State News

With enrollment for Minnesota’s health plans set to begin, many are watching to see the effects of insurers’ recent announcements of insulin out-of-pocket caps, according to the Star Tribune. Those who purchase coverage through MNsure or from Medica and UCare will have their out-of-pocket spending on each insulin prescription capped at $25 per month, regardless of annual deductibles. When asked, insurance companies have explained that an amendment in the state’s recent omnibus healthcare spending law makes it illegal for Minnesota insurers to profit from selling insulin. Consumers who use insulin note that it is an important necessity for them, but that other medical necessities are still expensive, like insulin pumps and glucose monitors.

The Michigan Department of Health has proposed removing pharmacy benefit managers (PBMs) from overseeing prescription drug claims and negotiating prices for the state’s Medicaid program in a hope to save Medicaid dollars, according to Modern Healthcare. The department expects the proposal will save the state about $40 million, streamline administrative processes and ensure uniform drug coverage for Medicaid enrollees. Other states have stopped outsourcing prescription drug services to PBMs after studies found that PBM prices often exceed Medicaid fee-for-service drug prices. While PBMs defend their practices by stating that they address high drug prices by negotiating payment rates from pharmaceutical companies by leveraging formularies and utilization management tools; critics assert that PBMs have an incentive to prioritize high-priced drugs over more cost-effective alternatives.

Nexus Montgomery, a collaboration between six competing Maryland hospitals, has created a cross-continuum of care partnership that includes skilled nursing facilities, according to Home Health Care News. The goal of this pilot is to leverage non-medical home care to help consumers live safely and independently in their homes. As hospitals are subject to financial penalties for high readmission rates, especially within Maryland’s global budget system, pilots such as this one may help keep people healthier and out of the hospital.

The New Jersey Department of Banking and Insurance will offer $2 million for health navigators to help enrollees and re-enrollees with the transition from a federally-facilitated exchange to a state-based exchange on a federal platform, and eventually to an autonomous state-based exchange, according to HealthPayerIntelligence. Because the state remained on the federal platform but will facilitate the exchange itself, New Jersey has access to more funding for health navigators since it can use it's own funding, adding over six times the previous amount to the enrollment fund. The state is now responsible for approving qualified health plans, setting up assisters to help with the enrollment process and conducting outreach to the population looking for insurance. It seems likely that the state will remain on the federal platform for a year before transitioning toward complete autonomy from the federal exchange. 

Roughly half of rural hospitals across Kentucky are in poor financial health – 16 of which are at high risk of closure, according to The Lane Report. Ten of the 16 hospitals are essential their communities, based on an analysis of trauma status, service to vulnerable populations, geographic isolation and economic impact. The financial strain on rural hospitals results from a number factors, including decreased demand for inpatient care and a loss of agricultural and manufacturing jobs in rural communities, leaving them with a shrinking population that tends to be older and poorer (and, therefore, more likely to be uninsured or on Medicaid or Medicare, which don’t pay for the total cost of care). Closures cost communities their immediate access to emergency and acute care and can also bring economic hardship from loss of employment. 

The New Jersey Department of Banking and Insurance announced that premiums sold on and off the ACA exchange will increase by an average of 8.7%, according to the Burlington County Times. State officials believe that rising medical costs were largely responsible for the increase, but also point to the reinstatement of a federal tax surcharge that had been suspended in 2019. Had this surcharge not been reinstated, the state's rate increases would have been 2.7% lower. Despite this increase, state officials say that on average, prices remain lower than they were in 2018. 

North Carolina’s Medicaid 1115 waiver allows the state to spend up to $650 million in state and federal Medicaid funding on “Healthy Opportunities Pilots,” designed to cover select services related to housing, food, transportation, and interpersonal violence that directly impact enrollees’ health outcomes, according to Managed Healthcare Executive. The state’s Medicaid managed care plans, known as Prepaid Health Plans (PHPs) have been set up in four regions of North Carolina to address these social determinants of health. Typically, Medicaid funds are not used to pay directly for non-medical interventions targeting social determinants of health, so this pilot will offer insights to how addressing social determinants of health may impact costs and health outcomes. 

Medicare cut payments to nine Montana hospitals as part of a program that aims to drive hospitals to reduce unnecessary patient readmissions, according to the Bozeman Daily Chronicle. This is the largest number of hospitals in the state penalized in a single year for failing to meet the federal standard, reports a Kaiser Health News analysis.

A rural safety net hospital and the only hospital serving Clark County, Wisconsin, managed to remain open by contacting city hall for help getting a loan, according to AP News, but other hospitals in other rural states are not as lucky. While 155 rural hospitals have closed in the past 15 years. However, as of 2017, 16 of Wisconsin’s 76 rural hospitals are operating on a financial deficit as their unpaid medical bills climb. Advocates and hospital administrators worry that Wisconsin may end up mirroring other states that have seen numerous rural hospital closures.