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State Legislative Sessions Pick Up Steam

In last month’s edition of the Washington Wire, we wrote about steps some states are taking with respect to their Medicaid programs. Here is a brief update on some of the Medicaid-related developments that have happened since then.

• Utah: the state legislature and Governor acted to override a 2018 ballot initiative approved by Utah voters that called on the state to make Medicaid available to people earning up to 138 percent of the Federal Poverty Level (the threshold established in the ACA). In February, Utah lawmakers instead enacted legislation that expands Medicaid eligibility up to only 100 percent of the FPL. This measure would also impose work requirements and enrollment caps, and calls for the federal government to block-grant Medicaid dollars to the state. Utah officials say they are confident that the federal Centers for Medicare and Medicaid Services (CMS) will approve this far more limited partial Medicaid expansion (which is expected to cover 60,000 fewer people than the version approved by voters).
• Idaho: Citizens in Idaho also voted last year to approve a ballot measure expanding Medicaid eligibility up to 138 percent of the FPL. An Idaho think tank subsequently sued claiming that the ballot measure violated the state constitution because it delegates too much power to the federal government. The Idaho Supreme Court rejected that claim in February, allowing the state’s Medicaid expansion to move forward. Conservative state legislators are trying to limit the Idaho measure, following the Utah example, though their efforts to date have been unsuccessful.
• Georgia: A Georgia Senate committee has approved a bill authorizing the Governor to pursue a partial Medicaid expansion, up to 100 percent FPL, most likely with work requirements attached. The bill (which contains few details) also authorizes the Governor to explore changes to the state’s ACA marketplace rules.
• North Carolina: Hemophilia of North Carolina joined with members of the National Organization for Rare Diseases to advocate for Medicaid expansion at their Hill day on Feb. 12.

State legislatures, of course, are also considering lots of measures that don’t touch on Medicaid. Here are some of the topics that state member organizations have advocated about so far this year:

• Step therapy: The Virginia General Assembly approved a step therapy reform bill that places patient protection guardrails around insurers’ use of “fail first” protocols. The bill has gone to the Governor’s desk. Congratulations to VHF, HACA and other Virginia advocates, who worked for three years to pass this legislation! Step therapy protections will be on the agenda for a number of other state member organizations this year.
• Accumulator adjusters: The Virginia General Assembly also approved a bill addressing the use of copay accumulator adjusters. The bill requires insurers to count co-pay assistance toward patient overall out-of-pocket maximums. This bill, too, has gone to the Governor’s desk for signature.
• Prior authorization: at its Maryland Legislative Day, HFM advocated for a bill that seeks to ease some of the burdens of prior authorization requirements. The bill would limit insurers’ ability to require repeated re-authorizations for ongoing use of prescription medicines for chronic conditions.
• Funding for state hemophilia programs: The Tennessee Hemophilia & Bleeding Disorders Foundation and Hemophilia of South Carolina planned to advocate for state-specific programs that benefit people with bleeding disorders in their states.
• Bleeding Disorders Awareness: The Texas Bleeding Disorders Coalition held its Legislative Day, advocating for legislation to designate March as Bleeding Disorders Awareness Month in state statute and into perpetuity. HB1508 was introduced in the House while community members were seated in the House Gallery.
• ACA non-compliant plans: A large number of states are considering bills that respond to the Administration’s ACA-related rulemakings from 2018. Some of these bills aim to bolster the patient protections originally contained in the ACA: limit short term plans, provide reinsurance funding to help cover the costs of covering enrollees with expensive health conditions, codify essential health benefits, etc. Other bills take the opposite tack, e.g., proposing to broaden access to Farm Bureau plans, short term plans, and other forms of lower cost, less comprehensive coverage. (Wider availability of these skimpier insurance options will siphon healthy people from the insurance market, leading to a “sicker” risk pool and higher premiums for people who need comprehensive insurance.)

HFA is following state legislative sessions around the country and will continue to update you via the Word from Washington and the Washington Wire. Remember, as you prepare to communicate with your state and local lawmakers, to check HFA’s Legislative Day toolkit for resources and information to help you advocate – and thank you for engaging in advocacy!
Quick hits:

• Applications for HFA’s 2019 Policy & Government Relations Internship close TOMORROW, March 1. Learn more about what the internship includes, and find the application here.
• HFA’s inaugural Advocacy Leadership Council officially kicked off this month with an orientation webinar. This group will take part in leadership training over the next two years so they can become advocacy leaders. Look to hear more about what they are learning and how they are putting those skills into action throughout the year.
• HFA signed onto coalition comments – and, with NHF, filed additional comments specifically outlining the bleeding disorders perspective – with respect to proposed federal rules that would govern the ACA marketplaces and ACA health plans in 2020. The coalition comments expressed concern about rule changes that would increase premiums and out-of-pocket costs for consumers; create confusion; and expose consumers to substandard plans. The separate HFA-NHF comments addressed provisions of the NBPP that would affect prescription drug coverage and limit the scope of “essential health benefits” that plans must cover.
• HFA joined with NHF to file comments with the Institute for Clinical and Economic Review (ICER) regarding methods to guide value-based pricing of potential cures (like, for example, a gene therapy for hemophilia). The comments urged ICER to work with the patient community to incorporate the patient voice and perspectives in any assessment of the value of innovative therapies.