The Kansas House sends approved Medicaid expansion legislation to the Senate; governors remain divided on Medicaid reform; and the Kaiser Family Foundation publishes a new library of 108 Medicaid expansion studies.

FEDERAL HEALTH REFORM NEWS:

Governors Remain Divided on an ACA Replacement as NGA Meeting Concludes

Healthcare reform was a top priority at the National Governors Association (NGA) Winter Meeting; while governors discussed reform options in several sessions, no consensus was reached on how to move forward, particularly with respect to Medicaid funding changes and efforts to bridge differences between states that expanded Medicaid and those that did not. As part of the Winter Meeting, governors participated in briefings with House Republicans and Democrats and met with President Trump. Several Republican governors, including John Kasich of Ohio, Scott Walker of Wisconsin, and Rick Scott of Florida, also met separately with President Trump to discuss ACA repeal.

Republican Governors Outline Capped Funding Options for Medicaid

A plan proposed by Republican governors at the National Governors Association Winter Meeting would allow states to choose either a per capita cap or block grant financing structure for their Medicaid populations, according to a leaked version obtained by multiple news outlets. Republican governors also proposed options in areas where consensus has not yet been reached, including around whether to allow states the option to keep the existing Medicaid financing structure for the expansion population, rather than adopting a per capita cap or block grant, and whether to limit the enhanced federal match for the expansion population to individuals with incomes under 100% of FPL. The plan would also grant new flexibility to states over program eligibility, benefits, use of managed care, and provider payment.

CMS Extends Transition Deadline for Some ACA Non-Compliant Plans Through 2018

CMS is extending the transitional relief policy for ACA non-compliant individual and small group plans (or, "grandmothered" plans) through 2018. Grandmothered plans are exempt from some ACA insurance standards, such as essential health benefit requirements, actuarial value standards and limited annual out-of-pocket costs. CMS has allowed individuals to keep these plans since 2014, however the transitional policy was scheduled to expire at the end of 2017.

STATE HEALTH REFORM UPDATES:

Florida: Senate Committee Approves Bill to Allow "Direct Primary Care," Including in Medicaid Managed Care

The State Senate Health Policy Committee approved a bill that would allow direct primary care agreements between providers and patients, which remove third party payers and instead allow patients to pay a monthly fee directly to providers for a defined set of primary care services. The agreements would not be subject to state insurance regulations. The bill would also require the State to seek federal approval to allow Medicaid managed care enrollees to select direct primary care as a delivery option.

New Jersey: Repeal Could Result in Loss of Over $4 Billion in Annual Federal Funding, Study Finds

Repealing the ACA without a replacement would result in the loss of $3 billion in federal funding for Medicaid expansion and $1 billion in federal Marketplace funding each year, according to an analysis by New Jersey Policy Perspective. The analysis, which includes county-specific data, notes that a complete repeal would impact coverage for 1.1 million residents, cost the State 86,000 jobs and reopen the Medicare prescription drug coverage gap (the "donut hole") for more than 200,000 seniors.

Texas: District Judge Grants Temporary Stay Against State Efforts To Cut Medicaid Funding to Planned Parenthood

A U.S. District Judge issued a preliminary injunction temporarily halting the State from withholding Medicaid funding from Planned Parenthood. Texas is one of seven states where federal courts have intervened to maintain Medicaid funding for Planned Parenthood's non-abortion services, which include cancer screenings and primary care. Texas Attorney General Ken Paxton said in a statement that the State would appeal the injunction.

Washington: Individual Market Plan Quality and Affordability Improved Under the ACA

New findings from the State Insurance Department show that following implementation of the ACA, the number of high deductible health plans in Washington's individual market decreased from 42% to 17%, the actuarial value of a typical individual health plan increased from 40% to 70%, and increases in individual market health plan premiums dropped from 18.5% to 6.7%. The analysis also noted that Washington's uninsured rate dropped by more than half after the ACA.

FEDERAL AND STATE MEDICAID EXPANSION ACTIVITY:

New Tool Compiles and Summarizes Research on Effects of Medicaid Expansion

A Kaiser Family Foundation issue brief and tables review findings from 108 studies released between January 2014 and January 2017 on the impact of Medicaid expansion. The collected body of literature suggests that Medicaid expansion has increased coverage, affordability, and utilization, and has provided states with economic benefits through reduced uncompensated care and increased employment.

Arkansas: Medicaid Expansion Increased Access to Care and Improved the Quality of Care, Study Finds

The State's Medicaid expansion, which uses Medicaid funds to purchase private Marketplace coverage for the new adult population, is associated with increased access to primary care, reduced emergency department use, fewer unfilled prescriptions, and improved self-reported quality of care, according to a new brief from The Commonwealth Fund. The study found similar rates of improvement in access and self-reported quality of care across Arkansas's private option expansion model and Kentucky's traditional expansion model, noting that whether a state expands Medicaid is more consequential than the type of coverage offered.

Indiana: New Report Disputes Program Evaluation Data in Expansion Waiver Application

A National Public Radio (NPR) analysis of Indiana's Medicaid expansion waiver extension application found that the State used "misleading and inaccurate information" as evidence of the waiver's success. Contrary to information provided in the application, NPR found that the number of expansion enrollees missing required payments into their POWER account, a health savings-like account, is increasing, and that more than half of expansion enrollees did not know they had a POWER account. The report also notes that the patient satisfaction survey data cited by the State was "unreliable", and that the State's claim that some groups of expansion enrollees are using emergency departments less frequently than others was not adjusted to reflect differences in health risks between populations. The waiver extension application is open for public comments on the CMS website through March 17, 2017.

Kansas: House Passes Medicaid Expansion Bill, Senate to Vote in March

The State House of Representatives passed a bill by a 81-44 margin that would expand the State's Medicaid program to include adults with income below 138% of FPL, or about 300,000 Kansans. The bill instructs the State's Department of Health and Environment to submit a waiver request to CMS to establish a work requirement for the expansion population and provide premium assistance to low-income individuals with employer-sponsored insurance. The bill now advances to the Senate, which will reconvene on March 6. Earlier this week, the bill was expected to be put on hold for the remainder of the legislative session.