April 10 Update

In This Week’s Update:

  • Promoting Equity in Medicaid Managed Care
  • Coverage of Preventive Services Without Cost-Sharing in Jeopardy
  • HHS Reminds States of Protecting Civil Rights During Unwinding
  • Black-White Disparities in Maternal Vulnerability and Adverse Pregnancy Outcomes
  • State updates: CA, ID, MD, MI, MN, MT, NH, NJ, NM, NY, SC, TX, VT & WA


Promoting Equity in Medicaid Managed Care

Last week, State Health and Value Strategies (SHVS) published an updated Compendium of Medicaid Managed Care Contracting Strategies to Promote Health Equity and a companion expert perspective, What’s New in State Approaches to Promoting Health Equity in Medicaid Managed Care, that highlights the new additions to this latest version. The Compendium, which has been updated seven times since its original publication in June 2020, identifies approaches states are taking within their Medicaid managed care programs to promote health equity. The Compendium highlights examples from states to further illustrate how they are implementing specific approaches and includes excerpts from state contract and procurement documents.


Also last week, SHVS published an expert perspective about the new Medicaid renewal-related search features Google recently announced as part of its annual healthcare technology event. Google is adding features to search results to provide specific information for users seeking to re-enroll in Medicaid. The expert perspective provides more information on the new search features and how state health agencies can ensure their landing pages appear in Google search results related to Medicaid renewal. 


Coverage of Preventive Services Without Cost-Sharing in Jeopardy

Nationwide, access to affordable preventive care services will be jeopardized if a federal judge’s ruling in Braidwood Management Inc. v. Becerra invalidating a critical section of the ACA is upheld. The ACA’s requirement that nearly all private health plans cover immunizations, cancer screenings, and other preventive care, without cost-sharing, has improved health and reduced out-of-pocket costs for millions of Americans. In a new blog post for The Commonwealth Fund, authors from Georgetown University examine the potential impact of the ruling. The preventive services requirement is one of the most popular provisions of the ACA, and it increased uptake of preventive care, improving consumers’ health and financial well-being. The court decision would reverse that progress, leaving consumers at the mercy of insurers. Yet as significant as this decision is, its ultimate impact could be far broader. While the latest ruling only affects recommended services from the U.S. Preventive Services Task Force, a much longer list remains at risk as the case works its way toward the Supreme Court.


HHS Reminds States to Protect Civil Rights During Unwinding

On April 4, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) issued a letter reminding states (and other entities subject to federal civil rights laws) of their obligations at the end of the Medicaid continuous coverage requirement with respect to: (1) providing equal access for communities of color and language access for individuals with limited English proficiency (LEP); and (2) ensuring effective communication with individuals with disabilities. The letter also highlights best practices (starting on page 5) to ensure that people of color and individuals with LEP or disabilities are not disenrolled during unwinding as a result of ineffective communications and provides a compendium of resources (starting on page 8) to support state efforts. SHVS has created a one-stop resource page that provides communications resources designed to support states as they inform stakeholders and consumers about the end of the Medicaid continuous coverage requirement, including resources translated into multiple languages.


Black-White Disparities in Maternal Vulnerability and Adverse Pregnancy Outcomes

Black birthing individuals in areas that have more access to maternal healthcare are at “disproportionately” higher risk of dying during or after childbirth than White women who live in underserved areas, according to a new study in The Lancet. The study, conducted by Surgo Health, uses a system called the U.S. Maternal Vulnerability Index, which assigns a score of 0–100 to each state and county in the country. A lower score means that a patient is less vulnerable to adverse maternal health outcomes. Researchers looked at 13 million births from Black and White birthing individuals ages 10 through 44, comparing vulnerability scores with multiple pregnancy outcomes, including maternal mortality rates. The study found that even in less vulnerable areas, Black birthing people were at higher risk of maternal mortality than White birthing people who lived in more vulnerable locations. The findings suggest that locally-informed precision health interventions and further research into racism are needed to achieve maternal health equity. SHVS recently published a compendium of state strategies to improve maternal health outcomes.

