This blog outlines considerations for policymakers and providers seeking to strengthen rural behavioral health through the community-based workforce.
This brief discusses the dilemma of rising healthcare spending and a three-part federal policy strategy to constrain drivers of cost growth.
This blog discusses coverage trends for new mothers from 2019 through 2024 due to federal and state policy changes, such as Medicaid unwinding and postpartum coverage extensions from COVID-19.
This brief analyzes the difficulties working-age adults and their families are experiencing using data from a nationally representative survey focused on wellbeing and basic needs.
This brief discusses the benefits of Medicaid on the health and wellbeing of everyone and offers policy recommendations for states to preserve access to preventive and life-saving care.
This brief analyzes disruptions to lawfully-present immigrant families' participation in essential services and immigrant-related concerns.
This brief summarizes findings from California's Guaranteed Income Pilot Program, which provides monthly guaranteed income through seven pilot sites focused either on foster youth aging out of care or low-income pregnant women in the state.
In this brief, Urban Institute uses data from its Wellbeing and Basic Needs Survey to estimate the share of adults experiencing household food insecurity in 2025 and assess changes in household food insecurity among working-age adults between 2019 and 2025.
This brief discusses the policy changes in CMS' proposed rule for Marketplaces, including impacts on state insurance departments.
This brief provides recommendations to help states establish the administrative infrastructure needed to implement RHTP plans.
This brief discusses the CARE Act and its impact on PTCs and healthcare affordability.
This brief analyzes the reasons for the sharp increase in Marketplace premiums, including medical trends, the expiration of enhanced premium tax credits, and policy changes.
This brief estimates the effects on coverage and healthcare spending if Medicare eligibility is eliminated for people ages 65 through 66.
This brief estimates parents' and children's reliance on Marketplace coverage to assess the impact of the expiration of enhanced premium tax credits.
This brief shares opportunities for the Supplemental Nutrition Assistance Program and Medicaid to support work requirements implementation and facilitate continuous access to food and coverage.
This brief estimates reductions in healthcare spending and increased rates of uncompensated care if enhanced premium tax credits expire.
This brief explores how agents and brokers may influence Medicare enrollment and identifies gaps in oversight.
This brief provides findings on Medicaid-covered dental visits and dental-related emergency department visits during pregnancy and one year postpartum.
This blog explains how partnerships between state agencies can improve Medicaid work requirements implementation.
This brief provides findings about perceptions of FIM programs, including the program aspects respondents value the most.
This brief discusses how Medicaid can help community health workers improve child health and wellbeing.
This brief provides findings for unmet subclinical health needs and presents strategies to reduce barriers to care.
This brief outlines strategies states can use to partner with Medicaid members and CBOs in implementing work requirement policies that reflect community input.
This brief provides potential 10-year cost and enrollment estimates following enactment of the DUALS Act.
This brief provides state-level estimates on uncompensated care and healthcare spending based on the reconciliation bill and Congressional Budget Office updated projections.
This brief analyzes proposed changes in the reconciliation bill and provides state-by-state estimates of Marketplace enrollment.
This brief considers the budget reconciliation bill’s implications for expansion enrollees with unstable employment and adults who experience job loss or instability before enrolling in Medicaid.
This brief explores the adoption of alternative payment models for pediatric primary care and considerations for state Medicaid agencies.
This brief estimates insurance rates for uninsured young adults in 2024 and encourages states to engage with them to boost enrollment.
This brief examines how providers would be affected by proposed cuts to Medicaid expansion.
This brief reviews a literature scan on racial and ethnic patient-provider concordance to highlight the potential effects of a less diverse healthcare workforce.
This analysis examines 12 Medicaid managed care state websites' transparency of enrollment, payment, and quality data specific to young children to measure their performance.
This brief examines the implementation of postpartum coverage extensions in five states and identifies key considerations for ensuring extended coverage translates to the use of comprehensive services.
This brief reviews discussions with experts on how the Medicaid Equity Monitoring Tool (MET) can address the effects of systemic racism in Medicaid.
This brief examines household spending increases on premiums by state and income if enhanced premium tax credits (PTCs) were to expire.
This brief presents insights on engaging people with lived experience to support behavioral health transformation.
This brief assesses changes in health insurance coverage and cost-related barriers to healthcare during the COVID-19 public health emergency following the implementation of policies that aimed to improve access to Medicaid and Marketplace coverage.
This brief reviews Wisconsin's endeavor to tackle homelessness across the state through the creation of the Ending Homelessness through State-Continuum of Care Partnerships (EHSCP) group.
This brief reviews the steps leaders of active and longstanding palliative care advisory councils in Maine, Maryland, and Texas to learn about their creation, impact, and lessons learned for states looking to do the same.
This brief provides an annual update to comparisons of uninsurance estimates from five federal surveys
This brief explores approaches to incorporating health equity in value-based payment design, creating payment models that positively impact health disparities, outcomes, and costs in Medicaid.
This brief provides states with examples of data-sharing agreements and promising practices to facilitate data-sharing efforts across health and housing systems at the state and local levels.
This brief describes the framework and outlines state leaders can use to align on policies and programs that serve young children and their families.
CMS recently added new questions on the topic of sexual orientation and gender identity (SOGI) to the application used by HealthCare.gov and released guidance for states that want to add the same questions to their Medicaid and Children’s Health Insurance Program applications. This brief summarizes the guidance and presents several considerations for states as they look to improve their collection of sexual orientation and gender identity data.
