April 11 Update

In This Week’s Update:

  • New Proposed Rule to Fix Family Glitch
  • Returning to Normal Eligibility and Enrollment Operations
  • 2023 NPP and Health Equity
  • Medicaid Churn and Coverage Transitions
  • State Strategies to Address Adverse Childhood Experiences
  • State Updates: CA, CO, CT, GA, MD, MN, NC, NM, NY, OK, TX & WI

New Proposed Rule to Fix Family Glitch

The Biden administration announced a proposed rule that is aimed at fixing the “family glitch” in the Affordable Care Act (ACA). The revamped policy would expand coverage to 200,000 people and lower insurance costs for nearly 1 million more, according to estimates. The Executive Order on Continuing to Strengthen Americans’ Access to Affordable, Quality Health Coverage directs federal agencies to identify ways to continue to expand the availability of affordable health coverage, to improve the quality of coverage, to strengthen benefits, and to help more Americans enroll in quality health coverage. 

CMS released two new resources, which they are referring to as sub-regulatory guidance, to support states as they return to normal eligibility and enrollment operations. The Strategic Approaches to Support State Fair Hearings as States Resume Normal Eligibility and Enrollment Operations After the COVID-19 PHE outlines potential operational and workforce strategies that states can employ to assess and process Medicaid fair hearings post-PHE, including leveraging section 1902(e)(14)(A) authority to manage the increased fair hearing volume. The Medicaid and CHIP Unwinding Planning Efforts: Summary of Best & Promising State Practices from CMS/State Discussions highlights common unwinding themes shared by state Medicaid officials with CMS, as well as promising strategies that states are deploying. And as a reminder, SHVS has a resource page for state officials on the PHE unwinding, which we continually update. Updates follow.

Stakeholder Perspectives and Feedback on Health Equity in the 2023 Notice of Benefit and Payment Parameters

CMS issued its proposed annual Notice of Benefits and Payment Parameters (NBPP), which updates regulations governing the ACA marketplaces. CMS requested and received public comments on the proposed rule, and researchers at CHIR reviewed and summarized a sample of those comments from consumer advocates, insurers and brokers, and state insurance departments and marketplaces. The notice of proposed rulemaking also requested feedback from stakeholders on ways for CMS to advance health equity. Georgetown’s Center on Health Insurance Reforms reviewed comments from states, insurers, and consumer advocates to see how they responded and summarized the findings in a new blog post.

Analyses of Churn and Coverage Transitions

MACPAC released an update of the analysis they presented at their September 2021 public meeting of enrollment data from the Transformed Medicaid Statistical Information System (T-MSIS). Overall, they found that gaps in Medicaid coverage are associated with increased rates of hospitalization for ambulatory care sensitive conditions. In addition, MACPAC found that few enrollees who disenroll from Medicaid subsequently enroll in exchange coverage, and when they do, they often experience a gap in coverage. The presentation concluded with a discussion of potential policy approaches to address these issues.

State Strategies to Address Adverse Childhood Experiences

In recent years, many states have focused on addressing adverse childhood experiences (ACEs)—stressful and potentially traumatic events, such as violence, abuse, or neglect, that occur prior to age 18. A new blog post by the Center for Health Care Strategies highlights efforts to address ACEs in California and New Jersey. California is the first state to prioritize mitigating the effects of ACEs and toxic stress across its programs, including ACEs Aware, a first-in-the-nation effort focused on encouraging Medi-Cal providers to screen for ACEs in children and adults, provide appropriate follow-up services and supports, and embrace trauma-informed care. New Jersey is the first state to stand up an Office of Resilience to coordinate statewide ACEs-related efforts. The Office of Resilience aims to center community voice and improve quality of life, particularly for individuals who are most impacted by ACEs.

