April 1 Update

In This Week’s Update:

  • CMS Releases Final Medicaid and CHIP Rules
  • CMS Extends the Special Enrollment Period
  • Modernizing Behavioral Health Systems
  • The Remaining Uninsured Eligible for Medicaid and CHIP
  • State updates: AK, CA, CT, GA, IL, MA, MD, ME, MI, ND, NJ, NM, NY, OR & RI

CMS Releases Final Medicaid and CHIP Rules
Last week, CMS released the Medicaid Eligibility and Enrollment final rule. State Health and Value Strategies (SHVS) published an expert perspective which provides a high level summary of the rule and is planning a webinar on the key requirements of the rule, so stay tuned for details. Also this week, the departments of Treasury, Labor and HHS released the final regulation of Short-Term/Limited Duration Insurance rule (STLDI). Our experts are in the process of reviewing the STLDI rule and we will have a summary of the considerations for states next week.


CMS Extends the Special Enrollment Period
Also, CMS announced the extension of the temporary special enrollment period (SEP) for individuals no longer eligible for Medicaid or CHIP to enroll in Marketplace coverage. The end date of the “Unwinding SEP” will be extended from July 31, 2024, to November 30, 2024. For the latest on how states are operationalizing unwinding, check out our new States of Unwinding post. Updates follow.


Modernizing Behavioral Health Systems
State health officials are prioritizing access to quality behavioral health services and supports across the continuum of care, enhancing capacity for interventions where and when people need them. Policymakers are responding to calls for the rapid modernization of strained and under-resourced public behavioral health systems and are seeking transformational approaches. In response, the National Academy for State Health Policy, with support from the Commonwealth Fund, embarked on an 18-month project focused on identifying state strategies to modernize the behavioral health system. This resource synthesizes strategies for state policymakers gleaned from engagements with leaders across the country and through multi-state technical assistance.


The Remaining Uninsured Eligible for Medicaid and CHIP
An issue brief from KFF examines the characteristics of the nonelderly uninsured population that is eligible for Medicaid or CHIP, using national survey data from 2022, prior to the end of the Medicaid continuous coverage requirement, and the most recent eligibility levels for Medicaid from 2023. Even with declines in the uninsured, the characteristics of the uninsured but eligible for Medicaid remained fairly stable from the prior year. Among the 6.4 million nonelderly people who are uninsured and eligible for Medicaid or CHIP, most are adults, and 5.2 million people reside in expansion states. Across all people who are uninsured and eligible, over 6 in 10 are people of color and nearly 7 in 10 live in working families. Understanding these characteristics can help inform outreach efforts as well as policy changes that can mitigate coverage losses by making it easier for people who are eligible to obtain or retain Medicaid coverage.


Perinatal Mental Health and Wellbeing
On Wednesday, April 3, from 1:00 to 4:00 p.m. ET, Health Affairs will host a virtual forum on the topic of perinatal mental health and wellbeing. Authors who are featured in Health Affairs’ April 2024 issue will present their work, engage in discussions and answer questions on important issues on equity, justice and wellbeing. Panels include overarching societal requisites for perinatal mental health, the burden of poor perinatal mental health, improving access and care, and tailoring solutions. Registration for the event can be accessed here.


