Illinois: House Fails to Pass Bill to Establish a State-Based Marketplace

The Illinois House failed to pass Senate Bill 636, which would have established a State-based Marketplace, before the end of the legislative session, as reported by the Chicago Tribune. The bill gained momentum in the House in recent weeks after concerns were raised about the potential for a U.S. Supreme Court ruling to end subsidies for Get Covered Illinois enrollees. While the Legislature could consider the bill again in future sessions, the State will no longer be eligible to receive an estimated $270 million in federal funding to support the cost of transitioning to a State-based Marketplace.

Minnesota: Marketplace Revises Fiscal Budget to Reflect Projected Drop in Enrollment

MNsure’s Board of Directors voted unanimously to approve the 2015 fiscal year budget, which forecasts a total revenue of approximately $5.3 million, a decrease of $1.8 million from earlier estimates. According to MPRnews, this reduction follows MNsure's projection that only one-third of the number of individuals who enrolled in 2014 coverage will enroll in 2015, largely due to the exit of PreferredOne, MNsure's largest and lowest-cost provider in 2014. Despite this year's loss in revenue, the budget for fiscal years 2016 and 2017 indicate an overall surplus.

North Carolina: Subcommittee Calls for 2015 Medicaid Reform Legislation

The Subcommittee on Medicaid Reform/Division of Medical Assistance (DMA) Reorganization released a Final Report to the Joint Legislative Oversight Committee on Health and Human Services recommending several principles on which to reform Medicaid. The goal of the reform – to reduce costs – was based on an analysis from the State’s Fiscal Research Division demonstrating that the current fee-for-service Medicaid model will continue to increase Medicaid costs. North Carolina Medicaid is currently a fee-for-service model with care management provided through a statewide medical home model. In recent years, policymakers have debated whether to implement both provider-led efforts (such as ACOs) and commercial managed care plans to manage total Medicaid cost. This report called for the enactment of legislation during the 2015 Session to establish a new healthcare system within three years that would include, among other features, shared financial risk.

Texas: Senate Committee Recommends “Texas-Specific” Medicaid Reforms

The Texas Senate Committee on Health and Human Services, charged by Lieutenant Governor David Dewhurst (R) to identify cost-effective alternatives to Medicaid and the ACA, released a report recommending the State pursue a federal waiver to operate Medicaid as a block grant, use local funding to help the uninsured enroll in private coverage rather than Medicaid, and implement cost-saving mechanisms, including health savings accounts and high-deductible emergency care plans. The three Senate Democrats serving on the Committee submitted an accompanying letter that recommended “closing the coverage gap” between Medicaid and the Marketplace and accepting all federal funds available under the ACA.

Utah: Governor Unveils the Healthy Utah Medicaid Expansion Plan

Governor Gary Herbert (R) revealed the details of his alternative Medicaid expansion plan – Healthy Utah – which aims to enroll nearly 95,000 eligible Utahns earning up to 133% of the federal poverty level (FPL) in qualified health plans (QHPs) on the State’s Small Health Business Options Program (SHOP) Marketplace. The plan contains cost-sharing obligations that increase with income, including premiums for individuals above 100% FPL, and would allow children eligible for traditional Medicaid to enroll in a parent’s QHP. Unemployed individuals, with some exceptions, would be automatically enrolled in an integrated work program, though the State is exploring options to enforce compliance with the benefit. The State would also offer the option to enroll in a plan with a higher co-pay for non-emergency visits to the emergency room ($50) and a lower premium, or a lower co-pay and higher premium. Eligible Utahns determined to be medically frail would enroll in traditional Medicaid expansion, and those with cost-effective employer-sponsored insurance would receive premium assistance to enroll in those plans. Healthy Utah, which requires approval by the State Legislature and the federal government, would be a three-year pilot program and cost the state $4.6 million in 2016 and $25.5 million in 2019.