State updates: CA, ID, MD, MI, MN, MT, NH, NJ, NM, NY, SC, TX, VT & WA 

  • California
  • California updated its Medi-Cal Continuous Coverage Toolkit to include a section focused on renewals. The toolkit is available in 19 languages and includes materials that can be customized to help ambassadors and partners assist Medi-Cal members with the redetermination process. The content encourages members to update their contact information to ensure they receive important information about keeping their Medi-Cal coverage. The toolkit includes flyers, social media posts, messaging, including interactive voice response call scripts, sample emails, and text messages. For more information, see Department of Health Care Services Coverage Ambassador sign up and details.
  • The California Department of Health Care Services (DHCS) released a toolkit in English and Spanish for DHCS Coverage Ambassadors and other partners to help encourage members of the COVID-19 Uninsured Group (UIG) program to enroll in ongoing health coverage through Medi-Cal (Medicaid) or Covered California (the state’s official health insurance Marketplace) after the UIG program ends. During the COVID-19 public health emergency (PHE), more than 500,000 Californians were able to obtain temporary health coverage for COVID testing and treatment through the UIG program, which will end with the end of the federal PHE.
  • Idaho – The Idaho Department of Health and Welfare (DHW) announced it has processed Medicaid renewals for 32,898 individuals since the beginning of February. Of the total 32,898 people processed, 13,647 have been found to still be eligible, and 19,251 have been found to no longer be eligible. Those who are no longer eligible will lose coverage starting April 1. Those determined to have too much income to qualify for Medicaid are being referred to the state-based health insurance Marketplace, Your Health Idaho.
  • Maryland – The Maryland Department of Health announced a request for applications to administer the Abortion Clinical Training Program. The program will help expand the number of healthcare professionals with abortion care training, increase the racial and ethnic diversity among healthcare professionals with abortion care education, and support the identification of clinical sites in need of training.
  • Michigan
    • Governor Gretchen Whitmer directed the Michigan Department of Insurance and Financial Services (DIFS) to take immediate action to protect Michiganders following the decision in Braidwood Management Inc. v. Becerra that struck down the Affordable Care Act (ACA) requirement that health insurers cover and pay for certain preventive care services without additional cost to the patient. Governor Whitmer’s letter directs DIFS to promptly issue gudiance to help inform Michiganders of which services are affected, immediately begin working with health insurers to determine what steps can be taken to ensure continued affordable coverage for these healthcare services, and develop recommendations as to other ways the state can take action.
    • The Michigan Department of Health and Human Services has expanded dental benefits for adult Medicaid enrollees and increased rates for dental providers. Many enrollees will have new services added, including deep teeth cleanings, sealants, root canals, crowns, and gum care. Benefit enhancements and service delivery began April 1.
  • Minnesota – Governor Tim Walz signed into law a bill providing resources to help eligible Minnesotans keep their Medicaid and MinnesotaCare health insurance. The bill provides state funding for the transition to regular Medicaid eligibility verification procedures, and $36 million to help county and tribal agencies process healthcare renewals.
  • Montana – Montana hosted an unwinding webinar for providers. The state also released a provider program notice which offers an overview of the various webinars for different provider types (e.g., behavioral health, home and community-based services). The state views providers as “a trusted source of information for Medicaid members” critical to letting members “know what they need to do to keep their coverage.”
  • New Hampshire
    • The New Hampshire Department of Health and Human Services announced the launch of the New Hampshire Smiles Adult Program, which will provide comprehensive dental coverage to adults who have insurance coverage through New Hampshire Medicaid. Adults age 21 and older with full Medicaid benefits will automatically be enrolled in the program and will receive an ID card from DentaQuest in the coming weeks. Covered services will include X-rays and examinations, cleanings, fillings, limited gum-related treatment, tooth extractions and other oral surgeries, and other appropriate general services such as anesthesia. Coverage is also provided for transportation to dental appointments and support for member oral health through care management.
