to expand Medicaid eligibility to an estimated 300,000 individuals. The expansion is to be effective no later than July 1, 2016 according to the order.

Louisiana becomes the 31st state (plus DC) to expand Medicaid income eligibility as permitted by the Affordable Care Act.

South Dakota Gov. Dennis Daugaard may find that the third time is the charm as he negotiates with the federal government to live up to its treaty obligations to provide health services to the state’s Native Americans. Twice before in recent state history, governors have tried and failed to solve the longstanding problem, which results in a massive cost shift to state revenues to pay for health care for many Native Americans. In his Dec. 8, 2015, budget address in Pierre, S.D., Daugaard proposed that should the federal government fulfill its obligation to provide health services to Native Americans, the state would use the projected $67 million annual savings to the state to finance the cost of Medicaid expansion.

CSG Director of Fiscal and Economic Development Policy Jennifer Burnett outlines the top five issues for 2016, including strategic decisions following modest revenue growth, workforce development, public pensions, federal instability, and health care costs. 

CSG Director of Health Policy Debra Miller outlines the top five issues in health policy for 2016, including Medicaid expansion, substance abuse and drug overdoses, cost containment, the graying of America, and population health. 

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