Maryland Total Cost of Care Model - Transforming Health and Health Care

In this week’s issue of the JAMA Network, Maryland’s Total Cost of Care Model is described and highlighted as a positive and successful demonstration of how a CMS Innovation Center partnership with a state can accelerate transformation across payers and generate significant savings. Maryland has made a commitment by taking total-cost-of-care accountability for all Maryland Medicare fee-for-service beneficiaries. The Maryland total-cost-of-care model will test new ways to reduce costs and improve quality across the health care continuum with an emphasis on population health. None of this is possible without a strong federal-state partnership. Together, CMS and the state are implementing a model that aligns financial incentives across an increasing number of Maryland clinicians, facilities, and suppliers and offers them new tools to help achieve better health and lower costs for the populations they serve.

Consumer Health First looks forward to continuing to promote the consumer perspective in the model on HSCRC's work groups.

Supreme Court Refuses to Take up Maryland Law on Pharmaceutical Price Gouging

On Tuesday, the Supreme Court of the United States let stand a ruling from the 4th U.S. Circuit Court of Appeals . The law was the first of its kind in the nation, although other states have considered similar measures.

The law applied to generic or off-patent drugs manufactured by at least three other firms. It would prevent those companies from imposing a significant price increase without justifying it to the attorney general, who could then ask a judge to order that the price increase not take effect. Violating the law carried a $10,000 fine.

The appeals court held the measure violated the U.S. Constitution by trying to regulate trade outside of Maryland.

This is a blow to consumers and efforts to achieve drug pricing transparency.

Consumer Health First is supporting current legislation efforts to create a Prescription Drug Affordability Board, which would protect State residents and certain stakeholders within the health care system from the high costs of prescription drug products, by requiring certain conflicts of interest to be considered when appointing Board members, and requiring the Board to identify certain prescription drug products with certain costs. It would also establish a Prescription Drug Affordability Stakeholder Council.

Get the Latest Data on Medicaid Benefit Coverage for Adults in Each State, including Behavioral Health Services

Federal Medicaid rules grant states flexibility to design their own benefit packages beyond meeting core federal requirements. The Kaiser Family Foundation recently surveyed Medicaid directors in all 50 states and the District of Columbia to identify those benefits covered for categorically needy traditional adult beneficiaries in their fee-for-service programs. Their updated Medicaid Benefits Database includes data about the various benefits covered in states, notable limits on those benefits, and cost sharing requirements as of July 1, 2018. Data from previous years (generally 2012 and earlier) is also accessible. Also available for the first time is another database that includes data on Medicaid coverage of a range of behavioral health services, by state, at KFF’s Medicaid Behavioral Health Services Database.

The databases should be useful for Medicaid officials, researchers, patient advocates and journalists trying to understand the variation across states in Medicaid benefits such as dental coverage, private duty nursing services and treatment for opioid addiction.

Medicaid Supports Maryland - Exciting New Resource!

The Medicaid Supports Maryland campaign we launched a year ago to make sure that elected officials and the public fully understand the broad reach and positive impact of this vital health care program.   

Did you know that: 

  • 1,046,579 individuals are enrolled in Medicaid at the end of 2018 - that's more than one in five Maryland residents.

    • Enrollees include individuals from all walks of life including four year old Kayleigh. Her mother wrote, "Medicaid gives us hope for the future and for Kayleigh to reach her maximum potential."  

  • $12.4 billion is the total for fund claims. As reported by Medicaid Program Director, Dennis Schrader, $7.7 billion are federal funds and $4.7 billion are state allocations.

Our 2017 poll, showed strong support for the program, and why we need to build on that support by providing the facts about Medicaid. That is why we developed the Medicaid 101 Briefing.

These are being provided to each member of the Legislative Committees that have oversight of the program, as well as new legislators, so that they are fully informed on the Medicaid program in Maryland. We are grateful to The Hatcher Group for helping to bring this project to fruition and for the financial support of the Maryland Managed Care Organization Association, Kaiser Permanente, Healthcare Initiative Foundation, and NARAL-Pro Choice.   

We are also grateful to Maryland's leaders for their commitment to the Medicaid program, but we must be alert for any threats to the program.  Last week, multiple news sources, including Axios, reported on the Trump Administration's efforts to bypass Congress and encourage states, through the 1115 waiver process, to implement block grants. This, despite the fact that Republicans failed to win the votes to do this with their previous legislative efforts to "repeal and replace" the ACA. The impact of that legislation, specific to Medicaid block grants, would have been the loss of insurance for millions of Americans, as reported by the Congressional Budget Office, in September 2017.  

Please, join Consumer Health First in supporting the Maryland Medicaid Program.

  • Donate to Consumer Health First and help us continue to ensure that all Marylanders have access to high quality, comprehensive and affordable health care.

DC May Be Shut Down, But Annapolis Is In Full Swing


Things are gearing up in Annapolis. Governor Larry Hogan was sworn in for his second term in office on Wednesday, and legislation is being filed daily.

For those who are unfamiliar with the General Assembly website you can find video tutorials to access the wealth of information to be found there. Legislation is, of course, a top priority and you can use several search tools as well as the a list of the bills by subject here.  

You can follow the bills Consumer Health First is supporting and monitoring this session. We update our bill tracking list every Tuesday.

The committee hearing schedules are also available online. Currently, many committees are having briefings on state programs. You can watch these live (found on right hand side of home screen) or find them later in the archives.   

Upcoming committee briefings in January include:

  • Tuesday 22:  Health, Government and Operations - All Payer Model and the Primary Care Program

  • Thursday 24:  Health, Government and Operations - Medicaid 101 and Long Term Care 101

  • Tuesday 29:  Senate - Total Cost of Care Model 

Important Dates to remember this Session:

    • Feb. 4 = deadline for introducing Senate Bills

    • Feb. 8 = deadline for introducing House Bills

    • March 18 = Bill Crossover Day

2018 - A Banner Year At Maryland Health Connection

On December 17, the Maryland Health Benefit Exchange  released the enrollment numbers for 2019 plans and showed an increase of 2% over the previous year. Nationwide,  enrollment was down  about 4%. This great success would not have been possible without the emphasis that the Board and staff placed upon outreach, marketing, and consumer assistance. There are a few numbers worth highlighting from the MHBE press release: 

  • 156,963 - the number of Marylanders who enrolled in private health coverage that is effective on January 1, 2019. A few hundred more whose applications were in process at midnight December 15 will bring the total above 157,000!

  • 5,432 - the number who enrolled on the last day (December 15), and this despite the uncertainty on the future of the ACA created by the decision of the Texas Judge the night before. In fact, this was the highest single-day enrollment in the exchange's history.

  • 38,558 - the number of consumers who used the "Enroll MHC" mobile app on Friday and Saturday. That doubled the number who used the app in the same period in 2017.

  • 4% - the increase over last year in young adult (18-34) enrollees.

  • 28% - the largest increase in enrollments was in Wicomico County.

  • 8% & 2% - the increase in, respectively, African American and Hispanic enrollees over 2018

Somewhat troubling is the fact that new enrollees were down by 10% from 2018. This and other factors that could impact the stability of the individual insurance market will be on Consumer Health First's agenda in 2019. But, for now, our thanks go the MHBE Board, Michele Eberle and her terrific team, and all those who staff Maryland's Connector Entities and others who provide such vital assistance to consumers. Congratulations and happy holidays to one and all!