August 12 Update

In This Week’s Update:

  • Upcoming SHVS Webinar
  • New Guidance on Family Planning Services and Supply Coverage
  • Commercial Market Affordability Strategies Technical Assistance Program
  • A Roadmap for Effective Community Engagement
  • Impact of Enhanced Marketplace Tax Credits
  • State updates: AZ, CA, CT, DE, IN, MI, NM, NY, PA, VA & WI

 

New Guidance on Family Planning Services and Supply Coverage
Last week, CMS released guidance summarizing state Medicaid agencies’ obligations related to coverage of family planning services and supplies and state options for ensuring timely access to these services. The informational bulletin provides states with guidance on requirements for the coverage of family planning services and supplies, strategies to reduce barriers and increase access to contraception, confidentiality protections for those seeking family planning services and supplies, and information on quality measures. Updates follow.

 

Commercial Market Affordability Strategies Technical Assistance Program
The Commonwealth Fund and Bailit Health are accepting applications for the second year of a technical assistance program customized for states that are actively engaged in the planning, design, implementation, and/or refinement of specific commercial market affordability strategies. This program provides state agencies with customized technical assistance through subject matter experts, peer-to-peer support, virtual group office hour sessions, and one in-person convening for all state participants. For additional information on eligibility for the program and instructions for how to apply, see here.

A Roadmap for Effective Community Engagement
The Camden Coalition’s Initiating National Strategies for Partnership, Inclusion, and Real Engagement (INSPIRE) is a coordinated team of organizations and people with lived experience committed to advancing the practice of authentic community engagement in the healthcare system. INSPIRE’s recent report provides a roadmap for how healthcare organizations and people with lived experience can realize the full potential of authentic community engagement to build trust, advance health equity, create cost-savings and efficiencies, and create healthy and thriving communities.

Impact of Enhanced Marketplace Tax Credits
In the coming months, work will begin on setting 2026 premiums for over 20 million people covered through the Affordable Care Act Marketplace (ACA). Without congressional action, the premium tax credits that make coverage more affordable for most enrollees will be lowered, resulting in net premium cost for eligible enrollees spiking 25% to 100% higher, 4 million becoming uninsured, and a destabilization of the ACA Marketplace. To inform the debate over preserving the larger premium tax credit, The Century Foundation published a commentary that examines how the enhanced tax credits achieved its goals to increase enrollment, reduce health insurance premiums paid by enrollees, and reduce the uninsured rate.

 

State updates: AZ, CA, CT, DE, IN, MI, NM, NY, PA, VA & WI

  • Arizona – The Arizona Health Care Cost Containment System (AHCCCS) has selected Solari, Inc. for the administration of the Housing and Health Opportunities (H2O) program. The H2O program aims to enhance and expand housing services and interventions for specific populations of AHCCCS members who are experiencing homelessness.
  • California
    • The Department of Health Care Access and Information announced the release of its Healthcare Payments Data (HPD): Fee-For-Service Drug Costs in the Commercial Market report. The report sheds light on the prohibitive cost of many common prescription drugs and enables the state to analyze future drug cost trends.
    • The Department of Health Care Services released three new ASL Interpretation videos covering topics important for Medi-Cal members. These videos help ensure that all members have access to information regarding interpreter services, billing protections, and a pilot program that aims to simplify the transition to Medicare for Medi-Cal members who are newly eligible for Medicare.
  • Connecticut – Governor Ned Lamont announced the launch of the In-Home Safety Grant Program, a new state grant program administered by the Connecticut Department of Social Services aimed at enhancing the safety and security of home healthcare workers in Connecticut. Established by Public Act 24-19, the program will provide grants to home health agencies to fund improved safety protocols and support services for their workers.
  • Delaware – Governor John Carney signed two pieces of legislation to support student mental health in schools. The first new law will help establish a mental health services unit for high schools in Delaware, which will lower the ratio of students to counselors to make mental health services more accessible. The second law will expand the reimbursement of school-based behavioral health services through Medicaid.
  • Indiana – The state will expand its Pregnancy Promise Program to support more expectant and new mothers with substance-use disorders (SUDs). The Indiana Family and Social Services Administration received a three-year, up to $2.7 million federal grant from the Substance Abuse and Mental Health Services Administration which will allow it to support an additional 300 pregnant residents over the next three years, with a focus on those living in rural and underresourced communities.
  • Michigan – The Michigan Department of Insurance and Financial Services issued a new bulletin that will ensure consumers are protected when insurance companies use artificial intelligence technologies when they underwrite new policies, make coverage determinations, or decide how much their products will cost. The bulletin details how existing state laws apply to these technologies and outlines the department’s expectations for insurers.
  • New Mexico – New Mexico Medicaid will hold a virtual public meeting to obtain public input on “Medicaid Forward,” the plan described in HB 400 to expand Medicaid coverage to more residents of the state. The proposed plan would expand Medicaid coverage for any resident under the age of 65 who is not otherwise eligible for Medicaid and who has a household income greater than 133% of the federal poverty limit.
  • New York – Governor Kathy Hochul announced that nine organizations statewide will receive a total of $500 million in awards over the next three years to create a new Social Care Network program in the state. The program will address health disparities in low-income communities by leveraging federal funding to facilitate Medicaid members’ access to nutritional meals, housing supports, transportation and other social services that can have a significant impact on an individual’s health. The program is part of New York’s Health Equity Reform Medicaid Section 1115 Demonstration Waiver, approved in January.
  • Pennsylvania – The Pennsylvania Insurance Department announced the 2025 rate changes requested by insurance companies operating in the individual and small group markets. Insurers have filed plans requesting an average statewide increase of 7.9% in the individual market and 7.8% in the small group market. The proposed rates are subject to change as the department conducts its review process.
  • Virginia – The state submitted an extension request to its section 1115 demonstration to extend the SUD program and continue coverage for former foster care youth.
  • Wisconsin – Governor Tony Evers announced he is directing the Wisconsin Department of Health Services to invest $258 million in funding already designated for home and community-based services from American Rescue Plan Act funds to create and fund a minimum fee schedule, and effectively raise wages for direct care workers and providers serving older adults and individuals with disabilities.