Essential Health Benefits
FEATURED ARTICLE
Q&A: How Maryland Uses Multiple Policy Levers to Improve Health Coverage, Affordability, and Access
/in Policy Maryland Blogs, Featured News Home Cost, Payment, and Delivery Reform, Eligibility and Enrollment, Essential Health Benefits, Health Coverage and Access, Health IT/Data, Health System Costs, Medicaid Expansion, State Insurance Marketplaces /by Christina CousartMaryland has a long history of enacting statewide health reforms and 2019 was no exception with the passage of several significant reforms, including the Maryland Easy Enrollment Health Insurance Program (MEEHP), which passed with bipartisan support and was signed by Gov. Larry Hogan in June. Maryland is also implementing a new value-based plan design for health insurance marketplace plans and […]
Legal Challenges to State Rx Laws
/in Policy Featured News Home, Toolkits Administrative Actions, Eligibility and Enrollment, Essential Health Benefits, Health Coverage and Access, Legal Resources, Prescription Drug Pricing, State Rx Legislative Action /by NASHP StaffNavigating Legal Challenges to State Efforts to Control Drug Prices: PBM Regulation, Price Gouging, and Price Transparency Katherine L. Gudiksen, PhD, Samuel M. Chang, JD, and Jaime S. King, JD, PhD[1] In the last several years, states have increasingly attempted to use legislative efforts to control drug prices. Trade groups representing the interests of the […]
State Insurance Reforms Tackle Price Transparency, Rising Costs, and the Uninsured
/in Policy California, Connecticut, Nevada Blogs, Featured News Home Cost, Payment, and Delivery Reform, Eligibility and Enrollment, Essential Health Benefits, Health Coverage and Access, Health System Costs, State Insurance Marketplaces /by Christina CousartSeptember was a busy time for state insurance regulators as they worked to finalize rate filings and prepare for the upcoming health insurance open enrollment season. While initial filings indicate nominal increases to individual market premiums for the 2020 plan year, insurance costs are escalating for individuals and families who receive coverage through their employers. […]
Resources to Help States Improve Integrated Care for Pregnant and Parenting Women
/in Policy Toolkits Behavioral/Mental Health and SUD, Care Coordination, CHIP, Chronic and Complex Populations, Chronic Disease Prevention and Management, Eligibility and Enrollment, Eligibility and Enrollment, Essential Health Benefits, Health Coverage and Access, Health Equity, Healthy Child Development, Infant Mortality, Integrated Care for Children, Integrated for Pregnant/Parenting Women, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Medicaid Managed Care, Physical and Behavioral Health Integration, Population Health /by NASHP StaffState Medicaid Levers to Promote Immunization: California’s Experience
/in Policy California Reports CHIP, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Eligibility and Enrollment, Eligibility and Enrollment, EPSDT, Essential Health Benefits, Health Coverage and Access, Health Equity, Health IT/Data, Health System Costs, Healthy Child Development, Immunization, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Population Health, Primary Care/Patient-Centered/Health Home, Quality and Measurement /by Rebecca CooperVaccines are a powerful and cost-effective tool to prevent diseases and save lives. Once common, deadly diseases such as polio, measles, and mumps are preventable and smallpox no longer exists outside of a laboratory. According to research estimates, of 4.3 million infants born in the United States in 2009, vaccines will prevent 40,000 deaths and […]
Montana Uses Patient-Centered Medical Homes to Holistically Address Children’s Health Needs
/in Policy Montana Blogs Care Coordination, Children/Youth with Special Health Care Needs, Children/Youth with Special Health Care Needs, CHIP, CHIP, Chronic and Complex Populations, Cost, Payment, and Delivery Reform, Eligibility and Enrollment, EPSDT, Essential Health Benefits, Health Coverage and Access, Healthy Child Development, Integrated Care for Children, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Medicaid Managed Care, Physical and Behavioral Health Integration, Primary Care/Patient-Centered/Health Home, Quality and Measurement /by Emma WatsonMontana recently expanded its Patient-Centered Medical Home (PCMH) program benefits to most children enrolled in Medicaid and the state’s Children’s Health Insurance Program (CHIP). Montana enhanced its PCMH program by: Expanding the pool of approved providers; Increasing the number of quality measures that must be tracked; and Adding complex care management (CCM) – a coordinated […]
