Faced with a fluid federal regulatory environment, many states continue to encounter challenges in stabilizing their individual health insurance markets, including large premium increases and declining insurer participation. One solution to continued market instability is a state-based reinsurance program similar to the federal program that reduced premiums by more than 10 percent per year from 2014 to 2016. The brief provides a roadmap of policy, program design, and financing considerations for states that are contemplating development of a state-based reinsurance program under 1332 waiver authority.
On December 17, 2018 State Health and Value Strategies hosted a webinar on Medicaid buy-in proposals. Over the past year, state policy makers and advocates have expressed interest in proposals that would permit people above Medicaid eligibility levels to “buy in” to Medicaid (i.e., leverage the state’s bargaining power in some way) in order to offer more affordable and accessible coverage. During this webinar, Manatt Health discussed state considerations for developing a Medicaid buy-in proposal, evolving models of state proposals, and the administrative considerations and authorities needed for each model.
In recent months, several proposals have been introduced at both the federal and state levels that would permit people above Medicaid eligibility levels to “buy in” to Medicaid or would leverage the Medicaid program to strengthen coverage across the individual market and Medicaid. In this webinar, the Robert Wood Johnson Foundation’s State Health and Value Strategies (SHVS) program, together with technical assistance experts from Manatt Health, examined the central considerations that a state must take into account when developing a Medicaid buy-in proposal; the primary models for state-administered Medicaid buy-in proposals, and the administrative considerations and authorities needed for each model. The webinar also reviewed Section 1332 waiver authority and related deficit neutrality and pass-through funding implications that states will want to consider as they craft their buy-in proposals. We also highlighted states’ current efforts to develop buy-in initiatives.
With three states using Section 1332 waivers to help fund reinsurance programs for the 2018 plan year, many more state officials are considering the model for their state in future years. Having worked directly with the 2018 reinsurance states, State Health and Value Strategies is pleased to present the following to-do list for states as they consider reinsurance for 2019.