April 12 Update

In This Week’s Update:

  • President Biden’s FY 2022 Funding Request
  • New Marketplace Enrollment
  • CDC Racism and Health Website
  • COVID-19 State Updates: FL, MN, VA, WI
  • Other State Updates: CA, CO, IL, MA, NM, OH, VA, WA
  • The No Surprises Act and State Balance Billing Protections
  • Federal Relief Funding for Kids During and Beyond COVID-19
  • Moving to Value-based Care post-COVID-19


President Biden’s FY 2022 Funding Request

Last week the Office of Management and Budget submitted President Biden’s budget request for Fiscal Year 2022 to Congress. The request lays out the president’s discretionary funding proposals across a wide range of policy areas, including health-related funding to help end the opioid crisis, new funding for public health infrastructure in states and territories, and additional funding for the Centers for Disease Control and Prevention (CDC) to improve readiness for future public health crises.


New Marketplace Enrollment

U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra announced last week that more than half a million consumers have already signed up for health insurance through HealthCare.gov as a result of the federal special enrollment period (SEP) for the COVID-19 Public Health Emergency between Feb. 15 and March 31. A report from the Centers for Medicare and Medicaid Services (CMS) also shows gains in enrollment among communities that historically have high uninsured rates, including Black individuals and those near the poverty level.


CDC Racism and Health Website

Last week, CDC Director Rochelle Walensky declared racism a serious public health threat. She highlighted several new efforts the CDC is leading to accelerate its work to address racism as a fundamental driver of racial and ethnic health inequities in the United States. She also unveiled a new website, “Racism and Health,” that will serve as a hub for the agency’s efforts and a catalyst for greater education and dialogue around these critical issues.


COVID-19 State Updates: FL, MN, VA, WI

  • Florida – The Agency for Healthcare Administration announced updated vaccine administration rates for Medicaid. COVID-19 vaccines administered with a date of service on or after March 15, 2021, must be paid at the rates updated by CMS effective March 15, 2021. All guidance is applicable to both the fee-for-service and statewide Medicaid managed care delivery systems unless otherwise stated.
  • Minnesota – The Department of Human Services published a bulletin explaining the treatment of coronavirus response payments under the American Rescue Plan for Minnesota health care programs. The bulletin describes how the additional Federal Pandemic Unemployment Compensation and recovery rebate payments are treated for purposes of determining eligibility for Medical Assistance and MinnesotaCare applicants and enrollees.
  • Virginia – Gov. Ralph Northam announced several efforts aimed at increasing Virginia’s vaccinator workforce. Health care providers who are now authorized to administer the COVID-19 vaccine include dentists, dental hygienists, veterinarians, optometrists, and health professions students enrolled in an accredited Virginia program. Eligible health care providers may register to volunteer as a COVID-19 vaccinator through either the Virginia Medical Reserve Corps or the newly established Virginia Volunteer Vaccinator Registry.
  • Wisconsin – The Department of Health Services released a new data table on its variant webpage that shows SARS-CoV-2 (the virus that causes COVID-19) variant proportions by Health Care Emergency Readiness Coalition region. The variants page now also includes information on two additional variant strains of SARS-CoV-2: variants B.1.427 and B.1.429. The Department of Homeland Security first identified these variants in Wisconsin in December 2020 and is now tracking them and displaying them publicly.


