Manatt on Health Reform: Weekly Highlights: December 2014 #3
Enrollment numbers and Medicaid reform top the news this week. Federal officials report 1.4 million consumers have selected plans on healthcare.gov. And in the states, Michigan and New Hampshire announce Medicaid expansion enrollment is exceeding expectations. Also this week, Tennessee’s Governor releases alternative Medicaid expansion plans; the Oklahoma Hospital Association offers an alternative strategy for coverage expansion; and Vermont reviews 1115 and 1332 waiver parameters to implement a single-payer healthcare system.
On Track for Enrollment Goal, 1.4 Million Consumers Select Plans on Healthcare.gov
Leading up to yesterday’s deadline to sign up for Marketplace coverage beginning January 1, HHS released enrollment reports that indicate, according to experts at Kaiser Health News, that Marketplaces are on track to exceed this year’s 9 million enrollment goal put forth by the Obama Administration. Nearly 1.4 million individuals selected a plan on Healthcare.gov between November 15 and December 5, with the breakdown roughly split between new (48%) and returning (52%) enrollees. HHS also noted that plan selections for the week of November 29 – December 5 were 33% higher than the first week.
CMS Proposes Changes to Ensure Same-Sex Couples are Afforded Equal Rights in Medicaid and Medicare Facilities
In light of the Supreme Court’s 2013 decision to strike down the Defense of Marriage Act, CMS issued a proposed rule outlining a number of policy revisions that would afford same-sex marriages equal treatment as opposite-sex marriages in Medicaid and Medicare facilities. The rule suggests revisions to conditions of participation, conditions of coverage, and other requirements that currently could be interpreted as denying federal rights and privileges to same-sex spouses. The revisions address spousal rights such as legal representation, informed consent, and discontinuation of care in a variety of facilities, including hospitals, ambulatory surgical care centers, hospice care, and long-term care centers.
STATE HEALTH REFORM ACTIVITY:
Colorado: Audit Identifies $32 Million in Problematic Marketplace Spending
The Colorado Office of the State Auditor released a report on Connect for Health Colorado’s (C4HC) administration of public funds during 2014 that identified $31.6 million of problematic spending, including payments to vendors without final contracts or Board approval, a lack of records for all transactions, and payments to vendors and grantees determined to be “unreasonable uses of federal funds.” C4HC pledged to implement all of the report recommendations, including establishing comprehensive procurement and payment policies; establishing polices for administering its grant program and evaluating advance payments to grantees; and improving internal management of accounting and financial transactions to ensure compliance.
Hawaii: Marketplace Pledges Sustainability Plan in Light of Shortfall
The Hawaii Health Connector, as reported by the Pacific Business News, is preparing a report to the Legislature pledging a long-term sustainability plan and seeking appropriations to fill the existing $2.5 million shortfall the Exchange faces for the current fiscal year, ending June 2015. As part of the sustainability plan, the Exchange will seek contributions from private and public foundations to support its operations until it becomes self-sustaining, projected to occur in the next 10 years.
Michigan: Healthy Michigan Medicaid Expansion Surpasses Enrollment Goals
Just eight months after enrollment began, 481,863 individuals have enrolled in the Healthy Michigan Medicaid expansion plan as of December 11, already surpassing its overall enrollment goals. State officials estimated the plan would enroll 322,000 Michiganders in its first year and aimed to eventually enroll 470,000 total. In addition to expanding coverage to individuals up to 133% of the federal poverty level (FPL), Healthy Michigan also added primary and preventive care requirements to the State’s Medicaid plan. Thus far, the Healthy Michigan plan has counted over 315,000 primary and preventive care visits for enrollees, which the Michigan Department of Community Health notes is a promising indication that residents are taking initiative to improve their long-term health.
New Hampshire: Medicaid Enrollment Exceeding Expectations Following Expansion
New Hampshire is on track to surpass its first-year enrollment goal less than six months after enrollment for the Medicaid expansion program opened. The latest figures indicate that 25,300 individuals have already enrolled, while State officials estimated enrollment of 30-40,000 in the first year. Mary Ann Cooney, associate commissioner of the Department of Health and Human Services, attributed the success to the State’s strong education and outreach efforts.
