April 17 Update

In This Week’s Update:

  • Health Coverage for DACA Recipients
  • Termination of the National Emergency Declaration 
  • Sustainable Financing Strategies to Support Community Investments by Health Plans and Hospitals
  • Crossing the Bridge to the Marketplace
  • Medicaid Stability is Critical to Nation’s Continuum of Health Insurance Options
  • State updates: AZ, CA, CO, DE, ID, IL, KY, MA, MI, NJ, NM, NY & PA


Health Coverage for DACA Recipients

Last week, President Biden announced the administration’s plan to expand health coverage options for recipients of Deferred Action for Childhood Arrivals (DACA) status—undocumented individuals who were brought to the United States as children and who meet certain other eligibility criteria. Per President Biden’s announcement, HHS will propose an amendment to the regulatory definition of “lawful presence” that will permit the 800,000 DACA recipients to “apply for coverage through the Health Insurance Marketplace, where they may qualify for financial assistance based on income, and through their state Medicaid agency.” As a reminder, SHVS’ Supporting Health Equity and Affordable Health Coverage for Immigrant Populations series examines a range of strategies that states have at their disposal to help extend coverage to immigrant populations.


Termination of the National Emergency Declaration 

Also last week, President Biden signed H.J.Res.7 (Public Law No. 118-3) into law, terminating the National Emergency Declaration under the National Emergencies Act (NEA) related to COVID-19. The termination of the NEA declaration, standing alone, will not have a significant impact on the many regulatory flexibilities and federal mandates that remain in place connected with the pandemic. CMS has also confirmed that the termination of the national emergency does not impact the planned May 11 termination of the public health emergency (PHE), any associated PHE unwinding plans, or any existing 1135 waivers. 


Sustainable Financing Strategies to Support Community Investments by Health Plans and Hospitals

There are a range of options state policymakers may consider to encourage health plans and hospital systems to invest in addressing prevention, health-related social needs, and social drivers of health not only at the enrollee level, but at the community level as well. On Wednesday, April 19 from 1:00 to 2:00 p.m. ET, SHVS’ Deputy Director Dan Meuse will join the Funders Forum on Accountable Health and the National Academy of State Health Policy for a webinar, Sustainable Financing Strategies to Support Community Investments by Health Plans and Hospitals. This webinar will explore what states can do with Medicaid policy, specifically managed care organization community investment requirements and hospital regulation policies, to better align community investments to improve population health and wellbeing. Registration for the webinar can be accessed here.


Crossing the Bridge to the Marketplace

Successful transitions to the Marketplace are key to minimizing coverage loss during the Medicaid unwinding. In a new expert insight for the Robert Wood Johnson Foundation’s Marketplace Pulse series, RWJF Senior Policy Advisor Katherine Hempstead examines the importance of successful transitions from Medicaid to the Marketplace, given that the percentage of Medicaid enrollees projected to lose their eligibility ranges across states from roughly 10% to 30%. In states with their own insurance Marketplaces, exchanges and Medicaid agencies are sharing data so that exchanges can reach out to members losing coverage. Managed care organizations facing the prospect of significant membership loss are incentivized to minimize churn, and are in many cases collaborating with state agencies and others in outreach efforts to members. SHVS has published resources to support states with coverage transitions during the unwinding including an expert perspective, Supporting Continuity of Coverage from Medicaid into the Marketplace: Unwinding Considerations for States, communications resources for Marketplace/CHIP transitions, and a toolkit Leveraging Managed Care Plans to Support Medicaid Continuous Coverage Unwinding.


Medicaid Stability is Critical to Nation’s Continuum of Health Insurance Options

A new Health Affairs Forefront article by Kate McEvoy, Executive Director of the National Association of Medicaid Directors, discusses how the Medicaid program deserves structural stability and continued federal financial support because of the people it serves, its role in the pandemic response, its positive impact on the health and economic security of its members, its contribution to state budgets and healthcare infrastructure, and its widespread public support. Beyond all that, at a time when pandemic-related Medicaid continuous coverage requirements are beginning to be “unwound,” McEvoy notes that Medicaid must remain an essential link in our current continuum of Marketplace and employer-sponsored health insurance coverage options. Medicaid—a successful federal-state partnership that provides health insurance to more than 90 million people—should be just as valued and prioritized by policymakers as Medicare and Social Security.

