Blog & News
Lynn Blewett Discusses Minnesota’s 1332 Reinsurance Waiver on Health Affairs BlogDecember 12, 2017:
SHADAC Director Lynn Blewett discusses Minnesota’s 1332 reinsurance waiver request and the federal response in a new post on the Health Affairs Blog.
Minnesota’s 1332 Waiver Request
Minnesota submitted a 1332 reinsurance waiver request to the Centers for Medicare and Medicaid Services in May 2017, asking for pass-through funding to support a reinsurance program and to support the state’s Basic Health Program, MinnesotaCare, which would otherwise face reduced funding with reinsurance in place.
CMS approved the pass-through funding for the state’s reinsurance program but not for the BHP, resulting in an estimated $369 million loss to the state over two years.
CMS took longer to respond to Minnesota’s waiver request than is typical, and the state’s Republican legislature and Democratic Governor Mark Dayton found themselves without enough time to craft an alternative plan due to ongoing tensions between the two sides. In mid-October, Governor Dayton officially but only partially accepted the terms and conditions of the 1332 waiver, objecting to CMS's interpretation of federal law in reducing the state's BHP funding and noting that Minnesota “reserves all of its rights” to the funding. According to the Governor, MinnesotaCare is fully funded through 2019.
Dr. Blewett points out that Minnesota may have pursued a different strategy toward its coverage programs had the risk to BHP funding been known and calls for clear timelines and waiver guidelines from CMS moving forward.
Blog & News
SHADAC Comments on New Direction for Center for Medicare and Medicaid InnovationDecember 07, 2017:
On September 20, 2017, the federal Center for Medicare and Medicaid Innovation (Innovation Center) issued a request for stakeholder feedback on a proposed new direction for the Center, which is shifting its focus toward testing new models of patient-centered care that emphasize choice and competition.
|Innovation Center: Elements of Proposed New Direction|
Potential Models of Interest
The Innovation Center laid out a set of guiding principles for this shift as well as a list of potential models of interest (see text box).
Comments from SHADAC: Summary
Drawing on our experience providing evaluation services to states implementing innovative ways to deliver and pay for health care, SHADAC provided feedback to the Innovation Center. This feedback is summarized below.
Feedback: Guiding Principles
SHADAC commented on the principles of (a) transparent model design and evaluation and (b) small-scale testing.
Regarding transparency in model design and evaluation, we emphasized two key points:
- Successful model design should include planning and discussion of parameters for evaluation. Specifically, the information, data, and evidence needed to determine the impact of new models should be determined in advance, and data collection and evaluation requirements should be prioritized from the outset and revisited over time.
- Evaluations of innovations should include clear documentation of actual interventions to assess outcomes. Evaluations must determine how models are implemented in practice (versus planned interventions) in order to better associate interventions with changes in outcomes.
Regarding the principle of small-scale testing, SHADAC identified two considerations:
- The Innovation Center should focus on developing the capacity to monitor similar state-based models across states to inform intervention scalability. To this end, effort should be put toward developing measurement frameworks, standards for data collection, and metrics to respond to questions about the efficacy of reforms.
- Adequate funding should be provided to support state and local evaluations and to support the timely release of interim and final evaluation results in order to promote accountability and shared learning.
Feedback: Potential Models – State-based and Local Innovation, Including Medicaid-Focused Models
SHADAC identified two important lessons from our work with states implementing delivery system and payment reform that can inform future state-based models:
- Flexibility in model implementation must be balanced with participant accountability.
- It is important to determine and communicate the value (or return on investment) of payment reforms and to develop data collection systems to support this work.
Feedback: Opportunities and Challenges Associated with Potential Models
SHADAC also identified opportunities and challenges for states implementing payment and delivery system models.
The opportunities identified were (among others): accelerating progress and facilitating learning through access to external expertise; facilitating evaluation of market and payment reforms through APCD analytic work and development; and encouraging provider organization participation by promising data analytics during model design.
On the flipside, SHADAC identified the following challenges: performance measurement issues; the demand for more timely claims data and the integration of clinical data with administrative/claims data; data privacy legal issues; and limited capacity among provider organization for provider electronic data-sharing outside of their own organization walls.
Other Feedback: Dissemination of Evaluation Findings
SHADAC encouraged the Innovation Center to continue to support rapid-cycle feedback reporting from required state-led evaluations. We also noted that evaluation plans and interim findings could be more accessible to other states through Innovation Center website links and up-to-date inventories, infographics, or dashboards of evaluation and monitoring methods, activities, data sources, and results.
View the full text of SHADAC's response below or download the PDF here.
