April 3 Update

In This Week’s Update:

  • Decision in ACA Preventive Services Case
  • The Expanding Role of Medicaid in the Criminal-Legal System
  • Resources to Support State Implementation of Renewal Mitigation Strategies
  • Maryland’s Total Cost of Care Model
  • State updates: AK, CT, FL, KY, MA, MI, NC, NJ, NV & NY


Decision in ACA Preventive Services Case

Last week, a U.S. federal district judge struck down a key provision in the Affordable Care Act (ACA) that requires health plans to cover and waive cost-sharing for many critical preventive services that come from the recommendations of the U.S. Preventive Services Task Force, including cancer and mental health screenings. This decision prevents enforcement of the ACA provision nationwide and grants insurers the discretion to apply cost-sharing to preventive services. This would apply to all types of insurance, including Marketplace coverage and employer-sponsored coverage. Additionally, O’Connor ruled that the requirement to cover the HIV prevention drug PrEP violates the religious beliefs of employers and individuals. For more information on the ruling, see a related Health Affairs article


Also last week, SHVS published the first expert perspective in a new series, States of Unwinding. Last Friday marked the end of the Medicaid continuous coverage requirement, and as states operationalize unwinding, the series will highlight examples of the work states are engaging in to minimize coverage losses. As a reminder, SHVS has created a one-stop resource page to support states as they plan for and implement unwinding.


The Expanding Role of Medicaid in the Criminal-Legal System

Community Oriented Correctional Health Services (COCHS) has been working to connect community and correctional health systems in order to improve the lives of people inside and outside of jails and prisons, as people deserve high-quality, integrated, patient-centered care wherever they receive it. COCHS recently completed the Beyond the Inmate Exclusion Project funded by the Robert Wood Johnson Foundation, which aimed to understand the challenges and opportunities for collaboration between community health systems and correctional health systems. A new brief, Breaking the Cycle: The Expanding Role of Medicaid in the Criminal-Legal System, highlights the challenges that people who are incarcerated face in accessing the care they need. It also discusses the impact of the Medicaid inmate exclusion rule on both community health systems and correctional health systems. The inmate exclusion has limited access to care when people need it the most, inhibited the ability of providers to offer high-quality care, and has driven costs to our health and justice systems.


Resources to Support State Implementation of Renewal Mitigation Strategies

CMS published a document that provides a list of available guidance, tools, and resources that may be helpful to states as they implement the CMS approved processes and procedures needed to be considered compliant for the renewal provision of section 5131 of the Consolidated Appropriations Act, 2023. Resources are organized by renewal requirement. As a reminder, SHVS recently published a tool that aims to help states qualify for the sustained enhanced Federal Medical Assistance Percentage, avoid corrective action imposed by CMS, promote continuity of coverage and care during unwinding, and make long-term improvements to eligibility and enrollment infrastructure.


Maryland’s Total Cost of Care Model

A new report presents estimates of the Maryland Total Cost of Care (MD TCOC) Model impacts in its first three years from 2019 to 2021. In 2018, CMS and Maryland signed an agreement that established the MD TCOC Model which builds on the Maryland All-Payer Model, which ran from 2014 to 2018 and created hospital all-payer global budgets for regulated Maryland hospitals. MD TCOC continues using hospital global budgets and extends that transformation beyond hospital walls by expanding statewide accountability for cost and quality outcomes and broadening the incentives and supports to providers to transform care. Overall, the report finds the following favorable effects during the first three years of the model: substantially reduced rates of all-cause acute care hospital admissions; moderately reduced total Medicare fee-for-service spending; and several improved quality-of-care measures.


