The $8.6 million in State Flexibility Grants announced by the Centers for Medicare & Medicaid Services (CMS) that would be allocated to 30 states and the District of Columbia comes with the Trump Administration’ approval despite recent attempts to disassemble the ACA. The funding from Obamacare, which is part of $250 million for State Rate Review Grants provided by the Patient Protection and Affordable Care Act (PPACA) to improve the process for how States review proposed health insurance rates were allocated in an effort to help stabilize the ACA exchanges and individual insurance markets. All states that applied are receiving funding. Texas was not included. In strengthening the health insurance marketplace states will have the ability to:
- Plan for consumer protections and market reforms
- Ensure that plans cover a range of services
- Utilize funds for hiring, reviewing policies, developing studies, or expanding the number of health plans residents have available to them
- Conduct economic analyses and market scans of the State’s health insurance market to improve and expand the number of affordable healthcare coverage options under new flexibilities offered to states by CMS guidance and regulations; and
- Examine plan policies, procedures and claims related data related to access to mental health and substance use disorder treatment services, including opioid treatment services.
Excerpt from FACT SHEET: Grant Awards Overview:
Approximately $8.6 million is being awarded to assist State Departments of Insurance in planning and
implementing select key insurance market reforms and consumer protections. Grant funds can be used for a variety of planning and implementation objectives related to the selected market reforms and consumer protections, including but not limited to implementing or enhancing policy form review, hiring or contracting with a clinician to review formularies, developing actuarial and economic analyses, and
performing market scans of the respective State’s health insurance market to improve and expand the
number of coverage options.
The grant will have a project and budget period of 24 months from the award date, August 20, 2018, to August 19, 2020. Each applicant awarded a grant will receive a minimum baseline amount of $274,345 (see Table 1 for award totals by jurisdiction). In addition to receiving a baseline award, each applicant awarded a grant will also receive “Workload” funds. Workload funds are determined based on the population and number of health insurance issuers in the State.