State Policy
States are taking center stage when it comes to developing novel policy approaches. Avalere’s team tracks and analyzes developments related to Medicaid expansion, individual market and exchanges, drug pricing, and other emerging trends. We can help you succeed in this dynamic marketplace.
Exchange Operational Models for 2022
In plan year (PY) 2022, most states continue to rely on the federal government for some or all exchange operational functions. However, 3 states have transitioned to state-based exchanges (SBEs).
Video: The Coverage Gap and Medicaid Expansion
Tune into another episode of Avalere Health Essential Voice. In this segment, our experts discuss the forthcoming debate around the coverage gap in non-Medicaid expansion states, potential policy options, and the impact on key stakeholders.
Podcast: The Coverage Gap and Medicaid Expansion
In this segment, our experts discuss the forthcoming debate around the coverage gap in non-Medicaid expansion states, potential policy options, and the impact on key stakeholders.
Medicaid Expansion Map
Since passage of the Affordable Care Act (ACA), 36 states and DC have expanded Medicaid. Some of the remaining states may reconsider expansion given new federal funding incentives.
Medicaid Networks More Than 60% Narrower Than Commercial in Some Areas
At a time when more Americans—particularly people of color—are enrolled in Medicaid, new Avalere analysis finds that provider networks for primary care and certain specialties in Medicaid are narrower on average than those of commercial plans in certain metropolitan areas, ranging from 63% smaller in Miami to 18% in New York.
States Mitigate Potential Coverage Losses Ahead of ACA SCOTUS Ruling
With the US Supreme Court (SCOTUS) set to hear arguments starting November 10 in California v. Texas and the swearing in of Justice Amy Coney Barrett on October 26, questions remain regarding the future of the Affordable Care Act (ACA) and its impact on laws passed in at least 18 states creating coverage protections for essential health benefits (EHB) and coverage of pre-existing conditions.
Podcast: State Medicaid RFP Response Considerations and Watch Outs
Tune into another episode of Start Your Day with Avalere. In this segment, our health plan experts delve into the key actions, considerations, and watch outs of a successful Medicaid procurement, or re-procurement, response from both the state and health plan perspectives.
Election Outcome Will Play Pivotal Role in State Healthcare Priorities
The outcomes of the 2020 elections will hold implications for state policymaking on key healthcare issues that could impact patients’ health insurance coverage status and how they access care.
Exchanges May Add More than 1 Million New Enrollees due to COVID-19
Affordable Care Act (ACA) exchanges have seen a significant uptick in enrollment, especially from those losing employer-sponsored coverage or who were previously uninsured. However, different approaches to special enrollment periods (SEPs) leave many with limited opportunities to enroll.
COVID-19 Impacts State Policy Priorities
After adjourning or suspending sessions due to the COVID-19 pandemic, state legislatures are reconvening with new priorities, as pandemic-related policy decisions take precedence.
State Medicaid Waivers for SUDs Present Opportunities for Stakeholder Engagement
1115 Waivers approved by CMS allow state Medicaid programs to better address substance use disorders among beneficiaries.
SCOTUS Decision to Review ACA Case Could Undermine Coverage and Access
On March 2, the Supreme Court (SCOTUS) announced that it will review an appeal of the 5th Circuit Court of Appeal’s decision in Texas v. Azar regarding the legality of the Affordable Care Act’s (ACA’s) individual mandate and other provisions.
Webinar: What’s Next for Medicaid Drug Pricing?
View the webinar recording to learn more about the latest policy, pricing, and reimbursement challenges in Medicaid.
States Choosing Healthy Adult Opportunity Program Will Need to Generate Savings to Stay Below Capped Funding Levels
New analysis from Avalere finds that states currently covering non-mandatory adult populations who choose to participate in the Healthy Adult Opportunity (HAO) initiative may need to generate up to 8% in Medicaid savings to keep spending below new capped funding levels.
CMS’s Healthy Adult Opportunity Program Includes Significant Changes to Medicaid Drug Benefit
The Centers for Medicare & Medicaid Services (CMS) announced the Healthy Adult Opportunity, a new Section 1115 demonstration initiative allowing states to shift toward capped Medicaid financing models with an opportunity for shared savings. If the option is chosen by states, it could be the largest change to Medicaid since the ACA.
Avalere Statement on CMS’s Healthy Adult Opportunity Program
CMS’s Healthy Adult Opportunity program, a new Section 1115 demonstration initiative, will allow state Medicaid programs to move toward capped financing models for some non-disabled adult beneficiaries with an opportunity for shared savings and additional flexibilities.
2019 State Elections: What to Watch in Healthcare Policy
Healthcare policy remains a top priority for both voters and policymakers in 2019 and has been a key part of campaign platforms.
State-Run Reinsurance Programs Reduce ACA Premiums by 16.9% on Average
Continuing analysis from Avalere finds that state reinsurance programs reduce individual market premiums by 16.9% on average in their first year, relative to estimated premiums without reinsurance.
7 State Policy Trends that May Shape Cancer Care in 2020
State healthcare legislation often holds important implications for high-value and high-cost drugs, such as those used to treat cancer patients.
Takeaways from NASHP: What’s Next in the States in 2020
Avalere’s state policy team recently attended the National Academy for State Health Policy’s (NASHP) Annual Conference for 3 days of interactive state health policy discussions and the facilitation of a roundtable on the direction of telehealth in the states.