  • California – California is launching a statewide effort to help Medi-Cal (Medicaid) enrollees keep their Medi-Cal coverage or be enrolled in other coverage at the end of the public health emergency. The Department of Health Care Services (DHCS) launched a customizable Medi-Cal Continuous Coverage toolkit and webpage to help trusted entities and individuals act as DHCS Coverage Ambassadors to push communications to Medi-Cal enrollees to encourage them to update their contact information with their counties.
  • Colorado – Connect for Health Colorado, the state’s official health insurance marketplace, released a new report which attributes record enrollments this past open enrollment period to federal and state policy changes making health coverage more affordable. The American Rescue Plan Act of 2021 gave people more premium tax credit assistance while Colorado’s Health Insurance Affordability Enterprise ran a program to give people more healthcare discounts when they use their plan.
  • Connecticut – Access Health CT (AHCT), the state’s official health insurance marketplace, announced the opening of its fiscal year 2023 Navigator Grant Program. The program will allow AHCT to deepen its community relationships with the goal of engaging, educating, informing and enrolling individuals in health insurance throughout Connecticut, particularly in minority communities that experience significant health disparities and higher uninsured rates.
  • Georgia – Governor Brian P. Kemp signed into law the Mental Health Parity Act which requires health plans to cover mental health and substance use treatment at parity with physical health. The legislation (HB1013) also institutes an 85 percent minimum medical loss ratio requirement for Medicaid plans in the state. 
  • Minnesota – MNsure, the state’s official health insurance marketplace, announced that more than 1,100 residents used the Minnesota Insulin Safety Net Program to access over $6 million worth of insulin in 2021, according to a recent report from the Minnesota Board of Pharmacy. For residents who are in immediate need of assistance, the urgent need program enables eligible Minnesotans to receive a 30-day supply of insulin right away at their pharmacy and pay no more than a $35 co-pay, one time per year.
  • New Mexico
    • The New Mexico Human Services Department (HSD) announced that Medicaid home- and community-based service (HCBS) providers statewide will receive a 15 percent temporary reimbursement increase. HSD, with additional funding for HCBS through the American Rescue Plan Act (ARPA), is investing over $130 million in the first of three rounds of HCBS temporary economic recovery payments to providers.
    • The New Mexico Office of Superintendent of Insurance (OSI) released details for the Health Insurance Marketplace Affordability Fund. The fund is authorized by Senate Bill 317, which allows the fund to be used to reduce premiums and out-of-pocket health care costs for New Mexicans who qualify for coverage on beWellnm, the state’s health insurance marketplace; reduce premiums for small businesses and their employees; provide resources for planning, design and implementation of healthcare coverage initiatives for uninsured New Mexico residents; and provide resources for administration of state healthcare coverage initiatives for uninsured New Mexico residents.
  • New York – The New York State Department of Health released its Quarterly County Opioid Report for April 2022 and announced key initiatives underway to fight opioid use statewide. As part of the state’s ongoing work to address the opioid crisis, the report provides actionable insights on the use of heroin and opioids to identify local trends and respond to those needs.
  • North Carolina – Governor Cooper signed Executive Order 256 to support the state’s ongoing fight against COVID-19 by providing flexibility for healthcare workers and care facilities, as well as easier access to vaccines, tests and treatments. The order extends provisions giving the North Carolina Department of Health and Human Services secretary flexibility to take actions to increase the healthcare workforce and to ensure continuity of existing operations in the state’s hospitals, adult care homes, nursing homes, and other long-term care facilities.
  • Oklahoma – The Oklahoma Health Care Authority has named Traylor Rains as the agency’s new state Medicaid Director, effective April 1, 2022. Rains succeeds long-time State Medicaid Director and Chief Operating Officer, Melody Anthony, who announced her intent to retire. Congratulations Traylor!
  • Texas – The Texas Health and Human Services Commission (HHSC) released the Texas STAR+PLUS managed care services request for proposals. The STAR+PLUS program, including the STAR+PLUS HCBS program, provides acute care services and long-term services and supports to the aged and disabled. Proposals are due by June 2, 2022, and awards are expected in January 2023. 
  • Wisconsin – The Wisconsin Department of Health Services is seeking public comment for its draft waiver request to CMS to extend postpartum Medicaid coverage for an additional 30 days, which would extend the total coverage to three months. Interested parties can provide comments through May 6, 2022.
  • Maryland and New MexicoMaryland and New Mexico announced the expansion of Medicaid coverage for pregnant enrollees. Both states will extend the period during which enrollees are eligible for postpartum care services from 60 days to 12 months as of April 1. For more information on the American Rescue Plan (ARP) state option to extend postpartum coverage, see this SHVS issue brief.