This brief highlights how pilot program efforts in Calif. are fostering innovative cross-sector collaboration to better serve people experiencing homelessness.
This brief outlines key strategies to engage families and providers in co-creating cross-sector alignment solutions that can more effectively serve children and their families.
This brief reviews innovative approaches and communication strategies states and territories are employing to address health equity needs.
This brief outlines strategies for state Medicaid agencies to help people experiencing food insecurity obtain continuous access to nourishing food.
This brief examines a conceptual map of structural racism in healthcare.
This brief examines rates at which adults with and without disabilities reported they were treated unfairly in clinical and work settings, and its impact on their wellbeing.
This brief examines challenges related to using credit cards to pay medical bills.
This brief examines whether neighborhood conditions vary with children who rely on Medicaid or CHIP for coverage.
This brief describes existing payment barriers and opportunities for primary care providers serving children to work toward financially sustaining care transformation.
This brief examines experiences with long COVID related to employment and material hardship using a nationally representative survey of nonelderly adults.
This brief identifies ways in which states can leverage their Medicaid managed care programs to advance their health equity goals.
This brief presents considerations and emerging state strategies for bolstering the rural behavioral health crisis care continuum at each level of care.
This brief examines past-due medical debt among non elderly adults and their families using nationally representative survey data collected in June 2022.
This blog covers key considerations to account for as the unwinding begins, including a newly announced special enrollment period (SEP).
This issue brief outlines the ways in which such efforts can improve communication, lead to more effective and efficient programs, and result in ongoing collaboration with people who have experienced state-run systems and services.
This brief discusses how the health impact assessment and the Health in All Policies are making advancements to ensure that everyone has the opportunity to be as healthy as possible.
This brief provides a practical guide for states that are designing and implementing doula coverage under Medicaid.
This issue brief documents how REL data are collected by the Medicaid programs in the 50 U.S. states, the District of Columbia, and five U.S. territories.
This issue brief summarizes the key policy changes established through the Oregon and Massachusetts waiver renewals (and reinforced through the Arizona and Arkansas approvals) and discusses key implications for states.
This brief reviews California’s approach to expanding health coverage to all lower-income residents, regardless of immigration status, in an effort to help the state’s 3.2 million remaining uninsured, of which 65% are undocumented.
This brief provides information on strategies to improve maternal health outcomes and synthesizes research about the national state-of-play across four domains: maternal health models, quality improvement, workforce and benefits, and eligibility and enrollment/coverage expansion.
This brief focuses on enforcement of parity requirements for “non-quantitative” treatment limits that insurers impose on enrollees, such as prior authorization requirements and medical necessity determinations.
This brief includes a checklist of eight key questions that can help state purchasers and other payers develop a robust payment and spending strategy focused on advancing health equity.
This issue brief reviews proactive strategies that states can deploy to support postpartum individuals in maintaining health coverage and access to care when the Medicaid continuous coverage guarantee ends and beyond.
This brief highlights key lessons to inform data-sharing partnerships between community-based organizations, state agencies, and individuals with lived expertise and outlines data-sharing.
This brief highlights key successes and lessons learned from Oklahoma's implementation of new harm reduction policies.
In 2021, ASTHO convened state environmental health directors (SEHDs) and directors of public health preparedness to discuss innovations developed during the COVID-19 pandemic such as virtual inspections. This brief explores how state health and partner agencies developed these methods to support environmental health work and how they are continuing to adapt them moving forward.
In this brief, researchers explore what will happen to healthcare spending if the American Rescue Plan Act Premium Tax Credits expire.
This brief examines both combined and individual rates of reported anxiety and depression symptoms for the total adult population as well as by specific breakdowns, including age, gender, race/ethnicity, income categories, and education levels.
This analysis of the California Health Insurance Survey (CHIS) shows that Californians were largely protected from experiencing a major erosion in their ability to pay for health insurance and care.
This update to the methodology documentation for the Urban Institute’s Health Insurance Policy Simulation Model explains how they estimated health coverage in 2023, taking into account major uncertain issues such as Medicaid enrollment after the HHS public health emergency and the potential expiration of enhanced premium tax credits for Marketplace coverage in 2023.
This brief presents benchmark premium data separated by urban versus rural rating regions and includes data on the differences between average benchmark premiums in 2019 and 2022 for all 50 states and the District of Columbia.
To assist states in closing digital skill gaps and preparing for digital equity planning, this brief offers key questions and resources for state leaders to consider.
This brief reviews the regulatory framework for network adequacy for Medicaid Managed Care Organizations and Marketplace qualified health plans and identifies policies and practices to ensure their networks include the number and mix of providers that enrollees need.
This issue brief identifies several areas in which state departments of insurance may want to coordinate with other agencies or external stakeholders, issue new regulations or guidance, and establish means for minimizing gaps in coverage or access to services once the PHE ends.
This brief provides a current snapshot of racial, ethnic, and language concordance between nonelderly patients ages 18 to 64 and their usual providers.
This brief analyzes data from the National Health Interview Survey, the Current Population Survey, and the Health Reform Monitoring Survey to explore trends in coverage status and type between early 2019 and early 2021.
This brief summarizes key findings from a new study led by Dr. Hannah Neprash which provides direct answers about how clinicians responded to the Medicaid expansion.
