2/7/2020 Update: Click here for a detailed analysis of the Healthy Adult Opportunity (HAO) guidance (SMDL 20-001) from PCG’s Health Policy News subject matter experts.
The Centers for Medicare and Medicaid Services (CMS) released its long-awaited guidance promoting block grant waivers – being referred to as the Healthy Adult Opportunity (HAO) – yesterday. As expected, under guidance, in exchange for funding limited to an annual aggregate cap or a per capita cap that would take into account enrollment changes (rather than funding dependent on the cost of the program) a state could get additional flexibilities, including relative to eligibility, benefits, cost sharing, and program administration. These include more limited drug coverage, broader copays than allowed currently, and flexibility relative to traditional Medicaid services including non-emergency medical transport and Early and Periodic Screening, Diagnostic and Treatment. In general, the guidance notes that states would be expected to align coverage under the waiver with the state’s individual health insurance market. State Medicaid Managed Care programs could also be subject to less federal oversight, and states with HAO waivers would have the opportunity to share in federal savings. Waivers would specifically apply to the covered adult population under age 65 who are not eligible for coverage based on a disability or the need for long-term care services and supports or otherwise under the state plan.
HPN subject matter experts continue to review the guidance in detail. Keep an eye on the blog next week for a more detailed analysis. In the meantime, you may find these materials from CMS helpful as you consider the implications for your state:
Published by Lisa Kaplan Howe
Lisa Kaplan Howe (J.D.) is a Senior Advisor who has spent her career working in health law and policy. At PCG, she focuses on statutory and regulatory analysis and strategic advising, particularly related to health care policy. Lisa has provided subject matter expertise to support state health care reform efforts, including policy development and regulatory support for health insurance Marketplaces and state insurance plan management efforts, Medicaid expansion and Medicaid Waivers (including DSRIP Waivers) and State Innovation Waivers. Lisa led PCG’s work with the New Hampshire Insurance Department relative the state’s Section 1115 Medicaid Waiver to provide coverage to newly-eligible adults through the Marketplace and continues to support the states’ Marketplace plan management work. In those roles, Lisa has served as the chief advisor and policy expert related to Medicaid and private insurance law to the New Hampshire Insurance Department, helping to identify, analyze and lead strategic consideration of federal opportunities and requirements. Lisa is also part of the team helping to design Colorado’s Delivery System Reform Incentive Payment (DSRIP) program. Ms. Kaplan Howe also provides broad policy and regulatory support to PCG’s other health care clients across the country, analyzing policy and regulatory developments, providing strategic advice relative to regulatory questions, and drafting policy briefs and position papers. Lisa is a managing editor of PCG’s monthly health practice area newsletter, Health Policy News.
Prior to joining PCG, Lisa served as Policy Director at New Hampshire Voices for Health, where she led legislative and regulatory analysis, strategic planning, and implementation of the organization’s policy agenda. Her work included drafting bills, amendments, testimony, and communications and testifying at hearings. Lisa also held the positions of Private Market Policy Manager and Consumer Health Policy Coordinator at Health Care for All of Massachusetts. While there, she managed private insurance market policy work and was a member of the organization’s internal health reform team. Lisa also practiced law in the Ropes & Gray health care department, advising health care provider and insurer clients.
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