State News

The Rhode Island Foundation is launching an $8.5 million plan over the next three years to both lead and strengthen diversity, equity, access and inclusion focused efforts in the community, with a primary focus on racial equity, reports Patch. The plan commits to improving health, economic and educational outcomes by focusing on system-wide reforms that stand to benefit those Rhode Islanders who have been left behind. The plan’s first step is to create the Rhode Island Foundation's Equity Leadership Initiative, which will identify and develop opportunities for BIPOC Rhode Islanders to help build a pipeline of future leaders in established positions of influence throughout the state.

Georgia’s Section 1332 State Relief and Empowerment waiver has been approved, announced the Centers for Medicare & Medicaid Services (CMS). Beginning in plan year 2022, Georgia will implement a reinsurance program that is expected to reduce annual premiums for individuals by an average of 10 percent by covering some insurance costs once claims reach a certain amount. Beginning in plan year 2023, Georgia will transition the individual insurance market from a federally facilitated exchange to a private sector platform called the Georgia Access Model. The Georgia Access Model will serve as a one-stop shop that enables consumers to compare and enroll in plans offered by health insurance companies, web brokers and traditional agents and brokers. The state anticipates that the reinsurance program and the Georgia Access Model will increase health insurance affordability and enrollment.

The North Carolina Department of Health and Human Services (NCDHHS) and the Cherokee Indian Hospital Authority (CIHA) have entered a contract to support the Eastern Band of Cherokee Indians (EBCI) address the health needs of American Indian/Alaska Native Medicaid beneficiaries through an Indian Managed Care entity, according to a press release by NCDHHS. This Indian Managed Care entity if the first of its kind in the nation and will establish a new delivery system, the EBCI Trial Option. The Option will manage the healthcare for North Carolina’s approximately 4,000 tribal Medicaid beneficiaries, with a strong focus on primary care, preventive health, chronic disease management and providing care management for high-need members.

The Governor of Pennsylvania announced the passage of two laws meant to increase coverage for mental health services. These laws require health insurers to verify that they conducted analyses to ensure that their plans offer mental health and substance use disorder coverage that has similar cost sharing and in- and out-of-network coverage compared to physical health services. In addition, insurers must be able to make this documentation available to the state insurance department, policyholders and providers upon request. These laws will help strengthen and enforce mental health parity among insurance plans.

The Wisconsin Department of Health Services (DHS) has announced grants totaling more than $3.1 million to increase access to care and enhance quality in rural Wisconsin. According to a press release by DHS, the grants support education and training to assist rural hospitals and clinics in filling “high-need, high-demand” positions. The grants also seek to grow Wisconsin’s rural physician workforce by prioritizing individuals with Wisconsin ties for new resident positions

Blue Cross & Blue Shield of Illinois is piloting new programs to improve health outcomes for minorities and increase racial and ethnic diversity among medical professionals, reports Modern Healthcare. The COVID-19 pandemic has laid bare the inequities faced by people of color, which has led to the development of the Health Equity Hospital Quality Incentive Program. The program’s goal is to work closely with hospitals serving a large number of Blue Cross members in communities with people most at risk of contracting COVID-19 and, ultimately, reduce racial and ethnic disparities in care. The value-based, three-year pilot program will pay doctors more for achieving certain metrics, such as meeting maternal healthcare requirements and equitably implementing telehealth. So far, at least 10 hospitals and health systems have been invited to join. 

A real estate agent and mother of two enlisted the help of the media to share her story when she received an unexpected medical bill that she was unwilling to pay, reports Kaiser Health News. She was charged twice for an outpatient procedure by a facility that offered her a discount on coinsurance that it was not authorized to provide, and her bill was sent to a collection agency. An investigation, prompted by a reporter’s call, verified the patient’s version of events, including a breakdown in the facility’s customer complaint process that should have prevented the bill from going to collections. While the issue was unintentional, it could have had serious financial consequences for a patient that lacked the time, resources or will to fight.

Indiana became the first state to receive a 10-year extension from the federal government for its alternative to traditional Medicaid expansion, the Healthy Indiana Plan, reports the Indianapolis Star. The plan provides benefits while at the same time requires beneficiaries to contribute in order to participate. Typically, states only receive a 2- or 3-year extension of their Medicaid expansion alternative health plan. The Healthy Indiana Plan currently insures more than 572,000 low-income Indiana residents, which is 100,000 more people than this time last year. The 10-year extension provides funding security for the next decade, while maintaining flexibility for Indiana to request federal approval to make improvements to the program down the line.

The State Treasurer of North Carolina, who manages the state employees’ health plan, has spent years trying to persuade hospitals to accept lower payments, but has struggled to discover the existing rates the plan pays each hospital and enact policies, reports Kaiser Health News. In North Carolina, hospital inpatient prices for private insurers, which typically drive health premiums, rose by 10 percent from 2014 to 2018. In an effort to help the state control healthcare costs, the Treasurer proposed to base prices on a percentage of Medicare rates, a form of reference pricing, giving hospitals 175 percent of what Medicare reimbursed for inpatient services and 225 percent for outpatient services—a move that would resulted in payment cuts to most hospitals. In response, the North Carolina Healthcare Association warned customers that if no agreement could be reached with the state plan, the hospitals would be considered out-of-network providers. In many states, hospital associations are political powerhouses, with lobbyists and influence from being the largest employer in many legislative districts.