Oklahoma: Hospital Association Proposes Medicaid Transformation Plan Including Alternative Expansion
The President of the Oklahoma Hospital Association presented a plan at the Oklahoma Healthcare Authority Board meeting to transform the State’s Medicaid program, including an alternative Medicaid expansion built on the existing Insure Oklahoma program — a premium assistance program that provides coverage to low-income adults not eligible for the State’s traditional Medicaid program. The Medicaid expansion plan would cover all newly eligible adults with access to cost-effective employer-sponsored insurance (ESI) through the State’s current ESI premium assistance program. Other newly eligible adults up to 100% of the federal poverty level (FPL) and all medically frail newly eligible adults would be covered under the “Insure Oklahoma: Individual Plan,” which would build on Oklahoma’s existing Medicaid program. Remaining newly eligible adults between 100% and 138% FPL would enroll in commercial health plans on the individual market. The expansion in coverage would be coupled with personal responsibility features, including premiums, cost-sharing, healthy behavior incentives and work and education referrals. The State funds a portion of Insure Oklahoma with a tobacco sales tax, the revenue from which has been steadily decreasing over recent years, and the waiver that authorizes the program is set to expire on December 31, 2015.
Oregon: State Announces System Changes to Medicaid and SHOP
Oregon Medicaid Director Judy Mohr Peterson announced that Oregon will use Kentucky’s Medicaid and Marketplace enrollment system to manage enrollment in the Oregon Health Plan, the State’s Medicaid program. The State will continue to use healthcare.gov to enroll individuals into qualified health plans through the State’s Marketplace. Because Kentucky’s technology was developed with federal grants, it will be free to use, though will require customization. In addition, Cover Oregon Executive Director Aaron Patnode announced that the Marketplace plans to develop a website for the State’s Small Business Health Options Program (SHOP) Marketplace for 2016. Currently, small businesses in Oregon must use a paper-based system to access subsidies through the SHOP Marketplace. Patnode was clear that the State would use a vendor to provide the website and not develop the technology itself.
Oregon: Only 10% of Oregonians Have Re-Enrolled in Marketplace Coverage
As of the end of November, only approximately 1 in 10 Oregonians who had enrolled in a qualified health plan last year had re-enrolled in coverage for 2015. Oregonians who enrolled last year are not eligible for auto-reenrollment and therefore are required to actively re-enroll because of the State’s transition from a State-based Marketplace in 2014 to a Federally Facilitated Marketplace in 2015.
Tennessee: Governor Announces Different Approach to Medicaid Expansion
Governor Bill Haslam (R) announced his alternative Medicaid expansion plan – “Insure Tennessee” – a two-year pilot program that would permit eligible individuals under 138% of the federal poverty level (FPL) to choose between two coverage options. Individuals with access to employer-sponsored insurance (ESI) may choose to receive a voucher that can be used to pay for premiums and other out-of-pocket expenses. Eligible adults may also instead choose to enroll in a standard managed Medicaid plan with cost-sharing obligations (including premiums only for those above 100% FPL) that would be reduced by participation in “Healthy Incentives for Tennesseans” and through depositing funds into a health savings account. The State’s hospitals have agreed to cover the State costs when the federal match falls below 100%. Insure Tennessee must be approved by the Legislature and the Federal government before implementation can begin.
Vermont: State Officials Outline 1115 and 1332 Waivers to Develop Single-Payer System Structure
Officials from the Health Care Reform branch of Vermont’s Agency of Administration recently outlined the waiver application options and benefit design standards for Green Mountain Care (GMC), slated to be Vermont’s publicly-financed universal healthcare system, for the GMC Board. As detailed in the presentation, Vermont intends to apply for both Medicaid 1115 and 1115A waivers as well as an Affordable Care Act 1332 waiver to develop the single-payer system. The presentation also reviews current standards for benefit design and cost-sharing levels to assess any modifications that would be necessary to be compliant with State law and ACA waiver parameters – which together would assure that GMC provide equal or better coverage options than currently available to Vermonters.