In This Week’s Update:
- Medicaid’s 57th Anniversary
- Section 1557 Proposed Rule
- Medicaid Managed Care Contracts
- CMS Releases Maternity Care Action Plan
- Latest Legal Challenges to the ACA
- Technology to Improve Quality within MMC
- State Updates: AZ, CA, CT, DE, GA, IN, KS, LA, MA, MS, NY & WI
Last week, HHS announced a proposed rule implementing Section 1557 of the ACA that prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs and activities. The proposed rule restores and strengthens civil rights protections for patients and consumers in certain federally funded health programs and HHS programs after the 2020 version of the rule limited its scope and power to cover fewer programs and services. For an analysis of the proposed rule, see this Health Affairs Forefront blog post authored by Katie Keith.
State Health and Value Strategies published an updated version of Medicaid Managed Care Contract Language: Health Disparities and Health Equity, a compendium of health disparities and health equity language from Medicaid managed care contracts and requests for proposals. This latest version includes language from California’s Department of Health Care Services Medicaid managed care procurement released in February 2022. A companion expert perspective examines the focus on health equity and reducing health disparities in California’s procurement.
Maternity Care Action Plan
This week, CMS released its Maternity Care Action Plan to support the implementation of the Biden-Harris Administration’s Blueprint for Addressing the Maternal Health Crisis. The action plan takes a holistic and coordinated approach across CMS to improve health outcomes and reduce inequities for people during pregnancy, childbirth, and the postpartum period. CMS’ implementation of the action plan will support the Biden-Harris Administration’s broad vision and call to action to improve maternal health. Through the action plan, CMS Administrator Chiquita Brooks-LaSure also encouraged industry stakeholders—including healthcare facilities, insurance companies, state officials, and providers—to consider key commitments the private sector can make to improve maternal health outcomes. Industry can submit proposed commitments at http://cms.gov/maternalhealthcommitments.
The Latest Legal Challenge to the Affordable Care Act’s Preventive Services Guarantee
Oral arguments began this week in a new lawsuit, Kelley v. Becerra, that imperils one of the Affordable Care Act’s most popular and well-used provisions—the requirement that insurers and health plans offer free preventive care. More than 152 million people with private health coverage benefitted from this provision in 2020 alone. The case’s outcome has implications for every insured person in the United States. In a new explainer published by the Commonwealth Fund, legal scholars Katie Keith, Timothy Jost, and Andrew Twinamatsiko break down this latest challenge to the ACA, detailing the arguments each side will make and what happens if the provision is ruled unconstitutional.
Leveraging Technology to Improve Quality within Medicaid Managed Care
Healthcare organizations are increasingly using technology-enabled innovations to improve access to and quality of care. Tech-enabled solutions include a wide variety of interventions such as telehealth, texting, health education apps, cross-sector data sharing, and e-prescribing, among others. Within Medicaid, however, there are unique challenges to scaling these innovations that have led tech entrepreneurs to focus less on developing solutions that meet the needs of Medicaid populations. In the absence of tech-enabled innovation, individuals served by Medicaid may not have access to solutions being adopted in other segments of the healthcare system. The Medicaid Innovation Collaborative (MIC) seeks to improve the health and well-being of Medicaid populations by bringing together Medicaid programs, managed care organizations, and other key stakeholders to identify and implement technology-enabled solutions. A new Center for Health Care Strategies blog post shares early lessons from MIC and provides insights into how other states can support the identification and implementation of these innovations.
- Arizona – The Arizona Health Care Cost Containment System posted a summary of its Public Health Emergency Operational Unwinding Plan to inform stakeholders of the state’s plan for reinstating regular enrollment and operational procedures when the PHE ends. The summary and full operational plan are available on the Preparing for the End of COVID-19: Return to Normal Renewals webpage along with fliers, messaging toolkits, and other resources to help communities prepare for the end of the PHE.
- California – Covered California, the state’s official health insurance marketplace, announced a special-enrollment period for people living in counties where a state of emergency has been declared due to raging wildfires. Affected Californians will have 60 days from the date the state of emergency was declared in their county to sign up for coverage.
- Delaware – The state submitted to CMS a request to amend the Delaware Diamond State Health Plan (DSHP) Section 1115 Medicaid demonstration. This amendment is requesting the flexibility to add several new benefits, including: coverage of two models of evidenced-based home visiting for pregnant women and children; permanent coverage for a second home-delivered meal for members receiving home- and community-based services in the DSHP Plus program; and coverage of a pediatric respite benefit. The federal comment period will be open through August 25, 2022.
- Georgia – The Georgia Department of Community Health announced grant awards totaling $9 million to 10 Georgia rural hospitals as part of its annual Rural Hospital Stabilization Grant program, currently in its seventh phase. Each hospital will receive $900,000 to support initiatives and services that strengthen access to quality care for Georgia’s underserved communities.
- Indiana – Indiana’s mobile integrated healthcare program, designed to reduce unnecessary emergency department visits and hospital readmissions, was featured in a new National Academy of State Health Policy issue brief. These programs may be particularly valuable for certain populations, including people with mental health or substance use disorder needs. The brief highlights lessons learned and considerations for other states.
- Louisiana – The Louisiana Department of Health announced the award of more than $673,000 in federal Medicaid funds to the LSU Health Sciences Center and Pennington Biomedical Research Center to conduct research on priorities for the Medicaid program over a two-year period. Findings from the research projects will guide policy-making and promote innovation and new approaches to improving: maternal and neonatal outcomes; early childhood health and development; mental health and substance use outcomes; and health equity.
- Mississippi – The Mississippi Division of Medicaid announced submission of a renewal request for the state’s Healthier Mississippi 1115 Waiver, which covers aged, blind, and disabled individuals who are not on Medicare or eligible for Medicaid. The waiver, which has an enrollment cap of 6,000, is currently set to expire on September 30, 2023. If approved, the waiver will be effective from October 1, 2023, through September 30, 2028.
- New York – The New York State Department of Health announced two funding opportunities that will provide $10.7 million in funding for small, community-based wellness organizations to encourage the expansion or development of new COVID-19 mitigation and prevention resources and services. These grants will support local organizations that are trusted voices within under-resourced communities, including rural communities that are at greater risk of contracting COVID-19.
- Wisconsin – Governor Tony Evers and the Wisconsin Department of Health Services awarded more than $2.5 million to 27 providers for community behavioral health services that will provide access to mental health and substance use treatment and recovery supports through telehealth. Grantees will use this one-time funding from the American Rescue Plan Act (ARPA) to expand access to these services by setting up private behavioral health telehealth stations in central locations, including community centers, food pantries, homeless shelters, libraries, long-term care facilities, and schools.
- Connecticut, Kansas, and Massachusetts – CMS approved the extension of Medicaid and CHIP coverage for 12 months after pregnancy in these three states under the new state plan opportunity established by ARPA. As a result, up to an additional 19,000 people annually—including 4,000 in Connecticut; 8,000 in Massachusetts, and 7,000 in Kansas—will now have access to Medicaid or CHIP coverage for a full year after pregnancy. With this approval, an estimated 284,000 Americans annually in 18 states and D.C. are eligible for 12 months of postpartum coverage. As a reminder, SHVS published an issue brief that reviews the ARPA state option to extend postpartum coverage.