State News

Oregon has expanded its Medicaid look-alike program, Healthier Oregon, to all residents who
qualify, regardless of their immigration status, reports The Lund Report. The program began in
2021, originally covering those 19-24 and 55 years and older. State officials estimate 55,000
people will be covered through the program.

Maryland will now offer coverage for pregnant and postpartum people, regardless of citizenship
status, according to the Baltimore Sun. This is part of the Healthy Babies Initiative, which aims
to reduce the number of maternal deaths in the state. Starting July 1, 2023, pregnant, income-
eligible residents will be able to receive the same benefits available to other pregnant individuals
with Medicaid coverage, including physical and behavioral health care, dental care, prescription
drug coverage without copays, through the CHIP “unborn child” option, plus an additional four
months of postpartum coverage using Health Service Initiative authority.

Rhode Island has passed legislation that allows insured individuals to access HIV-prevention
and post-exposure medications without any out-of-pocket costs, reports the Rhode Island
Current. The CDC estimates that only about one-quarter of individuals at risk of HIV
transmission are using PReP due to high costs, which can be up to $2,000 per month without
insurance. In addition to requiring all health insurance carriers in the state to cover pre-exposure
prophylaxis (PrEP) and post-exposure prophylaxis (PEP), the legislation also authorizes
pharmacists to prescribe the drug to eligible patients, potentially decreasing wait times for
patients prescribed PEP, which is most effective if taken within seventy-two hours of potential
exposure. Rhode Island joins a growing list of states that have passed similar legislation,
including Maine, Nevada, and Virginia.

Lawmakers in Minnesota have allocated $1.1 million to establish a nine-member Prescription Drug Affordability Board and an eighteen-member Prescription Drug Advisory Council to provide expert advice to the board on cost issues, reports Minnesota Public Radio. The board, in consultation with the advisory council, will be responsible for conducting cost reviews of prescription drugs and establishing upper payment limits if the drug is determined to cause affordability challenges for the health care system or patients. The legislation also prohibits "excessive price increases" for generic or off-patent drugs. Distributors that raise the prices of generic drugs by 15 percent in one year or 40 percent over three years would face penalties.

Illinois will establish a state-based health insurance marketplace as well as a rate review process, reports WWTV News. Under House Bill 579, Illinois will join the eighteen other states with state-based marketplaces, offering plans sold under the Affordable Care Act with subsidies for those earnings above the Medicaid income threshold. In addition, House Bill 2296 authorizes the Illinois Department of Insurance will have the authority to modify or reject proposed premium rate increases that it determines to be unreasonable or inadequate. It also increases transparency for consumers by adding reporting requirements for insurance companies.

Connecticut’s Governor signed legislation designed to address the rising costs of health care in the state, reports the State Department of Public Health. The law (HB 6669) includes a drug discount card program for all residents, stricter oversight of prescription drug marketing, updated annual drug reporting requirement thresholds to ensure enhanced scrutiny of costs, expanded prohibitions on facility fees, increased competition in health care markets, and improved Certificate of Need protocols. Additionally, the legislation mandates various studies on affordability-related topics be conducted in the upcoming years.

Connecticut’s budget includes provisions to eliminate medical debt for Connecticut families, reports the CT Insider. The plan involves collaborating with nonprofit organizations that negotiate with hospitals to purchase medical debt at significant discounts and subsequently cancel it. The budget allocates $6.5 million, which legislators believe can erase hundreds of millions of dollars in medical debt.

Connecticut and Pennsylvania have developed value-based payment models for Medicaid providers that are focused on maternity care, according to the NASHP. Connecticut uses a voluntary pay-for-performance model where providers are eligible for bonus payments if certain quality metrics are met, including receipt of a comprehensive postpartum visit, self-measured blood pressure, and low-dose aspiring for certain patients. Pennsylvania uses a bundled payment where providers receive bonus payments determined by quality metrics, such as postpartum depression screenings and follow-up, substance use disorder treatment, and well-child visits, as well as decreased cost of care. To address racial disparities in maternal mortality, providers that meet these metrics for Black patients in Medicaid can receive additional incentives.

Texas has passed a law prohibiting anti-steering and anti-tiering plans effective 2024, reported by ALM Benefits Pro. Anti-tiering provisions compel insurers to place favored providers in higher tiers even if they don’t meet cost or quality standards, and anti-steering provisions restrict insurer’s ability to direct patients to higher value care from competing providers, respectively. Under HB 711, employers will be allowed to steer workers toward higher-performing health centers and tier hospitals based on performance.