Week In Washington: Medicaid Expansion, MA Termination, and More

February 22, 2019

A lot of news on the Medicaid expansion front this week. A few highlights:

  • Utah – Politico broke news that CMS has provided signals that is looking favorably on Utah’s partial Medicaid expansion/enrollment cap waiver. Both concepts have never been implemented before but would likely be taken up by other states if approved.
  • Oklahoma – A bill expanding in Medicaid in Oklahoma passed an OK Senate committee. The bill would expand Medicaid through private expansion, as was done in Arkansas. In this model Medicaid expansion beneficiaries are enrolled in individual market coverage but are provided premium and cost-sharing subsidies.
  • Kansas – Medicaid expansion has apparently stalled out in Kansas. Initially there were some hopes the legislature would pass some form of Medicaid expansion. Instead Kansas appears poised to pass a bill expanding access to Farm Bureau Plans. Farm Bureau plans are non-ACA coverage available as coverage that can crowd out ACA coverage.
  • Florida/Missouri – Both of these states are considering making ballot initiatives more difficult to pass to prevent activists from having Medicaid Expansion be voted into law as was done in Idaho and Maine.

CMS Termination over Stars

CMS announced to MA and Part D plans that CMS could terminate plans over persistently low Star ratings. The first time plans could be terminated over low Star ratings is for the 2022 benefit year.

Health Expenditures

The Office of the Actuary released their National Health Expenditure report. You can read the Health Affairs version here. Overall OACT expects health expenditures to grow at 5.5% annually from 2018 to 2027 and represent 19.4% of GDP by 2027. Medicare growth is expected to outpace Medicaid and private insurance given the greying population. OACT projects uninsured rates will generally be stable.

Research You Can Use

Brookings released an important and sprawling paper on surprise out-of-network billing. The paper includes information on when it happens (nearly 50% of ambulance services result in a surprise out-of network-billing), why it happens, and what policy considerations can be done to reduce its occurrence. You can read it here.