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The Scoop: November 27, 2019 Edition

In this edition

Welcome to this week’s round-up of state-level health reform news, including:

Illinois expected to cap insulin cost-sharing at $100 per month as of 2021

Earlier this year, Colorado became the first state in the country to limit how much state-regulated insurers can require members to pay for insulin; the state’s $100/month cap takes effect in January. Illinois is now on the brink of enacting a similar bill, which would take effect in 2021. Illinois S.B.667 was approved by lawmakers earlier this month, and awaits Gov. J.B. Pritzker’s signature. If it’s enacted, Illinois residents with state-regulated (ie, not self-insured) individual or group health plans will have to pay no more than $100/month for insulin starting in 2021.

Tennessee submits modified proposal for Medicaid block grant funding

Tennessee has not expanded Medicaid under the ACA. But the state is awaiting federal approval for a proposed Medicaid work requirement, and is now the first state in the nation to submit a proposal for Medicaid block grant funding. In response to critical public reaction to the draft proposal, the final version of the proposal indicates that the state will not use the block grant waiver authority to reduce benefits under the TennCare Medicaid program.

BYU-Idaho will continue to allow students to rely on Medicaid

For the last few weeks – in this edition of The Scoop and this edition – we’ve been talking about BYU-Idaho’s controversial decision to stop allowing students with Medicaid to waive coverage in the school’s health plan as of 2020.

Idaho’s newly expanded Medicaid eligibility rules mean that many more students will be eligible for Medicaid as of January, but BYU-Idaho’s decision had caught students off guard and some were making plans to withdraw from the school as a result. Now BYU-Idaho has reversed course, issued an apology for the “turmoil” the school had caused, and announced that BYU-Idaho will continue to allow students with Medicaid to waive coverage under the school’s health plan. Unlike most student health plans, BYU-Idaho’s plan is self-insured and does not have to comply with the ACA. So the coverage is less robust than Medicaid, and also more costly for students.

Trump administration’s immigrant health insurance requirement blocked

A federal district judge in Oregon has issued a preliminary injunction blocking the Trump administration’s proclamation on health insurance for immigrants. The new rules were largely unworkable, and would have required prospective immigrants to have health insurance or obtain it within 30 days, albeit without using premium subsidies in the exchange. The injunction, which applies nationwide, means that the new rules will not take effect for the time being.

Lawsuit filed in Michigan to block impending Medicaid work requirement

Michigan’s Medicaid work requirement is scheduled to take effect in January, but four enrollees in Michigan’s Medicaid expansion program have filed a lawsuit in an effort to block it. Lawsuits have successfully blocked Medicaid work requirements in Kentucky, Arkansas, and New Hampshire. Indiana’s Medicaid work requirement is also facing a lawsuit, and the state opted to suspend its work requirement earlier this month. And the legal uncertainty facing Medicaid work requirements caused Arizona to indefinitely postpone its work requirement last month.

Some new short-term plans resemble a hybrid of ACA-compliant plans, traditional short-term plans, and pre-ACA plans

Last year, the Trump administration changed the rules for short-term health plans, allowing them to have total durations – including renewals – of up to 36 months. Some states have taken action to limit or ban short-term plans, but others have embraced these plans as a potential alternative for their healthier residents.

Insurers in some areas have begun to offer new short-term products that are something of a hybrid of ACA-compliant plans, traditional short-term plans, and pre-ACA plans.

A new plan that became available in Nebraska this fall is being marketed as “a great alternative to traditional Affordable Care Act plans,” although buyers should certainly read the fine print. Another new product is being rolled out in Idaho on December 1, under the state’s new “enhanced” short-term plan rules. Last year, CMS rejected Idaho’s plan to create non-ACA-compliant “state-based” plans. But CMS encouraged Idaho to essentially do roughly the same thing by using short-term plans, and that’s what the state is doing.

Oklahoma hires consultant to design alternative to Medicaid expansion

Last month, Medicaid expansion supporters in Oklahoma turned in more than enough signatures to get a Medicaid expansion initiative on the state’s 2020 ballot. But Oklahoma Gov. Kevin Stitt opposes Medicaid expansion and has hired a consulting firm – with a contract worth up to $1.49 million – to help him devise an alternative to the ACA’s Medicaid expansion.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.


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