This brief examines how labor and delivery closures in New Hampshire affected the providers and patients in rural communities.
This brief examines significant challenges and solutions identified by state health officials to mitigate coverage losses.
This brief projects Medicaid enrollment for the population under age 65 and federal and state Medicaid spending for 2022 and 2023, assuming the PHE is extended through the first, second, or third quarters of 2022.
This brief highlights strategies for states to expand affordable health coverage to immigrant populations in the United States and provides an overview of the status of the public charge rule.
This issue brief examines the current status of data collection to assess Medicaid enrollment and retention, summarizes potential forthcoming reporting requirements, and describes some of the best practices states should consider when developing a data dashboard to display this type of information.
This blog summarizes a phased set of priority measures and provides a model enrollment and retention dashboard template that states can use to monitor both the short-term impacts of phasing out public health emergency protections and continuous coverage requirements, as well as longer-term enrollment and retention trends.
This brief examines provisions of the Notice of Benefit and Payment Parameters for the plan year 2023 related to the state-based marketplaces and state insurance regulators.
This brief offers considerations for policymakers around the Children’s Health Insurance Program coverage as a method of enabling states to provide prenatal, labor and delivery, and postpartum services to pregnant individuals, regardless of immigration status.
This case study examines how Alaska's state and tribal leaders co-led the COVID-19 vaccination effort including allocation, distribution, funding, and communication.
This brief summarizes the unique structure of Virginia’s equity work, the strategy and actions taken to date, and success factors and lessons learned.
This brief explores how nearly 13 million adults delayed or did not get needed prescription drugs in the past year because of the cost, including 2.3 million elderly Medicare beneficiaries and 3.8 million nonelderly adults with private insurance, 1.1 million with Medicaid, and 4.1 million who were uninsured at any point during the year.
This issue brief explores opportunities for state Medicaid agencies to implement performance measures with contracted care entities that could strengthen their growing interest in social care and highlights several barriers to those applications.
This brief describes current use of and spending on routine vision and hearing services among all Medicare beneficiaries and select subgroups.
This brief highlights key state actions to increase cancer screening for adults covered by Medicaid and improving health outcomes.
This issue brief summarizes state strategies and experiences shared during a virtual summit on data and health equity, as well as lessons learned during the COVID-19 pandemic.
This brief synthesizes key accomplishments and lessons learned based on interviews with 10 state COVID-19 health equity task forces represented in the network.
The brief focuses on actions Medicaid agencies can pursue through their managed care programs or directly with provider organizations and highlights state interventions and collaborations that demonstrate promise in reducing disparities and begin to center equity in birth-related health policies.
This brief identifies key themes and policy considerations to help Massachusetts implement value-based payment models that better meet children’s needs.
This brief highlights a Nevada program that aims to target oral health care gaps among children who rely on school-based sealant programs to prevent dental decay, the most common chronic condition among children.
This brief examines how state Medicaid and public health programs can advance health equity for the communities they serve, especially for people of color, working both within their agency and through cross-agency partnerships.
This brief examines the information technology system, policy, and operational strategies states can consider to update key enrollee contact information to ensure eligible enrollees are able to keep or transition to new affordable health coverage at the end of the public health emergency.
This issue brief reviews state Medicaid/Children's Health Insurance Program agency data and information technology system “table stakes”—strategies that will have the highest impact for states seeking to ensure that eligible enrollees are able to keep or transition to new affordable health coverage when the Public Health Emergency continuous coverage requirements end.
This brief explores whether insurance shoppers are still being directed towards alternative coverage at a time when the Affordable Care Act coverage was broadly available and more affordable than ever because of the enhanced premium subsidies under the American Rescue Plan Act.
This issue brief—the first in a series “Supporting Health Equity and Affordable Health Coverage for Immigrant Populations”—provides an overview of the national immigrant health coverage landscape and offers considerations for policymakers related to state-funded affordable coverage programs for low-income individuals who do not qualify for subsidized health insurance under the Affordable Care Act or other public programs due to immigration status.
This issue brief presents a sustainable, hybrid coverage and funding approach for mobile crisis services in light of the new federal funding opportunities for states to improve access to behavioral health crisis services.
This brief documents how information describing sexual or gender minority populations is currently collected at the federal level and in Medicaid.
This brief highlights the Departments of Health and Human Services and the Treasury's final rule governing marketplaces and qualified health plans sold through the marketplaces in 2022.
This brief analyzes how three state governments (Illinois, Indiana, and Rhode Island) worked across agencies to respond to the COVID-19 pandemic.
This brief presents an updated version of the SHADAC COVID-19 Survey in April 2021, aimed at understanding respondents’ experiences with illness and death due to COVID-19 for themselves, their families, and their contacts.
This brief examines results from SHADAC's survey on population experiences with COVID-19 sickness and death.
This guide describes recommended process steps for states to integrate a focus on health equity in their Medicaid managed care programs.
This brief aims to assist state and federal analysts with survey development and/or analysis of existing survey data to generate estimates of health insurance coverage and access to care across racial and ethnic groups and according to nativity and/or immigrant status.
This issue brief outlines key priorities and considerations for modernizing Immunization Information Systems, including leveraging federal funding available to support these efforts.
This brief highlights the stories of people with Down syndrome who have benefited from Medicaid coverage.
