State news: Calif. split on Aetna-Humana merger, N.Y. enacts opioid prescription limits

Here’s a roundup of the latest healthcare news from California, New York, Kentucky, Illinois and Indiana.

Calif. insurance agencies differ on Aetna-Humana merger

Two insurance regulators in California have reached different conclusions on the pending $34 billion acquisition of Humana by Aetna.

The state’s insurance commissioner, Dave Jones, is against it, and sent a letter to the Department of Justice (DOJ) asking it to block the merger, citing concerns over how much of the Medicare Advantage market the new company would control and predictions of premium hikes.

“Aetna has a track record of excessive rate increases on small businesses in California. The Aetna merger with Humana would permanently remove one of the nation's largest health insurers from the market and further reduce competition," Jones said in a statement.

Jones wrote a similar letter to the DOJ on the Anthem-Cigna merger, though he has no authority himself to block the deal.

However, the deal was given a thumbs up a few days earlier by the California Department of Managed Health Care, on the condition that the combined Aetna-Humana be subject to greater oversight on rate reviews and limit premium hike for small groups in health maintenance organizations.

N.Y. law sets 7-day limit on initial opioid prescriptions

New York Gov. Andrew Cuomo has signed a bill which will prevent patients from getting more than a seven-day prescription for any opioid on their first visit to a physician.

The legislation also includes requirements that insurance plans cover overdose medications, eliminates insurer pre-authorization for inpatient drug treatment, and extends the time someone can be held for emergency treatment to 72 hours.

“We are losing young people at a death rate that is frightening,” Gov. Cuomo said according to the New York Daily News. “We need more treatment. We have to reduce the number of prescriptions for these painkillers.”

A recent state-funded report found the number of deaths related to heroin or prescription opioid overdoses in New York hit record levels in 2014.

HHS give lukewarm reaction to Kentucky governor’s Medicaid plans

Kentucky Gov. Matt Bevin is applying for a Medicaid Section 1115 waiver to enact several changes to the state’s expanded Medicaid program—and HHS’ initial response doesn’t appear positive.

Bevin has proposed moving 1.2 Medicaid enrollees to a new program which would require they pay small monthly premiums of between $1 to $15 per person. Dental and vision coverage wouldn’t be included, but could be obtained by enrollees doing volunteer work or taking job training courses.

HHS spokesman Ben Wakana said in a statement the agency hadn’t yet received Kentucky’s waiver application.

“We are hopeful that Kentucky will ultimately choose to build on its historic improvements in health coverage and health care, rather than go backwards,” he said.

HHS has said to other states work requirements can’t be included in Medicaid programs, such as in this April letter to Arkansas Gov. Asa Hutchinson.

According to Louisville Public Media, Bevin warned that unless the state’s plan was approved, the expanded Medicaid program put in place by his predecessor would be repealed.

Ill. insurance co-op sues over risk-corridor payments

Struggling Chicago-based insurance co-op Land of Lincoln Health has become the latest insurer to sue the federal government over risk-corridor payments promised under the Affordable Care Act.

Those payments were meant to mitigate losses during the first few years of the exchanges. Lacking an appropriation from Congress, however, only 12.6 percent of the requested payments were made.

The Associated Press reported Land of Lincoln Health is seeking $72.8 million from the government. In 2015, it lost $90 million, and has already announced plans to leave the group market in the state. It will remain in the individual market, where it covers about 42,000 people.

Indiana doubts CMS can protect Medicaid data

Indiana is publicly fighting with CMS over concerns the agency can provide adequate data security.

After the state missed a June 17 deadline to share Medicaid information with CMS about how its program has impacted access to care, the Indianapolis Star said Gov. Mike Pence’s administration brought up the security concerns in a letter to the agency.

“We cannot shortchange the state’s review process as this could put our citizens’ personal health information at risk and potentially create liabilities for the state,” wrote Tyler Ann McGuffee, insurance and health care policy director for Pence.

Indiana’s Medicaid program is being evaluated because it was allowed to test out new policies under a Section 1115 waiver, including requirements for enrollees to pay into health savings account and suspending reimbursement for non-emergency transport services.