State Health Policy Blog
As State Legislatures Convene, Lawmakers Quickly Submit Bills to Curb Prescription Prices
One week into the 2019 legislative season, lawmakers from 11 states have already submitted 30 bills to address the rising cost of prescription drugs. The bills submitted to date seek to implement wholesale drug importation programs, increase pharmaceutical pricing transparency, and regulate pharmacy benefit managers (PBMs), along with other drug cost containment initiatives. Last year, […]
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Federal Rule Delay Impacts States’ and Insurers’ 2020 Plans
State regulators are already working to develop guidance and rules that will determine health insurance plans’ benefits and costs in 2020. However, states lack critical information to make updated calculations because the federal government has not yet released its 2020 Actuarial Value (AV) Calculator. Why is the AV calculator important? AV is used to sort […]
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State Reinsurance Programs Lower Premiums and Stabilize Markets — Oregon and Maryland Show How
Across the nation, in response to rising health insurance premiums and unsettled markets, a growing number of states are using reinsurance programs to reduce premiums and stabilize jittery markets. What is reinsurance? A reinsurance program provides funds to health insurers to offset the costs of covering consumers with high medical costs. Generally, reinsurance funds become […]
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California Creates a State Surgeon General Position
California Gov. Gavin Newsom unveiled several health care initiatives in his inaugural address last week, including a well-publicized plan to lower drug costs using public purchasing power. But a less-publicized action – establishing a state surgeon general post – to help tackle the social determinants of health and health equity, presents a significant opportunity for […]
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As Drug Prices Rise, Oklahoma’s Medicaid Agency Advances Alternative Payment Models
Escalating drug prices are forcing state Medicaid agencies to explore new payment models. According to Burl Beasley, director of Pharmacy Services for Oklahoma’s Medicaid program, older Medicaid payment strategies, such as negotiating enhanced rebates and multi-state purchase agreements, are not keeping pace with rising drug expenditures. Beasley cited the strain prescription drug costs were putting […]
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Why Is Affordable Care Act Marketplace Enrollment Declining?
Early reports from the Centers for Medicaid & Medicare Services indicate 2019 enrollment in the federally facilitated marketplace (FFM) could be lower than 2018, which would continue a declining enrollment trend first seen in 2017, which prompts the question – why? As this chart shows, policies and investment in outreach and application assistance for consumers […]
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New Federal Initiatives Help States Expand Support for Children and Families Affected by Substance Use
In the recent election, Republican and Democratic gubernatorial candidates offered strategies to address the opioid epidemic and meet the needs of children and families affected by substance use disorder (SUD). Incoming and incumbent executives will have new federal resources – including the new Maternal Opioid Misuse (MOM) and Integrated Care for Kids (InCK) models and […]
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How States Provide Long-Term Services and Supports to Children in Medicaid Managed Care
For years, states have used managed care delivery systems to help control costs and improve health care and outcomes for adult Medicaid beneficiaries with complex health care needs. Now, more than a dozen states are using managed care to provide long-term services and supports (LTSS) to children and youth with special health care needs (CYSHCN). […]
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Q&A: How Rhode Island Tackles Social Determinants of Health through its Accountable Entity Model
Across the country, states are launching new payment models that reward quality, promote care integration, improve access, and address the social determinants of health (SDOH) in an effort to improve population health. One of these ground-breaking initiatives is Rhode Island’s Accountable Entity (AE) Program, created to improve the health of Rhode Islanders enrolled in Medicaid […]
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Six Slides to Help New Governors Improve Health
Governors across the country want their residents to live long, healthy, and productive lives. Residents’ life conditions — such as their neighborhoods, education, and income — make up 80 percent of the factors affecting their health, yet most health spending goes primarily to clinical care (Slide 2). As stewards of public resources and bound by […]
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