This brief summarizes COVID-era changes and challenges for four major federal surveys—American Community Survey, Current Population Survey, Medical Expenditure Panel Survey, and National Health Interview Survey—and explains what effects these adaptations may have for understanding 2020 data as it becomes available.
This brief examines how several adults have gone without needed health care during the COVID-19 pandemic over concerns about being exposed to the novel coronavirus in hospitals, doctor’s and dentist’s offices, and other health care settings.
This issue brief outlines key barriers states face in their efforts to increase vaccination rates among BIPOC and highlights strategies states are pursuing in partnership with community-based organizations to address these challenges.
This guide is comprised of three tools to help state officials with the language they use to discuss and write about race and health equity.
This brief examines how enrollment gains in public insurance helped offset declines in employer-sponsored insurance during the COVID-19 pandemic. Unlike previous recessions, the uninsurance rate did not change.
This brief describes Nevada's new public option that is intended to provide consumers with comprehensive, but lower cost health insurance.
This brief examines how public health activities in the United States are critical to disease prevention, health promotion, environmental health monitoring, and emergency preparedness.
This brief examines how state are shifting strategies to increase accessibility and engage communities with low COVID-19 vaccine uptake.
This brief highlights the stories of people with heart conditions who have benefited from Medicaid coverage.
This brief describes a process used to identify a set of patient- and staff-reported measures for the Advancing Integrated Models initiative, eight pilot sites implementing approaches that seek to improve integrated, person-centered care models for adults and children with complex health and social needs.
This updated brief describes the American Rescue Plan Act’s home and community-based services enhanced federal medical assistance percentage (FMAP) provision, CMS’s recent implementation guidance, and considerations and next steps for state policymakers.
This issue brief documents how states are collecting information about race, ethnicity, and language on their Medicaid applications.
This brief highlights the stories of people who have benefited from Medicaid coverage during the COVID-19 pandemic.
This brief summarizes the time frames for emergency measures for Medicaid and Children's Health Insurance Program flexibilities during the COVID-19 pandemic.
This brief reviews the policy and operational considerations for states of the new option to extend postpartum coverage in the American Rescue Plan Act.
This brief seeks to show the maximum potential impact of the American Rescue Plan Act's (ARPA) enhanced marketplace subsidies on health insurance coverage by modeling the new subsides as if they were permanent changes.
This toolkit outlines template language that state-based marketplaces can adapt and use in consumer-facing communications regarding new Internal Revenue Service (IRS) information about how consumers can receive relief from repayment of excess advance premium tax credits for 2020 under the American Rescue Plan Act.
This brief describes the American Rescue Plan Act's home- and community-based services federal medical assistance percentage increase provision, the requirements for states receiving the enhanced federal funding, and considerations and next steps for state policymakers.
This brief provides updates to Medicaid Managed Care Contract Language: Health Disparities and Health Equity, published by SHVS which includes excerpts from managed care contracts, procurement questions, and other policy documents from twelve states and the District of Columbia.
This series of policy briefs include evidence-based recommendations to help people through the immediate health and economic crises and longer-term recommendations to ensure a fair and just opportunity for health.
This brief uses data from the Minnesota Department of Health to show how insurance rates in the state were relatively unchanged by the COVID-19 pandemic.
This toolkit outlines state options to address Medicaid spending without harming enrollee health and provider stability and access to care.
This brief draws its key findings from the Michigan Coronavirus Racial Disparities Interim Report and other sources to explore Michigan’s approach, key features, results to date, and lessons learned.
This brief estimates estimate the chilling effects on public program participation because of green card concerns and because of broader immigration concerns among adults in immigrant families.
This brief present that if the remaining 14 states had expanded eligibility in 2020, 4.4 million fewer people would have been uninsured that year.
This report explores flu vaccination rates across multiple years for U.S. adults across the 50 states and the District of Columbia as a proxy to identify population subgroups that may be harder to reach with a COVID-19 vaccine.
This brief summarizes key learnings from conversations with 50 leaders of state Medicaid programs across 14 states about implementing strategies to improve consumer engagement in policy and program planning.
This brief explores the key challenges faced by the rural ambulatory safety net in delivering primary care and behavioral health services since COVID-19 and the policy changes that have been implemented in response.
This brief explores the shares of a typical nongroup insurance premium attributable to essential health benefits and estimates the financial implications should they be eliminated from the nongroup insurance benefit package.
This brief explores impediments and accelerants to advancing health equity as states are increasingly being called upon to drive change.
This brief explores the ways in which public and private health insurance coverage options bolstered by the Affordable Care Act are mitigating the impact of employer-sponsored insurance losses during the COVID-19 pandemic.
This brief explores the ways in which various organizations worked together to improve access to and use of tobacco cessation benefits among Minnesota's Medicaid population with the goal of reducing commercial tobacco use in this population.
This brief explores the response to the COVID-19 crisis, taking stock of what we have learned and how we have changed.
This brief provides an introduction to screening for social risk factors, the first step most states are taking through their Medicaid managed care programs to address how social determinants of health influence enrollees' health status and spending.
This brief reviews the evidence on how the Affordable Care Act has affected individual and family health care coverage, access, affordability, hospital finances and national health expenditures.
This brief considers how a Supreme Court ruling overturning the Affordable Care Act would affect average people and illustrative, hypothetical families in different circumstances.