State updates: AK, CT, FL, KY, MA, MI, NC, NJ, NV & NY

  • Alaska – The Alaska Division of Public Assistance created a webpage to inform Medicaid enrollees about the continuous coverage unwinding. The page features SHVS’ Continuous Coverage Unwinding: Enrollee Outreach Video, customized for Alaska. 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.
  • Connecticut
    • The Department of Social Services (DSS) and Access Health CT, the state’s official health insurance Marketplace, shared a comprehensive 12-month operational and outreach plan to redetermine eligibility for HUSKY Health (Medicaid) enrollees and resume routine public program operations. Less than a quarter of the approximately 434,000 Connecticut residents being redetermined are expected to no longer be eligible. DSS also created a webpage “Update Us, so we can Update U” for enrollees in HUSKY Health, cash and food assistance programs to update their contact information.
    • Governor Ned Lamont announced the findings of Connecticut’s first-ever healthcare cost growth benchmark report which finds that healthcare spending in the state increased by 6% between 2020 and 2021, surpassing the state’s benchmark target of 3.4%. According to the report, Connecticut spent $34 billion on healthcare and insurance costs in 2021, up from $31.9 billion in 2020, driven by an 18.8% increase in commercial health spending.
  • Florida – The Florida Agency for Health Care Administration announced a 30-day public comment period and two public meetings, to solicit input from the public on the proposed five-year extension request for Florida’s 1115 Family Planning Waiver. The Family Planning Waiver operates statewide and provides family planning services to non-pregnant women between the ages of 14 and 55 years who meet the financial eligibility criteria.
  • Kentucky – Governor Andy Beshear signed two pieces of legislation to support Kentuckians in accessing treatment for substance use disorder. House bill 248 supports recovery housing by setting requirements for certification, operation and oversight of these residences. It is also aimed at helping these resources be more accessible and equitable. House bill 148 will ensure direct payments from health insurance to the facilities providing care.
  • Massachusetts
    • The Massachusetts Health Connector created a website dedicated to unwinding the Medicaid continuous coverage requirement that includes resources for individuals and families to take action to stay covered, resources for employers and employees, and a toolkit from MassHealth (Medicaid) with member-facing materials for redeterminations.
    • The Massachusetts Health Connector, the state’s official health insurance Marketplace, is hosting a webinar “Keeping or Getting Coverage through MassHealth and the Health Connector” on April 12. This session presented by MassHealth and the Health Connector staff will cover how enrollees renew MassHealth coverage, report any changes, how to access an online account, and get help with completing renewal or enrolling in Health Connector coverage.
  • Michigan – The Michigan Department of Insurance and Financial Services (DIFS) issued a bulletin which ensures that all financial service and insurance entities regulated by DIFS, including health insurance plans, cannot deny access, limit benefits, impose additional cost-sharing, or engage in discriminatory marketing practices based on an individual’s sex, which now explicitly includes gender identity and sexual orientation as clarified in the newly-amended Elliott-Larsen Civil Rights Act signed by Governor Whitmer.
  • Nevada – Nevada Health Link, the state’s official health insurance Marketplace, announced an estimated 200,000 Nevadans may be redetermined ineligible for Medicaid benefits over the next 14 months. For individuals who are not renewed for Medicaid coverage, Medicaid will contact individuals to advise them of their account transfer and Nevada Health Link representatives will do active outreach to those individuals to help them with next steps regarding their account.
  • New Jersey – The U.S. Department of Health and Human Services approved New Jersey’s request to extend and amend its Medicaid section 1115 demonstration, “New Jersey FamilyCare Comprehensive Demonstration.” Under the demonstration, CMS is approving initiatives related to continuous eligibility, coverage expansion, and health-related social needs (HRSN). The continuous eligibility approval will allow the state to provide 12 months of continuous eligibility to adults whose Medicaid eligibility is based on Modified Adjusted Gross Income (MAGI). CMS is also authorizing the provision of certain services that address HRSN, such as nutritional services and nutrition education, as well as transitional housing supports for individuals with a clinical need or who are transitioning out of institutional care, congregate settings, homelessness or a homeless shelter, or the child welfare system.
  • New York – The New York State Department of Health announced that beginning this spring and continuing through spring 2024, more than 9 million New Yorkers enrolled in Medicaid, CHIP and the Essential Plan (the state’s Basic Health Program) will need to renew their health insurance. Renewal notices will be sent on a rolling basis and renewal deadlines will be based on the enrollees’ enrollment end dates and will range from June 30, 2023, through May 31, 2024. Consumers are encouraged to renew by the 15th of the month.
  • North CarolinaGovernor Roy Cooper signed Medicaid expansion into law. House Bill 76, Access to Healthcare Options, is expected to provide health coverage to over 600,000 people across North Carolina and bring billions in federal dollars to the state. North Carolina is the 40th state to expand Medicaid. Medicaid expansion will take effect upon the signing into law of the FY 2023-25 appropriations act.