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.
Avalere experts discuss an evolving Medicaid program supported by a new administration and novel state approaches.
New research from Avalere Health finds 11 states and DC lack an adequate number of providers certified to prescribe buprenorphine, a medicine used to prevent relapse in people with opioid dependence.
Beneficiaries show signs of pent-up demand with acute healthcare needs early in their enrollment, but over time costs increase substantially and shift toward chronic care.
If federal government permits states to expand Medicaid to only 100% of poverty, nearly 4M people could shift from Medicaid to exchanges, and 7M could be newly eligible for coverage.
The Better Care Reconciliation Act (BCRA) would cap Medicaid funding to states. In this analysis, Avalere worked with The SCAN Foundation to examine how BCRA Medicaid changes would impact dual-eligible beneficiaries. We compare these outcomes to the impact of the House-approved American Health Care Act.
Across 8 therapeutic areas, the Veteran's Administration (VA) National Formulary covers 49 percent fewer drugs than Ohio's largest Medicaid managed care plan and 68 percent fewer drugs than the Ohio Medicaid preferred drug list (PDL).
All 50 states and DC would receive fewer Medicaid dollars for non-disabled children.
Capping Medicaid funding could also shift costs to Medicare
Analysis shows Medicaid block grants and per capita caps could result in state budget gaps.
While 31 states and DC expanded Medicaid under the ACA, the future of expansion is uncertain.
New analysis from Avalere finds that 1.2 million individuals from non-expansion states could gain Medicaid coverage in 2017 should a newly elected governor decide to expand the program.
Popular low cost options see smaller increases.
The CalPERS Basic Plan Drug List, which is the formulary for all California public employees, includes 222 brand drugs and 287 generic drugs. In contrast, drug coverage in the Veterans Administration (VA) and Medi-Cal (California's Medicaid program) is far more limited than the CalPERS drug list.
Believing that states are productive incubators of innovation, the Center for Medicare & Medicaid Innovation (CMMI) launched a State Innovation Model (SIM) grant program in 2013 to encourage state-by-state testing of innovative payment and delivery models.
Over the past four years, enrollment in Medicaid managed care has increased by 48 percent, with 46 million beneficiaries now receiving coverage through these plans. The government will soon update regulations that direct the plans providing this coverage.
A new survey conducted by Avalere and the National Comprehensive Cancer Network® (NCCN®) shows that exchange plan participation by the nation's leading cancer centers is highly varied, but may be better than initial 2014 reports suggested.
Exchanges run by the federal government both retained a higher percentage of 2014 enrollees and enrolled a higher percentage of new enrollees in 2015 than states that run their own exchanges, according to a new Avalere analysis.
28 States & DC Are Expanding Medicaid Eligibility; Others May Decide to Expand
28 States & DC Are Expanding Medicaid Eligibility; Others May Make Decisions to Expand.
In at least six states, Medicaid programs could be expanded as a result of the outcome of the 2014 governors' races.