This brief compares four studies that project the effects of the COVID-19 recession on employment-based health insurance coverage and the number of uninsured people in 2020.
This brief highlights how Nebraska’s Medicaid agency and its Division of Public Health partnered to share antibiotic prescribing information between Medicaid claims and evaluation and management codes to determine where targeted education and outreach efforts were needed.
This brief provides an overview of New Hampshire’s recent directed payment to six types of essential Medicaid providers in order to help them keep their doors open during the COVID-19 pandemic.
This brief provides a chart describing the effective dates of various federal provisions to allow for temporary flexibilities in the Medicaid and Children's Health Insurance Program programs.
This toolkit is intended to serve as a resource for states as they begin to strategize about reopening and plan for the next phase of the COVID-19 pandemic.
This document provides examples of potential Medicaid messaging states can use during the COVID-19 pandemic.
This brief provides an overview of Children Health Insurance Program (CHIP) Health Services Initiatives (HSIs) and identifies ways that states can leverage them as part of their targeted response to the COVID-19 pandemic.
This Q&A responds to questions received regarding the April 9 Targeted Options for Increasing Medicaid Payments to Providers During COVID-19 Crisis Webinar and corresponding Toolkit.
This Q&A provides a moment-in-time update in response to questions about the federal government’s response to the COVID-19 pandemic.
This brief addresses how Medicaid Managed Care Organizations (MCOs) and states can individually and collectively play a role in responding to the COVID-19 pandemic.
This brief includes communication examples to help states answer questions on how health insurance covers COVID-related testing and treatment, encourage consumers to enroll in coverage, and engage with providers to keep them informed.
This brief estimates that in the four weeks leading up to April 11, 2020, as many as 18.4 million individuals in the United States may be at risk of losing their employer-sponsored health insurance (ESI) coverage, including policyholders and their dependents.
This brief discusses the new established guidelines regarding placing COVID-19 related ads on social platforms.
This brief is a compilation of state marketplace communications examples during the novel coronavirus outbreak.
This brief provides a template for states to inform residents of health insurance options during the COVID-19 pandemic.
This brief examines the Families First Coronavirus Response Act that was signed into law to provide resources to help states address the effects of COVID-19.
This brief examines the strategies being implemented by states to combat opioid use disorder in the midst of the COVID-19 pandemic.
This Q&A examines what the Families First Coronavirus Response Act is doing to help states address the COVID-19 pandemic.
This brief gives an overview of the multiple actions states are taking toward ensuring accessible coronavirus (COVID-19) testing and cross-agency collaboration.
This brief is a compilation of communication examples from state departments and agencies during the COVID-19 pandemic.
This brief provides some answers about who is eligible to enroll in coverage as many seek new health coverage, or help paying for coverage, during the novel coronavirus outbreak.
This article examines Advancing Integrated Models (AIM), a project through which eight organizations are designing and piloting new strategies for integrating innovative, “next-generation” approaches to person-centered care for individuals with complex health and social needs.
This blog from the Delta Center illustrates five key insights related to program design and evaluation from the productive partnership between the Partnership HealthPlan of California (PHC) and local community health centers (CHCs) to create a care coordination (CCM) program.
Using the American Community Survey, the brief presents that uninsurance increased by 0.2 percentage points between 2016 and 2017 despite a strong economy, meaning 700,000 more uninsured Americans.
These resources describe the core roles of state Medicaid and public health agency staff when partnering to implement evidence-based prevention interventions.
This analysis examines how people with different characteristics would be affected if the Texas v. United States decision invalidates the Affordable Care Act.
In this blog, two former state medicaid directors demystify the distinct yet complementary roles of public health and health care — and how these state agencies can align efforts around prevention strategies to impact health and costs.
This brief presents an analysis of targeted reforms to the Affordable Care Act.
This brief examines the prevalence of precarious work schedules among working adults whose families participate in federal safety net programs, using data from the December 2018 Well-Being and Basic Needs Survey.
This fact sheet explores the extent to which families of young children experience material hardship and psychological distress.
This fact sheet explores the extent to which families with young children continue to experience food insecurity.
America’s day-to-day readiness to manage health emergencies has improved significantly over the past six years according to a nationwide index of health security.
This table highlights new programs and federal initiatives to combat the opioid crisis.
The issue brief identifies the key questions for states pursuing Medicaid buy-in programs to consider as they seek to design and implement their proposals.
States can work to make sure hospitals truly seek out and act on meaningful input from a wide range of community representatives — not just community members on a hospital’s board or leaders from high-profile community groups.
Several states are developing accountable health models to improve health and control costs by addressing health-related community needs, such as transportation, recreation, and housing. This brief examines their organizational and governance structures.
This brief found that ACA markets have become more competitive between 2018 and 2019, but have not regained the level of competition they had in 2017.
This issue brief looks at progress made in using multi-payer claims databases for various strategic purposes, and offers considerations for states seeking to optimize claims databases to improve health care system performance improvement.
This brief reviews considerations for policymakers assessing their state Medicaid managed care programs and exploring strategies for advancing cost, quality, and accountability goals.
This brief reviews a number of Medicaid strategies states are implementing to prevent and treat substance use disorder and support long-term recovery.
This brief reviews the role that social and economic factors--such as housing, healthy food, and income--play in a “whole person” approach to health care, especially among Medicaid’s low-income enrollees.