State updates: AK, CA, CT, GA, IL, MA, MD, ME, MI, ND, NJ, NM, NY, OR & RI

  • Alaska – CMS approved an extension to Alaska’s section 1115 demonstration, newly named, “Behavioral Health Reform.” The approval continues the state’s existing authority to provide substance-use disorder (SUD) treatment services in settings that qualify as an institution for mental diseases and provides additional services for children, youth, and adults with serious mental illness (SMI), severe emotional disturbance, and/or SUD.
  • California – The Department of Health Care Services is expanding the Naloxone Distribution Project to include fentanyl test strips, which can be obtained by eligible organizations through the state.
  • Connecticut – Governor Ned Lamont announced the legislative approval of a new personal care assistant (PCA) labor agreement which the administration will submit to CMS for approval. PCAs assist the elderly, persons with disabilities and persons recovering from illnesses and operations with their daily living activities. The agreement would include expanded healthcare premium assistance for PCAs who do not qualify for Medicaid or Marketplace coverage and do not have access to other health insurance with financial assistance through Access Health CT, as well as wage increases, increased paid time off and support for career development.
  • Georgia – The state submitted an amendment to the Georgia Medicaid section 1115 demonstration entitled “Georgia Planning for Healthy Babies.” The amendment aims to provide the state with authority to permit legally responsible individuals to be reimbursed for the provision of medically necessary personal care services to medically fragile children under age 21 enrolled in the Georgia Pediatric Program.
  • Illinois – GetCovered Illinois, the state’s official health insurance Marketplace, announced a special enrollment period for individuals losing coverage due to a change in eligibility policy for the state’s Health Benefits for Immigrant Adults (HBIA) and Health Benefits for Immigrant Seniors (HBIS) programs, effective April 30, 2024. Lawful permanent residents who have been in the U.S. for less than five years will no longer be eligible for the HBIA and HBIS programs, but are eligible for federal subsidies through the Marketplace. As a reminder, SHVS has an interactive map of state-funded coverage programs for non-citizen populations.
  • Maine – The Maine Department of Health and Human Services issued an update to Medicaid members on accessing prescriptions as they return to normal operations following the cyberattack at Change Healthcare. Members who were incorrectly charged for a prescription are advised to bring their receipt and MaineCare card back to the pharmacy to begin the refund process.
  • Maryland – The state submitted a request to amend the “HealthChoice Medicaid Section 1115 Demonstration,” to provide pre-release services to certain individuals with SUD, SMI, or both, who are soon-to-be former inmates of a public institution and otherwise eligible for Maryland Medicaid.
  • Massachusetts – The Healey-Driscoll administration announced a plan to award $10 million in grant funding over three years to strengthen maternal health and family planning services in Massachusetts. The program, administered by the Department of Public Health (DPH), will invest in access, workforce and infrastructure for organizations that provide women’s health services, including prenatal care, postpartum depression care, post-miscarriage mental healthcare, midwifery services and reproductive healthcare. DPH will prioritize applicants based in communities with the most significant inequities.
  • Michigan – The Michigan Department of Health and Human Services announced the release of a new application tracker on the MI Bridges website where Michiganders apply for benefits like Medicaid, food assistance and more. The new tracker will allow residents to follow the progress of their benefits application online rather than waiting for a determination letter or having to call into a local office.
  • New Jersey – Governor Phil Murphy announced the appointment of Lisa Asare, who had previously served in the New Jersey Departments of Health and Human Services, as the President and Chief Executive Officer of the New Jersey Maternal and Infant Health Innovation Authority. The authority is tasked with overseeing the New Jersey Maternal and Infant Health Innovation Center and will be the arm of government that continues the vital work of the Nurture NJ program.
  • New Mexico – The New Mexico Human Services Department announced the inclusion of Opill, the first over-the-counter daily oral contraceptive pill, in its coverage for Medicaid enrollees. Additionally, Medicaid enrollees will have access to no-cost pregnancy tests and emergency contraception.
  • New York – Governor Kathy Hochul announced $30 million will be made available to expand residential treatment facilities for children and adolescents with complex mental health needs. Amounts up to $10 million are available for service providers operating residential or psychiatric inpatient programs for youth. The funding may be used to acquire new property, construct a new facility, or rehabilitate existing buildings to develop a new facility.
  • North Dakota – North Dakota Health and Human Services announced that the new Family Paid Caregiver pilot program will allow family members who provide extraordinary care to either a child or adult enrolled in an eligible Medicaid 1915(c) waiver to receive payments from the state.
  • Oregon – The Reproductive Health Program at the Oregon Health Authority (OHA) has launched a new website that makes it easier for people to seek abortion care information and services. The “Abortion Access in Oregon” website includes information about accessing abortion services, legal rights and privacy, a list of abortion providers in the state, options to help cover the cost of abortion services, and OHA’s Abortion Access Plan.
  • Rhode Island – CMS approved the new “Rhode Island Comprehensive Demonstration” Medicaid section 1115 demonstration, which will allow the state to cover certain personal care services (PCS) in acute care hospital settings as part of the state’s existing home and community-based services (HCBS). PCS are provided to eligible people to help them stay in their own homes and communities rather than live in institutional settings, such as nursing homes. Rhode Island will also expand eligibility for certain HCBS for adults with disabilities at risk for long-term care and add an option for eligible people who may be interested in pursuing remote HCBS monitoring and support.