April 24 Update

In This Week’s Update:

  • Supporting Reentry for Justice-Involved Populations
  • ACA’s Preventive Services Requirement
  • Notice of Benefit and Payment Parameters
  • Final 2024 Notice of Benefit and Payment Parameters
  • Attempts to Scam Medicaid Members Popping up Nationwide as Unwinding Commences
  • Protect Medicaid 2023
  • State updates: CO, DC, IA, IL, KY, ME, MI, MN, ND, NE, NM, NY, OR, RI, UT, WA & WV

Supporting Reentry for Justice-Involved Populations 

Last week, CMS released a State Medicaid Director Letter (SMDL), “Opportunities to Test Transition-Related Strategies to Support Community Reentry and Improve Care Transitions for Individuals Who are Incarcerated.” The SMDL outlines the opportunity for states to waive the inmate exclusion and receive federal funding for expenditures for certain pre-release healthcare services for individuals who are incarcerated and otherwise eligible for Medicaid. 


ACA’s Preventive Services Requirement

Also last week, SHVS published an expert perspective outlining the background and implications of the recent ruling in Braidwood Management, Inc v. Becerra, blocking the federal government from enforcing the ACA’s requirement that health plans and issuers cover, without cost-sharing, high value preventive services. The expert perspective discusses who will be impacted by the court’s decision and the preventive services most at risk, and updates SHVS’ September 2022 checklist of actions states can take to maintain access to preventive services.


Final 2024 Notice of Benefit and Payment Parameters

On April 17, 2023, the U.S. Department of Health and Human Services published the final 2024 Notice of Benefit Payment Parameters (NBPP). The rule contains a wide-ranging set of provisions, which are summarized in a three-part Health Affairs Forefront series. The first article of the series from Sabrina Corlette at the Georgetown Center on Health Insurance Reforms, focuses on market reforms and consumer assistance. The second article from Matthew Fiedler at the Center for Health Policy at The Brookings Institution, summarizes provisions related to the individual and small group market risk adjustment programs. The final article in the series from Tara Straw at Manatt Health summarizes the provisions that are specific to the exchanges on the federal enrollment platform and to state-based exchanges where specified. As a reminder, SHVS published an expert perspective on the proposed 2024 NBPP and implications for states.


Attempts to Scam Medicaid Members Popping up Nationwide as Unwinding Commences

The National Association of Medicaid Directors (NAMD) published a blog post highlighting a trend several states are observing of scams targeting Medicaid members and demanding they pay a fee, as much as $500, or risk the loss of their Medicaid coverage. Eligibility leaders in Wyoming were some of the first to discover fraud in their state and issued a press release to let the public know what messages from the state are legitimate and clarify that the state would never require payment in the renewal process. NAMD has elevated this issue for all 56 states and territories ensuring eligibility leaders, public information officers, and others in Medicaid agencies across the country are aware and are encouraging Medicaid programs to warn national and state partners as well as consumers. SHVS is working with our communications experts to evaluate what messaging materials could be helpful to states. In the meantime, if you would like to discuss how your state can communicate about this issue, please be in touch.


Protect Medicaid 2023

The National Health Law Program (NHeLP) has launched a new series entitled Protect Medicaid 2023 as congressional leaders are considering policies that would cut funding for Medicaid as part of the debt ceiling negotiations. NHeLP’s team of legal and policy experts will analyze debt ceiling proposals as they emerge, such as Medicaid work requirements, block grants, and per capita caps, which would limit federal funding and make it harder for people to access healthcare programs and services. If enacted, such policies would jeopardize the health and financial security of the tens of millions of low-income individuals and families who rely on Medicaid. Resources include Medicaid Fast Facts and an 11-part series, Protect Medicaid Funding, with information on particular issues and populations such as children’s health, access to reproductive and sexual healthcare, and health inequities.


State updates: CO, DC, IA, IL, KY, ME, MI, MN, ND, NE, NM, NY, OR, RI, UT, WA & WV