This brief reviews the opportunities state policymakers have to affect the health—and future well-being and productivity—of their youngest residents through their Medicaid programs.
This brief reviews the growing body of research on Medicaid's health and economic impacts, including access to care; self-reported health status; preventive health screenings; delaying care because of costs; hospital and ED utilization; and mortality rates.
This brief outlines the basics of the Medicaid program, including financing and eligibility, for new state policymakers in order to lay the groundwork for considering the challenges and opportunities that lie ahead.
This brief highlights priority issues for consideration and potential action, including: the structure of the Medicaid agency; enabling coverage and access; addressing the needs of special populations; and value-based payment policies.
This brief explores opportunities to better address patients’ non-medical needs, including: identifying non-medical needs; employing non-traditional workers; partnering with community-based organizations/agencies; testing new technologies; and identifying funding.
Adult Unhealthy Days is a new measure that provides state-level estimates of the average number of days in the past 30 days that an adult’s mental or physical health was not good.
This case study explores how Indiana’s Family and Social Services Administration is working to rethink how to optimize the integration and delivery of health and social services for Medicaid beneficiaries.
New health insurance coverage estimates for Q1-Q2 2018 from the National Health Interview Survey find nationwide, 12.5% of nonelderly adults were uninsured in the first half of 2018.
This monitoring and tracking project will document changes to the implementation of national health reform to help states, researchers and policymakers learn from the process as it unfolds.
This technical assistance tool shares criteria used by innovative organizations that are identifying individuals for their complex care programs, to help others develop or refine eligibility criteria for complex care management programs.
This State Health Policy Highlight profiles three State Health and Value Strategies issue briefs that provide states with practical approaches to improve individual and population health and create joint accountability across health care and other sectors.
This State Health Policy Highlight profiles two issue briefs and a webinar on how state Medicaid programs can address social determinants of health.
This brief examines changes in health insurance coverage and health care access and affordability for parents and their children between 2013 and 2018 using data from the Health Reform Monitoring Survey.
These tables of state and county uninsurance estimates for 2017 and comparison year 2016 come from the 2017 American Community Survey via the U.S. Census Bureau's American FactFinder tool.
The Minnesota State Employee Group Insurance Program has covered Minnesota state employees and their dependents using a tiered provider model since 2002. A recent SHARE-funded analysis examined the tiering model as well as patient and clinic responses to this tiered provider network approach.
Recognizing an unmet need for toiletries and household products among clients, AccessHealth Spartanburg stocks a closet where eligible clients can “shop” for items. This builds trusting relationships between clients and staff and meets basic client needs.
State officials can align prevention strategies with value-based payment goals through a variety of mechanisms outlined in this brief, which draws from state-based 6|18 Initiative implementation efforts to help Medicaid and public health officials make the case for investing in prevention strategies and aligning these efforts to achieve state VBP goals.
An analysis of what would happen if the remaining 19 states that have not expanded Medicaid did so.
In Morrison County, Minnesota, an innovative state approach to improve population health is also helping combat the opioid crisis and save money. The Unity Accountable Community for Health (ACH) initiative has saved the state’s Medicaid program $3.8 million over three years by reducing claims for prescription opioid and related drugs.
This issue brief summarizes key features of the February 9, 2018 10-year CHIP extension. CHIP covers nearly 9 million children and is a key contributor to record-low levels of uninsurance among children.
The nation’s opioid epidemic claimed more than 42,000 lives in 2016, and more than 2 million people in the United States have an opioid use disorder (OUD). Yet, only 1 in 5 people suffering from an OUD receive treatment. In this issue brief, data from three states—New Hampshire, Ohio and West Virginia—highlight Medicaid’s role as the linchpin in states’ efforts to combat the opioid epidemic.
Many states continue to encounter challenges in stabilizing their individual health insurance markets, including large premium increases and declining insurer participation. One solution 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.
This brief compares the health topics each governor addressed in their 2018 State of the State remarks.
This brief provides an overview of State Health Compare's most recent estimates for state public health funding, which come from data collected by the Trust for America’s Health.
This brief provides an analysis of legislation recently introduced in the U.S. Senate that would create a mechanism for states to offer their residents the opportunity to buy a Medicaid-based public insurance option.
In response to President Trump’s October 12 executive order (EO), the U.S. Department of Labor (DOL) published proposed rules to expand the availability of health coverage sold through associations to small businesses and self-employed individuals. The full brief provides state health officials with a detailed review of the content of the proposed rule and examines the implications for states.
Uncertainty about the future of health insurance options and concern about the ability of Affordable Care Act (ACA) marketplaces to offer adequate competition and choice have spurred states to look for new coverage approaches. Innovative strategies states are proposing include allowing consumers to buy into state Medicaid programs and developing state-specific coverage options within the ACA’s framework.
As Congress barrels toward the end of the year, several bills are in play that will have major and almost immediate ramifications for health insurance markets. They include: Tax Cuts and Jobs Act (H.R. 1); The Alexander-Murray insurance market stabilization bill; The Nelson-Collins reinsurance program bill; and the temporary elimination of the health insurance tax (H.R. 4620).
More than 200 state health officials crowded into a NASHP annual conference session to learn about strategies to improve population health and reduce costs while simultaneously transforming their state’s health care finance and delivery models.
