In This Week’s Update:
- Federal PHE extended
- Reforms on Access to Coverage
- Decline in marketplace premiums
- Equity in state-based marketplace plans
- Reducing maternal mortality and morbidity
- State updates: CA, CT, DE, MA, NY, OK, OR, PA & WI
Federal Public Health Emergency Extended
Last week HHS Secretary Xavier Becerra extended the federal public health emergency (PHE) to July 15, 2022. As a reminder, SHVS is continuing to develop and update resources for states as they prepare for the eventual unwinding of the PHE, including the Medicaid continuous coverage requirement, on our resource page.
Achieving Substantial Reforms on Access to Coverage
CMS released a request for information (RFI) seeking feedback on topics related to healthcare access. The RFI presents an important opportunity for states to share with federal partners input and creative ideas to achieve substantial reforms on access to coverage as well as the standards for defining and monitoring enrollee access to care. (For more information, see this expert perspective that summarizes the RFI.) To inform and support state responses to the RFI, SHVS published an expert perspective that provides model comments. We encourage states to submit comments, including by leveraging and building on any of the language in the expert perspective that reflects state priorities. Note: states must submit all comments by Monday, April 18, 2022, via the online portal. SHVS and Manatt Health are available to help as your state considers whether and how to respond to the RFI.
CMS Announces Key Actions to Reduce Maternal Mortality and Morbidity
CMS released more details about the proposed “Birthing-Friendly” hospital designation intended to drive improvements in maternal health outcomes. The new designation would assist consumers in choosing hospitals that have demonstrated a commitment to maternal health and the delivery of high-quality maternity care. In addition, the agency announced it is also working with ten states and the District of Columbia to extend postpartum coverage for 12 months after pregnancy as part of the new option available via the American Rescue Plan. These states will follow Illinois, Louisiana, Michigan, New Jersey, and Virginia, which have started offering Medicaid and Children’s Health Insurance Program (CHIP) coverage for 12 months after pregnancy. In case you missed it, SHVS recently updated our publication on the American Rescue Plan’s State Option to Extend Postpartum Coverage.
Marketplace Premiums Continue to Decline as Competition Rises
With support from the Robert Wood Johnson Foundation, the Urban Institute released a new study finding that ACA marketplace premiums have been declining in most states for the past three years, while employer-sponsored insurance premiums rose. Several new factors affected insurers as they set premiums for 2022, including subsidies from the 2021 American Rescue Plan Act, increased outreach and enrollment spending by the Biden administration, and an increasing number of insurers in the marketplaces. Premiums for benchmark plans in the marketplace fell 1.8 percent nationally in 2022, following declines of 3.2 percent in 2020 and 1.7 percent in 2021. These trends contrast with premium increases in employer-sponsored plans of 3.6 percent in 2021 and 3.9 percent in 2020. Additionally, the number of insurers participating in the marketplace increased from 198 to 288 between 2020 and 2022 in the regions analyzed. The increase in the number of insurers in a marketplace also correlated with lower premium increases in those regions.
What Four States Are Doing to Advance Health Equity in Marketplace Insurance Plans
A new issue brief by the Commonwealth Fund explores marketplace equity strategies pursued in California, Connecticut, the District of Columbia, and Massachusetts. While the brief finds that there is no consensus among the four marketplaces on how to approach health equity, the variety of state approaches described in the brief show there are multiple paths to improving health equity. The first step stakeholders identified was the need for insurers and the marketplaces to gather more data to understand the people they serve and to design effective health equity strategies. At the same time, marketplaces are pursuing strategies to ensure plan designs meet the needs of people of color, to help enrollees use their coverage to receive equitable care, and to create accountability for meeting equity goals.
- The California Department of Public Health is partnering with key community-based organizations throughout the state to increase vaccinations for youth ages five and up. From April 11 to June 5, the state will increase its ongoing youth vaccination efforts by pairing vaccination opportunities with fun activities for children and families. Events will be held at after school programs, libraries, local parks, and other recreational areas and involve pediatric medical providers.
- Governor Gavin Newsom announced $70 million in awards for six new Homekey projects throughout California. When fully operational, the projects will provide 232 housing units for people experiencing, or at risk of experiencing, homelessness.
- Connecticut – CMS is accepting comments on Connecticut’s Section 1115 new demonstration application entitled “Covered Connecticut.” The application requests waiver authority to provide premium assistance to certain eligible individuals who enroll in a silver-level qualifying health plan on the state’s health insurance marketplace, Access Health CT. The demonstration would also provide dental services and non-emergency medical transportation services comparable to the benefits under Connecticut Medicaid and provided through the state’s Medicaid delivery and payment system, HUSKY Health. These demonstration benefits would be available to individuals who have incomes that are between the Medicaid limit and 175 percent of the federal poverty level. The federal public comment period is open until May 13, 2022.
- Delaware – The Department of Health and Social Services launched a new website that allows residents to compare the average costs of care for medical services based on actual medical claims in the state. The website compares hospital costs for five common types of care across six hospital systems: cardiac procedures, C-sections, emergency department visits, knee and hip replacements and vaginal delivery.
- Massachusetts – MassHealth released the request for responses (RFR) for its Accountable Care Organization (ACO) Program. MassHealth anticipates an extension of its 1115 waiver which will continue the focus on accountable care delivery systems. This ACO RFR supports the goals of MassHealth’s 1115 waiver by extending and improving the ACO program based on lessons learned in the first five years of the program.
- New York – The New York State Department of Health filed an amendment to its Medicaid 1115 waiver seeking authority to spend $13.5 billion in Medicaid funds over five years for a demonstration project aimed at addressing health disparities and delivery system problems magnified by COVID-19. The state will conduct two virtual hearings on the waiver amendment. The public comment period is open until May 13.
- Oklahoma – The Oklahoma Health Care Authority and Oklahoma Human Services is partnering to help Oklahoma children receive health services through the new Specialty Program for At-Risk Kids (SPARK). Through the SPARK program, the two agencies will aim to identify behavioral health and medical needs earlier and refer participants to needed interventions which is expected to result in diversion from higher, more restrictive levels of care and promote placement stability for youth.
- Oregon – The Oregon Health Authority announced that Governor Kate Brown appointed 13 members to a healthcare Bridge Program Task Force, as required by HB 4035. The Task Force will begin meeting in April to design a “bridge program,” which could offer healthcare coverage to people leaving the Oregon Health Plan (Medicaid) at the end of the PHE, and potentially offer such coverage in the future for people in Oregon under certain income thresholds. The Task Force will develop recommendations by September 1, 2022.
- Pennsylvania – Acting Insurance Commissioner Michael Humphreys announced that the Department of Insurance has submitted a statement of policy to the Pennsylvania Bulletin that will allow insurers to ask applicants to voluntarily provide race and ethnicity data on insurance applications in an effort to promote equity initiatives.
- Wisconsin – DHS hosted an event to share findings of its pilot program, Birth to 3 program, which aims to address the social and emotional needs of children under the age of three who have developmental delays or disabilities. DHS awarded $1.2 million in grants to support these programs in 2020.