Other State Updates: CA, CO, IL, MA, NM, OH, VA, WA

  • California – The Department of Health Care Services (DHCS) released for public comment the state’s revised California Advancing and Innovating Medi-Cal, also known as CalAIM, Section 1115 demonstration waiver proposal. DHCS is also seeking an amendment to expand the existing Specialty Mental Health Services (SMHS) Section 1915(b) waiver and consolidate Medi-Cal managed care, dental managed care, SMHS, and the Drug Medi-Cal Organized Delivery System under a single 1915(b) waiver. The public comment period is open through May 6.
  • Colorado – As part of Colorado’s Health IT Roadmap Care Coordination Initiative, the Office of eHealth Innovation and the eHealth Commission developed two resources: a white paper that aims to create a shared vision among Colorado stakeholders interested in improving whole-person care coordination and a social determinants of health screening guide for health care providers interested in screening for social determinants of health and documenting the results in an electronic health record.
  • Illinois – The Department of Healthcare and Family Services and the Department of Insurance published a report examining the feasibility for coverage affordability initiatives in Illinois. The report is the product of a feasibility study required by legislation and explores policy options to make health insurance more affordable for low- and middle-income Illinois residents. The study is designed to provide policymakers with a menu of policy options to improve health care affordability, reduce the number of uninsured residents, and improve health equity.
  • Massachusetts – The Executive Office of Health and Human Services plans to submit a request to CMS to amend the state’s Section 1115 demonstration. The request includes extending eligibility for postpartum coverage to 12 months and authorizing postpartum coverage for members not otherwise eligible due to immigration status. The state is accepting public comments through April 25.
  • New Mexico – Gov. Michelle Lujan Grisham signed into law Senate Bill 317, establishing the Health Care Affordability Fund, which is dedicated to reducing the cost of health insurance and medical expenses for working families. The bill also prohibits copays and other cost sharing for people with insurance who seek behavioral health services. The Health Care Affordability Fund will be financed by replacing a recently phased-out federal fee on insurance companies with a state version by updating New Mexico’s existing surtax on insurance companies from one percent to 3.75 percent. As  reminder, State Health and Value Strategies has a resource for states on the considerations for developing a state health insurer fee following repeal of the federal fee.
  • Ohio – The Ohio Department of Medicaid (ODM) selected Aetna to serve as the specialized managed care organization for the state’s children with the most complex behavioral health needs under the new Ohio Resilience through Integrated Systems and Excellence (OhioRISE) program. Aetna will work with ODM and Gov. DeWine’s Family and Children First Cabinet Council to implement a child- and family-centric model featuring new targeted services and intensive care coordination delivered by community partners. Aetna also will coordinate with the state’s Medicaid managed care organizations and the new single pharmacy benefit manager to ensure medical and pharmaceutical services and supports are integrated into the child’s comprehensive health plan.
  • Virginia – The Commonwealth submitted an application to HHS requesting to amend Virginia’s Section 1115 demonstration “FAMIS MOMS and FAMIS Select” to extend health coverage from 60 days to 12 months postpartum.
  • Washington – The state submitted an amendment to CMS for the Washington Medicaid Transformation Project Section 1115(a) demonstration. The amendment request includes four components: Delivery System Reform Incentive Payment (DSRI)P program value-based payment (VBP) adoption target for demonstration year five, which is calendar year 2021; DSRIP VBP improvement score methodology; Long-term Services and Supports presumptive eligibility; and expanding transportation services for Medicaid Alternative Care and Tailored Support for Older Adults enrollees. The federal public comment period is open through May 2.


The No Surprises Act and Preemption of State Balance Billing Protections

In enacting the No Surprises Act, Congress recognized that many states already passed (or will pass) state-level protections against surprise medical bills. The No Surprises Act thus defers to some state laws, but in other areas will preempt the state law unless the state conforms to the federal standard. A new fact sheet from experts at Georgetown University’s Center on Health Insurance Reforms summarizes the current understanding of this preemption framework and highlights considerations for state policymakers and federal regulators. The resource provides a Q&A on the key considerations of the federal law, including preemption considerations, regulation of self-insured plans, and the state factors to decide whether to amend or adopt state-specific surprise medical bill protections.  


The Cradle-to-Career Guide to Federal Relief Funding for Kids During and Beyond COVID-19

The Children’s Funding Project published an updated guide focused on helping states and communities leverage federal funding opportunities focused on children and youth to respond to, recover from, and emerge stronger from the COVID-19 pandemic. The guide is designed to be a go-to resource for leaders and advocates across the cradle-to-career spectrum who want to 1) obtain a quick birds-eye view of kid-focused federal relief over the past year, and 2) learn more about new federal funding opportunities and flexibilities for the programs and services most relevant to population(s) they serve. It also highlights examples of how states and communities have leveraged federal resources during this challenging year for the benefit of children and youth.


State-Driven Initiatives To Support Moving To Value-Based Care in the Era Of COVID-19

The National Governors Association Center for Best Practices, in partnership with the Duke-Margolis Center for Health Policy and with support from The Commonwealth Fund, published an issue brief based on an expert roundtable they hosted for senior state officials, national experts, and industry participants to discuss states’ roles in accelerating the transition to value post-COVID-19. This issue brief summarizes four key areas where state-driven strategies can standardize and streamline broader adoption of value-based payment efforts, supplemented by case examples and priority areas where additional federal support could amplify efforts. The four key areas where states can leverage their central role as regulators, conveners, and administrators are developing a long-term vision, aligning payers, convening stakeholders, and collecting data.