CMS released two informational bulletins detailing a new, streamlined approach for the review and management of Section 1115 demonstrations and state plan amendments and 1915 waivers. The streamlined approach may enhance states' ability to design innovative health care delivery initiatives in their Medicaid programs. These changes come at a critical time as states develop new approaches to reduce health care costs and stem the opioid epidemic.
HHS released proposed changes in its annual notice that governs standards for issuers and the health insurance marketplaces. The annual notice is one of the most significant tools the Administration wields in shaping the health insurance markets and this proposed notice carries significant implications for markets and states.
Understanding premium increases for individual market plans is more complicated this year. In many states, carriers attempted to recapture that lost revenue by increasing the premium of the silver plan relative to other metals. ‘Silver-loading’ gives subsidized non-cost-sharing reduction (CSR) consumers the opportunity to purchase a relatively more affordable bronze or gold plan.
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 presents a to-do list for states as they consider reinsurance for 2019.
This brief puts a state lens on emerging proposals in the ACA repeal and replace debate. Over the last decade, 21 states introduced legislation to sell across state lines, only five states enacted such laws, but no insurer has yet to offer.
Sens. Lamar Alexander (TN) and Patty Murray (WA) released a bipartisan bill designed to bring short-term stability to the health insurance market. While there are indications that Alexander and Murray secured the 60 votes needed for passage in the Senate, it faces an uncertain fate in the House and with the President.
The Administration signaled a willingness to give states more flexibility to address health and prevention in new and innovative ways under Section 1115 of the Social Security Act, allowing the Department of Health and Human Services to approve experimental and innovative projects that promote the goals of Medicaid. This comes at a pivotal time when many states are developing new ways to improve health care, reduce costs, and address health-related social needs such as housing.
The prospects for these new players reflect tensions for the market as a whole. Clearly the massive number of net exits signals a retrenchment by many market participants in 2018, resulting in shrinking of territorial footprints and outright withdrawal by large parts of the industry. For a variety of reasons, including attempts to repeal the ACA, the potential of the individual market has not yet been fully realized. Yet, it still remains the source of coverage for millions of people.
While there are risks to the stability of their markets that states cannot well control, one important route to adverse market outcomes may be state policy decisions. There are frequent calls for more state flexibility, but these data suggest that the exercise of existing state flexibility is one way that states have visited a considerable amount of trouble upon their markets. Yet there is a hopeful note here as well, since this suggests that there are steps that states can take to improve their situation.
This blog reviews cost-sharing reduction (CSR) programs designed to reduce the cost of insurance for consumers purchasing policies on individual markets.
Low-income and vulnerable populations often need services and supports outside the scope of a single state agency to live healthy lives. In some states, braiding or blending funding streams lends programs a measure of flexibility, efficiency, and resiliency. Some states are considering whether innovative funding models could help them address the health-related social needs of vulnerable residents.
The Senate released two bills as part of its efforts to repeal the Affordable Care Act (ACA): A revision to the Better Care Reconciliation Act (BCRA) eliminating the “Ted Cruz Amendment,” which provided funding to create coverage alternatives for high-risk individuals, and the Obamacare Repeal Reconciliation Act (ORRA), which would repeal many of the major provisions of the ACA within a two-year period, but does not offer plans to replace those provisions.
The data thus far suggest that most counties will have at least two insurers offering plans on the exchange, and most people will be able to choose from at least three.
Mental health and substance use coverage could roll back to pre-Affordable Care Act (ACA) levels if the American Health Care Act (AHCA) becomes law. Analysis finds the AHCA could limit access to mental health treatment.
CMS has signaled a willingness to evaluate new types of Medicaid proposals from states, such as Medicaid waiver applications that include programs to connect individuals to employment or incorporate features of private market coverage. In response to CMS’ letter, some states have developed proposals that include these types of requirements for certain individuals covered by the Affordable Care Act’s Medicaid expansion—and a few states are seeking similar changes for their non-Medicaid expansion populations.
This blog examines three potential changes to state public health programs, based on insights in the proposed White House budget for FY 2018. The budget is expected to change in Congress; however, it is important for states to consider what the administration’s priorities could mean for public health. It proposes some targeted infrastructure investments and proposes to reduce funding for public health infrastructure and services.
State health policymakers are increasingly acknowledging housing as a key component of health and are weaving housing strategies into their broader health system transformations. States have powerful levers at their disposal and a range of funding streams that they can bring to bear to support integrated health and housing, while local public housing authorities also play a large role in community efforts to house vulnerable, low-income households.
Under the authority of Section 1115 demonstrations, some states have implemented DSRIP programs to improve care, improve health, and lower costs. DSRIP programs restructure Medicaid funding into a pay-for-performance arrangement in which providers earn incentive payments outside of capitation rates for meeting certain metrics or milestones based on state-specific needs and goals, which are used to measure success.
Medicaid can play a unique and critical role in responding to public health emergencies and health crises. This brief explores the role Medicaid has played in responding to events such as the opioid and HIV/AIDS epidemics, the 2001 World Trade Center attacks, the Flint, Michigan lead contamination crisis, and Hurricane Katrina.
The AHCA, which proposes to repeal and replace the ACA, would dismantle the Prevention and Public Health Fund (PPHF). States received over $625 million from the PPHF in fiscal year 2016, and stand to lose more than $3 billion over five years if it is repealed. The bill would repeal all new appropriations for the PPHF starting in fiscal year 2019, and rescind any funds left over at the end of 2018.
