CMS Requires Mental Health and Substance Use Disorder Parity for Medicaid and CHIP

CMS final rules apply the Mental Health Parity and Addiction Equity Act (MHPAEA) to Medicaid managed care organizations (MCOs), Medicaid Alternative Benefit Plans, and CHIP, largely adopting requirements included in the proposed rules. These final rules, which are modeled on existing parity regulations applicable to commercial health insurers, clarify states' responsibilities for overseeing and ensuring parity where Medicaid benefits are offered through MCOs and interrelated delivery systems, extend parity protections to long term care benefits, and clarify parity requirements for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefits for children. MCOs are required to comply with the provisions of the final rule within 18 months of the publication date.

Medicaid and CHIP Enrollment Growth Rates Higher in State-Based Marketplaces

States that use State-based Marketplaces (SBMs) have experienced higher Medicaid enrollment growth compared to those using HealthCare.gov, according to a report from The Commonwealth Fund. The report attributes the higher growth rates—measured as the percentage change in Medicaid and CHIP enrollment between the six months prior to the first open enrollment period and November 2015—to the federal requirement that SBM states enable their Marketplace to make final Medicaid eligibility determinations, whereas states that use HealthCare.gov have the option of processing eligibility determinations through their State Medicaid agency (assessment states) or through HealthCare.gov (determination states). The report also found that determination states tend to experience higher Medicaid enrollment growth than assessment states. These findings, according to the authors, indicate that Medicaid enrollment will be adversely impacted if Kentuckyreplaces its SBM with HealthCare.gov, as Governor Matt Bevin (R) has announced he intends to do. The authors suggest that the "biggest impact [of the transition] may accrue to the State's Medicaid program," and that the "adverse impact" on Medicaid enrollment may be felt both by new applicants and current enrollees renewing their coverage.

Kentucky: New Benefit Enrollment System Facing Challenges

Benefind, a new web-based portal for enrollment in Medicaid, SNAP, and the State's cash assistance program, has created confusion and delays for consumers, thousands of whom received erroneous notices indicating coverage termination, according to several media reports. Governor Matt Bevin (R) and other administration officials acknowledged the widespread problems and said they are working to rapidly correct them, including adding 185 workers to manage the high volume of calls and visits to local benefit offices. The rollout and challenges faced by Benefind come as Governor Bevin continues efforts to dismantle kynect, Kentucky's State-based Marketplace, and transition to HealthCare.gov by the end of the year. Governor Bevin indicated that he intends to use Benefind, which was developed by the previous administration, as an integrated platform for enrollment into Medicaid and other social service programs, but reiterated that Benefind is entirely unrelated to the shuttering of kynect.

Ohio: State to Request Medicaid Cost Sharing Waiver

Governor John Kasich's (R) administration will seek a federal Medicaid waiver to permit mandated cost sharing for all non-disabled Medicaid recipients regardless of income, in accordance with last year's Statebudget. Under the waiver, beneficiaries would be required to contribute 2% of their family income or $99, whichever is less, into a health savings account (HSA) or be disenrolled from Medicaid beginning in January 2018. The State Medicaid program would contribute $1,000 to enrollees' HSAs, from which enrollees would draw copayments until the account is depleted. To date CMS has not approved disenrollment from Medicaid for failure to pay a premium for enrollees below the federal poverty line. A draft of the waiver will be made available for public comment on April 15.

Oklahoma: Proposal Would Extend Medicaid to Uninsured and Transition Current Enrollees to the Marketplace

The Oklahoma Health Care Authority (OHCA) has proposed extending Insure Oklahoma, the State's premium assistance program, to 175,000 currently uninsured adults ages 19-64 earning up to 133% of FPL, and moving 175,000 children and pregnant women from Medicaid to the Marketplace, where they would be eligible for federal tax subsidies. The "Medicaid Rebalancing Act of 2020" would require federal approval and would cost the State an estimated $100 million, which would be matched by $900 million in federal funds. The transition of current Medicaid enrollees to the Marketplace would not occur until maintenance of effort requirements expire on October 1, 2019, but would then save the State an estimated $60 million. The plan would also restore Medicaid provider reimbursement rates to current levels "as soon as possible." This proposal was introduced as an alternative strategy to address the State's anticipated budget shortfall instead of the previously announced 25% provider reimbursement rate cut effective June 1; OHCA's CEO Nico Gomez described the cuts as "a last resort."