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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.

Robin Duddy-Tenbrunsel

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.

Kate Sikora

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.

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.

Megan Olsen

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.

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