HHS Secretary Tom Price issued a letter to governors encouraging them to take advantage of Sec. 1332 State Innovation Waivers under the Affordable Care Act and cited Alaska‘s request as an example. Alaska’s waiver seeks federal funds to support a reinsurance plan to stabilize its individual insurance market.
Congressional action to repeal and replace the ACA is on the fast track. The administration and GOP leaders have outlined a three-pronged effort to reform healthcare beginning with passage of the American Health Care Act (AHCA). Congress released Manager’s Amendments to the AHCA, inclusive of a series of policy and technical changes to the bill. Here is a full statutory text of policy and technical amendments.
While the focus of debate regarding repeal of the Affordable Care Act (ACA) has been on Marketplaces and the Medicaid expansion, myriad other provisions of the ACA are at risk of repeal—including those that streamline Medicaid eligibility and enrollment systems and implement a national, simplified standard for income eligibility. As of January 2016, 37 states are able to complete an eligibility determination in real time, defined as less than 24 hours, and among these, 11 states report that at least half of their applicants receive an eligibility determination in real time. The future of the ACA’s streamlined eligibility and enrollment-related provisions and the system improvements states have invested in to implement them are the subject of this issue brief.
Recent state waivers can inform the question of whether and how low-income individuals could benefit from health savings accounts (HSAs) with high-deductible health plans. State experiences incorporating health savings accounts into Medicaid can be instructive, as policymakers consider the role of HSAs in proposed health care reforms. This brief looks at health savings and similar accounts in Michigan and Indiana.
CHIP can provide critical financial support to states as they seek to implement cost-effective lead abatement activities to protect children. This issue brief describes the CHIP State Plan option, which does not require a waiver, and the opportunity it provides for states to make significant tangible reductions in lead exposure and improvements to children’s health. The brief includes specific examples in case studies from Michigan and Maryland.
When it comes to prevention, identification, and mitigation of public health crises, states are at the forefront. These crises require a multi-sector state agency approach as often they disproportionally impact disadvantaged communities and are linked with challenging social determinants of health.
Congress began its ACA repeal effort and evolving replacement options are receiving considerable attention. NASHP is tracking issues that appear in multiple proposals and will provide state perspectives, including: How might they impact states? What might they cost? Have they been tried before in states and what did we learn from past initiatives?
High-profile diseases such as Ebola and Zika grab headlines, but state health policymakers know that emergency preparedness begins long before the first news stories—or symptoms—appear. At the nexus of federal policy and local concern, state health policymakers are well-positioned to lead prior to, and during, health emergencies.
Stark health disparities make it difficult to move the needle on health outcomes and costs and reflect the fact that states face a variety of political and resource constraints when it comes to implementing health equity initiatives. While disparities still exist, all states have opportunities to advance health equity through a range of approaches, from incremental targeted programs to integration in broad health reform initiatives.
Leaders from across state governments, in both the executive and legislative branches, convened to help identify cross-cutting issues that provide opportunities to advance health reform and transform our health system to one that lowers cost, rewards value, and improves health. This brief presents key opportunities before the new administration that could maintain and accelerate state-based reforms.
To help better prevent and control costly conditions such as chronic diseases and break the cycle of poor health, states are experimenting with mechanisms to incentivize healthy behaviors and personal responsibility for wellness. In October 2016, leaders from Connecticut, Idaho, and Indiana shared their experiences along with the unique approaches their states are taking to address this issue.
State agencies across the country, from Medicaid to public health, to social services and corrections, are deeply engaged in multi-sector initiatives to reduce infant mortality. And for good reason: the United States ranks 25th among industrialized countries in infant mortality with a disproportionate number of being African Americans.
As public health departments adapt to meet the growing and changing needs of their communities, several national initiatives emerged to serve as pathways for health departments to be conveners, providers, and strategists to improve health and well-being. PHNCI, a division of the PHAB, was created to act as a national convener to incubate and share innovative ideas that help improve public health practice and serves as the hub for 21st century health. As part of PHNCI’s aim to provide strategic coordination at the national level, this brief provides an overview of national initiatives and their connections to accreditation.
Changes in population-based payment models in health care delivery have spurred enhanced efforts toward closer integration between state purchasers of health care and state, county, and local public health officials. This issue brief investigates approaches that state agencies might employ in order to better integrate public health and health care delivery as a means of improving health and the value of health care, and it is organized according to seven features of integration. The issue brief is accompanied by three case studies providing additional detail to some of the examples cited in the brief.
In this brief, we explore two revenue sources states may deploy to fund the non-federal share of expansion: provider assessments and provider donations. Both are authorized by federal law and both have been used by states in connection with expansion.
This issue brief examines seven safety-net ACOs across five states to understand their origins, organization, characteristics and functions and to identify federal and state policy questions associated with their emergence. The issue brief identifies both challenges facing safety-net provider ACO aspirants and state strategies to support safety-net provider development of ACOs.
As state Medicaid programs increase their focus on value-based payment, it is important to consider how FQHCs may participate in payment reform strategies. Through their focus on improved health outcomes, patient satisfaction, and access to appropriate care, alternative payment methodologies can benefit FQHCs, the state purchaser, and most importantly Medicaid beneficiaries. This brief describes a number of state-level payment reform strategies that include FQHCs and offers strategies and considerations for states and FQHCs alike.
