On April 2, 2018, the Centers for Medicare and Medicaid Services (CMS) issued instructions to Medicare Advantage plans encouraging more flexible service coverage policies in such plans for 2019. Such capitated plans cover the same services as traditional, fee-for-service Medicare, plus supplemental benefits adopted by the plan with CMS approval. Under the new CMS instructions, any Medicare Advantage plan would have additional flexibility to cover supplemental benefits to compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.

On Monday, February 26, 2018, twenty states, led by the attorneys general of Texas and Wisconsin, sued officials of the U.S. Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS), alleging that the law revoking the penalty aspect of the ACA’s individual mandate rendered the entire ACA unconstitutional.  The lawsuit was filed in the U.S. District Court for the Northern District of Texas. 

On February 20, 2018, the Government Accountability Office (GAO) released a report recommending changes in federal policies and procedures governing state-operated Medicaid demonstration waiver projects.  These projects represent the leading edge in state Medicaid innovation as well as over $109 billion in federal Medicaid spending annually. GAO found in its review of these projects that the Centers for Medicare and Medicaid Services (CMS) has not always demanded thorough, scientifically valid, and timely data evaluations as to whether the projects achieved state-specified, CMS-approved goals to improve care and to contain costs.  

The State Flexibility to Stabilize the Market Grant Program (“State Flexibility Grant Program”) was developed to support states as they implement several of the market reforms and consumer protections under Title I of the Affordable Care Act (ACA). This new funding opportunity builds upon many of the efforts currently underway in states related to the Consumer Protection grant funds, which were awarded in October 2016. PCG assisted many states with projects related to those consumer protections grant funds and our team has used that experience to compile the following insights and suggested activities to help states with their grant applications for this new federal funding opportunity.