State Updates: AZ, CA, CO, DE, ID, IL, KY, MA, MI, NJ, NM, NY & PA

  • States of Unwinding – The second expert perspective in the new States of Unwinding series features updates from Arizona, California, Connecticut, Idaho, Louisiana, Massachusetts, Minnesota, Montana, Nevada, New York and Texas. This series highlights the work states are engaged in to operationalize unwinding following the expiration of the Medicaid continuous coverage requirement. States continue to focus on outreach and communication efforts. To share information with the public about the roll out of unwinding, states are publishing their unwinding plans and reporting how many enrollees they have renewed to date. Other efforts states are working on include: coordinating with their State-Based Marketplace; investing additional resources to increase their workforce and support the operations of unwinding; and leveraging federal flexibilities to implement more efficient renewal processes.
  • Arizona – The U.S. Department of Health and Human Services approved the extension of Medicaid coverage for 12 months after pregnancy in Arizona. This approval marks 31 states and the District of Columbia that have extended postpartum Medicaid/CHIP coverage to a full year. As a reminder, SHVS published an issue brief on the American Rescue Plan Act’s option to extend postpartum coverage.  
  • California
    • Governor Gavin Newsom announced that California has secured a stockpile of Misoprostol, an abortion medication that can be taken on its own to induce a safe and effective abortion. More than 250,000 pills have already arrived in California, and the state has negotiated the ability to purchase up to 2 million Misoprostol pills as needed through CalRx.
    • The California Department of Health Care Services hosted a technical assistance webinar on newly released behavioral health screening and transition of care tools. Previously, multiple tools were in use to screen Medi-Cal (Medicaid) enrollees across the state, leading to inconsistencies in care. The new tools were developed with robust stakeholder input, including beta and pilot testing in a variety of counties across the state including counties with large urban areas, small population sizes, and large rural regions.
  • Colorado – Connect for Health Colorado, the state’s official health insurance Marketplace, published a report that provides a comprehensive look at the open enrollment period data and outcomes for plan year 2023. A record number of 212,174 Coloradans enrolled in coverage, of which 10,416 were undocumented individuals. The report also includes information such as average costs and enrollments by county and the significance of broker and assister enrollment assistance.
  • Delaware – The Delaware Department of Health and Social Services released its third annual healthcare benchmark trend report which analyzes trends in Delaware’s healthcare spending and quality, comparing new 2021 data against a set benchmark of 3.25%. In 2021, there was an 11.2% per capita increase, reflective of the state’s healthcare market rebounding from the reduction in healthcare spending and utilization in 2020 driven by the COVID-19 pandemic.
  • Idaho – Your Health Idaho, the state’s official health insurance Marketplace, released frequently asked questions (FAQs) on the Medicaid continuous coverage unwinding that address topics such as what happens to someone who has lost coverage and what actions they need to take in order to maintain or transition to another source of coverage. The Marketplace also has step-by-step instructions for individuals referred from Medicaid to the Marketplace and instructions for individuals starting an application without a referral.
  • Illinois – The Illinois Department of Insurance (IDOI) unveiled a new and improved consumer complaints system to better serve Illinois insurance consumers. The IDOI Help Center improvements include a cleaner design and more intuitive interface to help consumers navigate the complaint process. Healthcare providers will also benefit from the system when they believe health coverage claims are delayed, denied, or unsatisfactorily settled by insurance companies and health maintenance organizations.
  • Kentucky – The Kentucky Health Benefit Exchange has created a webpage focused on the Medicaid unwinding which includes the state’s unwinding approach, a stakeholder FAQ document, and communications materials. The state is also hosting monthly stakeholder meetings to address questions individuals are encouraged to submit through a survey.
  • Massachusetts – Governor Maura Healey directed the University of Massachusetts and healthcare providers to take action to stockpile doses of Mifepristone, and the governor issued an executive order confirming protections for medication abortion under existing state law.
  • Michigan – Governor Gretchen Whitmer announced that insurers representing 100% of the fully insured health insurance market in Michigan have agreed to maintain no-cost preventive services despite the ruling in Braidwood Management Inc. v. Becerra that struck down the requirement under the Affordable Care Act. The agreements apply to fully insured Michigan health insurance plans in the individual, small group, and large group markets, which includes plans sold on the Marketplace.
  • New Jersey – Governor Phil Murphy and Chief Innovation Officer Beth Simone Noveck announced the launch of Transgender.NJ.gov—a new, one-stop hub designed to aid New Jersey’s transgender and non-binary community in finding information about essential programs and services. The website’s initial version contains information such as how to change a name, acquire legal assistance, obtain mental health and medical support, learn about rights and legal protections, and more. The website has launched as a beta version, allowing it to be continually updated and enhanced based on feedback from New Jerseyans and community stakeholders who use the site.
  • New Mexico
    • New Mexico has created the Medicaid Transition Premium Relief Program intended to support coverage transitions during the unwinding. Through the program, the first month’s premium may be paid for most people moving from Medicaid to beWellnm, the state’s official health insurance Marketplace. The program is meant to minimize coverage disruptions and lock-in consumer protections for qualifying individuals and families who need affordable coverage.
    • The New Mexico Office of Superintendent of Insurance published guidance on New Mexico’s Health Insurance Marketplace Affordability Program for 2024. Program changes for the 2024 plan year include: improved out-of-pocket assistance between 250% to 300% of the federal poverty level (FPL); deductibles cannot apply to primary care or generic medications for Turquoise plans (plans with state-funded out-of-pocket assistance); issuers must use co-pays (not coinsurance) for primary care and generic drugs for Turquoise plans; an annual maximum out-of-pocket limit of $500 for an individual under 150% FPL; and issuers are required to offer the Standardized Health Plans adopted by the beWellnm Board of Directors.
  • New York – Governor Kathy Hochul announced that the state will stockpile the abortion medication Misoprostol as part of ongoing efforts to protect access to abortion. At the governor’s direction, the New York State Department of Health will immediately begin purchasing Misoprostol in order to stockpile 150,000 doses, a five-year supply, in order to meet anticipated needs.
  • Pennsylvania – Governor Josh Shapiro launched a new website for reproductive healthcare access resources to provide help for those seeking critical services no matter what part of the state they live in or whether they are traveling from a state that has restricted abortion access. On the new site, the public can find information about medication abortions as well as in-clinic procedure abortions. Users can also take advantage of an interactive map and the “Find A Provider” tool to locate a local provider, seek assistance on their journey with help from the “Make A Plan” section, and get connected with financial support under “How to Pay.”