    • The New Hampshire Insurance Department released two orders concluding longstanding examinations of two major health insurers in the state regarding compliance with the Mental Health Parity and Addiction Equity Act. The order acknowledges the significant progress made by the health plans in demonstrating that their mental health coverage is in parity with their coverage for medical/surgical services.
  • New Jersey
    • Governor Phil Murphy signed Executive Order No. 326 establishing New Jersey as a safe haven for gender-affirming healthcare by directing all state departments and agencies to protect all persons, including healthcare professionals and patients, against potential repercussions resulting from providing, receiving, and assisting in providing or receiving, seeking, or traveling to New Jersey to obtain gender-affirming healthcare services.
    • The New Jersey Economic Development Authority took its next step toward developing the Trenton-based Maternal and Infant Health Innovation Center by issuing a request for qualifications for three anchor tenants to lead the center: a healthcare service provider, an institution of higher education, and a Trenton-based multi-service organization. For more information about how New Jersey is addressing maternal and infant-health disparities, listen to my podcast episode on the topic.
  • New Mexico – Governor Michelle Lujan Grisham signed into law Senate Bill 13, which codifies protections outlined in the governor’s August 2022 executive order, including prohibiting entities within the state from sharing patient information related to reproductive healthcare for New Mexico patients and providers, and prohibiting public bodies from restricting access to abortion and gender-affirming healthcare.
  • New York
    • New York received CMS approval for two 1902(e)(14) waivers: 1) to accept contact information from managed care plans without additional verification; and 2) “zero-income” renewal. For more information on 1902(e)(14) waivers, see SHVS’ Leveraging Section 1902(e)(14) Waiver Authority Amid Unwinding expert perspective.
    • Governor Kathy Hochul announced NYRx, the state’s new pharmacy benefit program, which will improve prescription drug access and coverage for the eight million New Yorkers enrolled in Medicaid statewide. Under the NYRx model, New York state’s Medicaid program will pay pharmacy costs directly, eliminating the need for managed care organizations to administer this benefit through pharmacy benefit managers.
  • South Carolina – The South Carolina Department of Health and Human Services (SCDHHS) announced that Medicaid members who have provided SCDHHS with a cell phone number will receive a series of text messages to remind the member to return their annual review form. SCDHHS also released a new document upload tool which will allow members to provide requested information, report a change in income, return an annual review form or submit other documents. The information received through the tool will allow SCDHHS to contact members if there are any questions about the documents. Members may also continue to return their annual review form in-person or via mail, email, or fax.
  • Texas – The Texas Health and Human Services Commission (HHSC) announced that in order to handle the expected workload of Medicaid renewals, HHSC has increased its eligibility workforce through various recruitment and retention efforts, including hiring temporary staff to assist with the workload, implementing merit pay and salary adjustments, promoting flexible work schedules, and streamlining training requirements. Since April 2022, HHSC has added 1,000 eligibility staff to its workforce. This month, HHSC will begin mailing all Medicaid renewal notices in a yellow envelope that says “Action Required” in red. In addition to mailed notices, HHSC is using social media posts, online banner messages, flyers, emails, and text messages to notify enrollees about renewing their benefits. HHSC has supplied outreach tools to partner organizations or ambassadors to help spread the word about the end of continuous Medicaid coverage.
  • Vermont – The Vermont Department of Health has launched a newly designed website to help improve Vermonters’ ability to access important public health information. The updated site has improved search function and works better for mobile devices and screen readers. It also helps Vermonters find information in languages other than English, with prominent links to professionally translated materials and to Google translate.
  • Washington
    • Insurance Commissioner Mike Kreidler sent a letter to Washington health insurers in response to the U.S. District Court ruling in Braidwood Management Inc. v. Becerra requesting they continue the critical coverage of all recommended preventive services that individuals and families have relied upon since 2010.
    • Governor Jay Inslee announced that Washington state has taken action to purchase a three-year supply of mifepristone, an abortion medication. Inslee directed the state Department of Corrections, using its existing pharmacy license, to purchase the medication last month.