  • Colorado
    • Governor Jared Polis signed SB23-222 which will help eliminate Health First Colorado, the state’s Medicaid program, co-pays for most members for pharmacy and outpatient healthcare services. By eliminating co-pays, the Department of Health Care Policy and Financing will pay providers a higher amount and be able to draw down additional federal funds for the incremental difference. A co-pay will still be charged for non-emergency care delivered in an emergency room. 
    • Governor Jared Polis signed three bills protecting access to reproductive and gender-affirming healthcare. SB23-188 prevents the state from recognizing or engaging in any criminal prosecutions or lawsuits for anyone who receives, provides, or assists in abortions and gender-affirming care; SB23-189 increases access to reproductive healthcare services, including HIV prevention drugs and abortion care; and SB23-190 makes punishable certain deceptive actions regarding pregnancy-related services, such as falsely advertising availability or referrals for abortions or emergency contraceptives.
  • District of Columbia – Mayor Bowser announced that the District will cancel up to $90 million in medical debt for many of the 90,000 District residents who have unpaid medical bills. The initiative is funded by $900,000 in anticipated year-end surplus funds from the fiscal year 2023 budget to address health inequities and racial disparities related to medical care.
  • Illinois – CMS approved a state plan amendment (SPA) that will provide Illinois more Medicaid funding for eligible children receiving Medicaid-covered healthcare services in schools. Illinois’ newly approved SPA allows schools to receive more Medicaid funding for covered services for all children with Medicaid, rather than only those children with an Individualized Education Program, which is a plan or program tailored for children with disabilities.
  • Kentucky – The Kentucky Cabinet for Health and Family Services created a resource outlining the various flexibilities that were leveraged in the state during the public health emergency along with the state’s unwinding decisions. The resource is organized by federal authority and includes information about the decisions made for unwinding the flexibilities or updating policy to implement them going forward.
  • Maine – Maine’s official health insurance Marketplace, CoverME.gov, announced a special enrollment period (SEP) for Mainers transitioning from MaineCare (the state’s Medicaid program). The SEP, which began on April 15, 2023 and will continue through July 31, 2024, will align with the HealthCare.gov Unwinding SEP.
  • Michigan – The Michigan Department of Insurance and Financial Services (DIFS) is taking action to help Michigan seniors who may lose Medicaid coverage during the unwinding by outlining Medicare enrollment opportunities. DIFS has issued an order enabling eligible Michiganders to purchase a Medicare Supplement policy. This will allow individuals who became eligible for Medicare during the continuous coverage requirement and missed the Medicare Supplement open enrollment window to access Medicare Supplement plans during the unwinding.
  • Minnesota – The Minnesota Department of Human Services created a webpage informing individuals enrolled in Medicaid or MinnesotaCare (the state’s Basic Health Program) to be prepared to renew their coverage during the unwinding. The webpage provides information about how to maintain coverage during the unwinding, the timeline for renewals, and communications toolkits. The communications page features SHVS’ Continuous Coverage Unwinding: Enrollee Outreach Video, customized for Minnesota. Each state can customize the end card of the videos with specific branding elements, such as agency logos, call center phone numbers, and web addresses. If you are interested in a customized video, please contact Laura Buddenbaum at lbuddenbaum@princeton.edu.
  • Nebraska – The Nebraska Department of Health and Human Services Division of Medicaid and Long-Term Care is hosting a listening tour focused on unwinding the continuous coverage requirement. “Unpacking the Unwind: A Medicaid Listening Tour” will be held in eight cities this April and May, along with two virtual options. The tour will include a presentation that will focus on important updates for both members and providers regarding the end of the public health emergency and continuous coverage requirement. After the presentation, Nebraska Medicaid will field questions and feedback from those in attendance.
  • New Mexico – Governor Michelle Lujan Grisham signed into law five healthcare-related bills that will support and strengthen the state’s healthcare workforce and make healthcare more affordable and accessible across the state. The bills provide support for rural healthcare delivery in underserved parts of the state; create a healthcare authority department responsible for purchasing, regulation and policy; and establish cost-sharing consumer protections for prescription drugs.
  • New York – NY State of Health, the state’s official health insurance Marketplace, released the 2023 Health Insurance Coverage Update, a detailed summary of NY State of Health enrollment, including demographics, quality measures, and the cost savings realized by millions of New Yorkers who have comprehensive health insurance through the Marketplace. As of January 31, 2023, NY State of Health enrollment is nearly 6.9 million, or more than one in three New Yorkers across the state.
  • North Dakota – North Dakota Health and Human Services is inviting individuals with developmental disabilities, their families, guardians and service providers to a public meeting on April 27 to learn about upcoming changes that include returning to some pre-pandemic policies and practices when the public health emergency ends on May 11.
  • Oregon – CMS approved an amendment to the Oregon Health Plan (OHP) demonstration that authorizes Medicaid coverage for individuals ages 19 through 64, with incomes from 133% to 200% of the federal poverty level, who are currently enrolled in OHP as a result of the Medicaid continuous coverage requirement. The amendment will streamline retention of coverage by not requiring people to move to the Marketplace.  
  • Rhode Island
    • The state is implementing an auto-enrollment program with premium assistance during the unwinding to connect Rhode Islanders who are terminated from Medicaid with health coverage through HealthSource RI, the state’s official health insurance Marketplace. Those eligible for auto-enrollment will be enrolled in a silver health plan with financial support to cover the first two months’ premiums. Individuals may also select and enroll in a dental plan and may be eligible for additional premium payments for their dental coverage.
    • CMS approved the expansion of Medicaid and CHIP postpartum coverage in Rhode Island to 12 months after birth. With this approval, 32 states and D.C. 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. 
  • Washington – CMS approved an amendment to the state’s Medicaid section 1115(a) demonstration, titled “Medicaid Transformation Project.” Approval of this demonstration amendment includes continuous eligibility for Medicaid children from the point they become eligible until they reach age six, regardless of income fluctuations or changes that would affect eligibility. 
  • Iowa, Minnesota, Oregon, Rhode Island, Utah, Washington & West Virginia – These seven states have published data related to unwinding either in the format of a dashboard or a static report. SHVS will continue to update an expert perspective, State Dashboards to Monitor the Unwinding of the Medicaid Continuous Coverage Requirement, as additional dashboards and reports go live.