Q&A: How Medicaid Expansion Put Naloxone in the Hands of the People Who Needed It Most
/in Policy Blogs Behavioral/Mental Health and SUD, Chronic and Complex Populations, Chronic Disease Prevention and Management, Eligibility and Enrollment, Essential Health Benefits, Health Coverage and Access, Medicaid Expansion, Population Health, Safety Net Providers and Rural Health /by NASHP StaffMedicaid expansion, which took effect as the opioid epidemic ballooned, provided insurance coverage to people at highest risk of opioid use disorder (OUD) – lower-income, younger adults. Because Medicaid covers the overdose-reversal drug naloxone, the expansion gave Harvard Medical School professor Richard Frank an opportunity to compare how Medicaid expansion impacted naloxone prescribing in expansion […]
How Washington State Is Reducing Costs and Improving Coverage Value – A Q&A with its Health Benefit Exchange CEO
/in Policy Washington Blogs Eligibility and Enrollment, Essential Health Benefits, Health Coverage and Access, Safety Net Providers and Rural Health, State Insurance Marketplaces /by Christina CousartWashington State made history recently with passage of Chapter 364 – a new law that is poised to revolutionize the state’s individual insurance market. The law takes a multi-pronged approach to its market redesign by: Creating a quasi-public option product for Washington’s individual market; Requiring standard plan design for plans sold on its exchange; and […]
States Add Coverage Mandates to Cover Infertility Treatment following Cancer Treatments
/in Policy Blogs Essential Health Benefits, Health Coverage and Access, Integrated for Pregnant/Parenting Women, Maternal, Child, and Adolescent Health, State Insurance Marketplaces /by Joyce Reinecke, JD, Alliance for Fertility Preservation executive director and Oncofertility Consortium founderUnder the Affordable Care Act (ACA), individual and small group plans must cover essential health benefits, such as pre-existing conditions. However, states can go beyond the ACA’s requirements and mandate coverage for other conditions, such as infertility or autism, though they must cover those additional costs. A new wave of state mandates have expanded what […]
How States Promote Recovery for Pregnant and Parenting Women with Substance Use Disorder
/in Policy Colorado, Pennsylvania, Texas Blogs Behavioral/Mental Health and SUD, Care Coordination, Chronic and Complex Populations, Chronic Disease Prevention and Management, Essential Health Benefits, Health Coverage and Access, Healthy Child Development, Infant Mortality, Integrated Care for Children, Integrated for Pregnant/Parenting Women, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Medicaid Expansion, Medicaid Managed Care, Medicaid Managed Care, Physical and Behavioral Health Integration, Population Health /by Hannah Eichner, Becky Normile and Carrie HanlonSubstance use disorder (SUD), including opioid use disorder (OUD), is prevalent among pregnant and parenting women, and these women have unique and often un-met treatment needs. Despite significant efforts, states report that access to treatment continues to lag for this population. In 2014, half of pregnant women with OUD who were enrolled in publicly-funded treatment […]
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
How States Address Social Determinants of Oral Health in Managed Care Contracts
/in Medicaid Managed Care Maps Child Oral Health, Children/Youth with Special Health Care Needs, CHIP, CHIP, Chronic Disease Prevention and Management, Essential Health Benefits, Health Coverage and Access, Maternal, Child, and Adolescent Health, Medicaid Expansion, Medicaid Managed Care, Medicaid Managed Care, Oral Health, Population Health, Social Determinants of Health, Special Populations and Services /by NASHP Staff