Hawaii: Draft 1332 Waiver Application Released

The State Health Care Innovation Task Force released its draft Waiver for State Innovation this week in advance of public hearings that began September 14. Hawaii's draft 1332 waiver, the first in the country to be released, proposes to waive the ACA's employer mandate and Small Business Health Options Program (SHOP) Marketplace provisions and replace them with the State's longstanding employer-sponsored insurance requirements under the Hawaii Prepaid Health Care Act ("Prepaid"), which has higher standards than the ACA. Fewer than 1% of employers and only one insurer in Hawaii used the State’s SHOP, which closed in June 2015. Under the proposed waiver, Hawaii would waive the requirement to maintain a SHOP Marketplace and redirect small business tax credits to premium relief under Prepaid. Because Prepaid is exempt from ERISA regulation, which generally restricts a state’s ability to regulate employer-sponsored health benefits, Hawaii is likely the only state that could strengthen its employer mandate with this approach.

Oregon: Medicaid Provider Reimbursement Rates to Decrease

The Oregon Health Authority announced that reimbursement rates for the State's 16 Coordinated Care Organizations (CCOs) will drop by 0.8% in aggregate this year, having developed new reimbursement rates for 2015 after CMS requested that it re-examine its previous rate-setting methodology. The new methodology aims to match payments to risk for each CCO, minimize variability within each region and incorporate data from the Medicaid expansion population. All CCOs received sharp rate decreases for adults under 45, with decreases ranging from 15% to 46%, while rate changes for other groups were mixed. For example, the State raised rates for older Medicaid members by as much as 47%. The overall impact on individual CCOs under the new methodology will vary.

Rhode Island: Marketplace Reports Uninsured Rate Drops to 5%

The percentage of uninsured in Rhode Island has been reduced by more than half since 2012, from 11% in 2012 to 5% in 2015, according to a state-wide survey commissioned by HealthSource RI. State officials credit the decrease to expanded Medicaid and the State-based Marketplace. Nearly half of the remaining uninsured are eligible for Medicaid and another 41% “would likely qualify” for a federal premium tax credit, according to HealthSource RI. The survey also found that 52% of uninsured Rhode Islanders are ages 18-34 and that the uninsured tend to earn less than 200% of the federal poverty level. HealthSource RI will release additional survey findings related to access and the insurance market over the coming weeks.