Blog & News
December 5th Webinar: Impact of Medicaid vs. Marketplace Coverage on Out-of-Pocket Spending for Near-Poor AdultsMarch 08, 2019:
SHADAC will host a coffee-break webinar on December 5th at 12:00 p.m. Central featuring Urban Institute's Dr. Fred Blavin, whose SHARE-funded research asks how medical spending burdens for near-poor families in non-expansion states would change if the states were to expand Medicaid.
|Medicaid vs. Marketplace Coverage for Near-Poor Adults: Impact on Out-of-Pocket Spending|
Presenter: Fred Blavin, PhD
In states that chose to expand Medicaid under the ACA, adults between 100% and 138% of the federal poverty level (i.e., the "near-poor") are Medicaid-eligible and typically face minimal or no premiums or cost-sharing for medical expenses. In states that have chosen not to expand Medicaid, this population cannot enroll in Medicaid but may quality for tax credits to purchase marketplace health insurance plans that entail out-of-pocket (OOP) premiums and cost-sharing. Dr. Blavin's analysis uses data years 2013 to 2015 from the Current Population Survey and state Medicaid expansion decisions as a natural experiment to estimate the impact of access to the Medicaid expansion on OOP health expenses, compared with access to subsidized marketplace coverage.
Dr. Blavin will answer questions from attendees after the presentation.
Blog & News
State Implementation of the ACA’s Medicaid Smoking Cessation Provisions: SHARE Findings at Dissemination & Implementation ConferenceDecember 01, 2017:
Dr. Sara McMenamin of University of California, San Diego, will present results from her SHARE-funded research at the 10th Annual Conference on the Science of Dissemination and Implementation in Health.
Dr. McMenamin’s SHARE research examined state progress in implementing the ACA’s four provisions regarding Medicaid coverage for smoking cessation treatments. These provisions address: (1) coverage for pregnant women; (2) coverage for all enrollees through an increased federal match incentive; (3) coverage for all enrollees through Medicaid formulary requirements; and (4) coverage for Medicaid expansion enrollees.
From January through June 2017, Dr. McMenamin and her team studied Medicaid programs in all 50 states and the District of Columbia and found that 46 Medicaid programs had increased coverage for smoking cessation treatments by executing one or more of the four provisions. The most commonly implemented provision was coverage of comprehensive treatments for pregnant women without cost-sharing, which 27 Medicaid programs had in place. In all, only 11 state programs had implemented all four smoking cessation treatment provisions in the ACA.
Dr. McMenamin’s presentation is on December 4th at 2:50 p.m. at the Crystal Gateway Marriott, Salon B.
Blog & News
How Do State Policy Decisions Impact Out-of-Pocket Spending & Health Insurance Coverage? SHARE Panel at APPAMOctober 30, 2017:
The panel, "How Do State Policy Decisions Impact Out-of-Pocket Spending & Health Insurance Coverage? Evidence from Federal Survey Data," will feature the following presentations:
- The Impact of Medicaid Expansion on Employer Provision of Health Insurance
Anne Royalty, Indiana University
- Medicaid vs. Marketplace Coverage for Near-Poor Adults: Impact on Out-of-Pocket Spending Burdens
Fred Blavin, Urban Institute
- Do Minimum Wage Changes Affect Employer-Sponsored Insurance Coverage in the Post-ACA Era?
Michael Dworsky, RAND Corporation
All three papers on the panel use federal survey data to consider the impacts of state policy choices on health insurance coverage and/or spending. The first paper uses data from the Medical Expenditure Panel – Insurance Component (MEPS-IC) to investigate how employer insurance offers, workers’ eligibility, and out-of-pocket premiums are changing as a result of state Medicaid expansion decisions. The second paper uses data from the Current Population Survey (CPS) to examine the comparative out-of-pocket spending burdens for adults with incomes between 100 and 138% of the federal poverty level (FPL) in states that have chosen to expand Medicaid—where this group faces little to no cost-sharing in most cases—and in states that have chosen not to expand Medicaid, where this group may face out-of-pocket premiums and cost-sharing for coverage purchased through the marketplace. Finally, the third analysis uses CPS data to examine the impact of recent state minimum wage increases on enrollment in employer-sponsored insurance (ESI) coverage and considers whether the impact of the minimum wage changes varied between Medicaid expansion states and non-expansion states.
SHADAC Director Lynn Blewett will moderate the panel session, and SHADAC Investigator Kathleen Call will act as the panel discussant.
This panel will take place on Saturday, November 4th, 3:30-5:00 p.m., in the Hyatt Regency Chicago Toronto Room.