August 15 Update

In This Week’s Update:

  • Inflation Reduction Act
  • Toolkit: Medicaid Managed Care Procurements
  • Section 1902(e)(14) Waiver Approvals
  • New Public Health Modernization Project
  • Developments in Section 1115 Budget Neutrality Policy
  • State Updates: CO, CT, FL, GA, ID, MS, NJ, NM & OR

Inflation Reduction Act

Last week, the Inflation Reduction Act (IRA), a $740 billion package that includes an extension of the American Rescue Plan Act’s (ARPA) premium tax credit expansion until 2025, passed the Senate and is expected to pass the House. State Health and Value Strategies published an expert perspective on the healthcare provisions included in the IRA and their implications for states. For a refresher of how ARPA expanded premium tax credits, see this SHVS expert perspective.

Toolkit: Medicaid Managed Care Procurements

SHVS published an updated Medicaid Managed Care Procurements: A Toolkit for State Medicaid Agencies. The Toolkit guides Medicaid agencies through key action steps and considerations in the major phases of the procurement cycle. Initially published in 2017, this 2022 update to the toolkit reflects current procurement best practices and refreshed state examples, drawn in part from a scan of recent Medicaid managed care procurements.

See How Your State Compares: Section 1902(e)(14) Waiver Approvals

Last week, the Centers for Medicare & Medicaid Services (CMS) released a new resource highlighting the states that have obtained CMS approval for various section 1902(e)(14) waivers to support “unwinding” from the Medicaid continuous coverage requirement. Among the 20 states with approved waivers, 70 percent have obtained flexibility to (1) conduct ex-parte renewals for individuals with no income and no data returned, and (2) accept updated enrollee contact information from managed care plans. Of note, one state (Alabama) has been granted “off-menu” authority to renew Medicaid eligibility for Temporary Assistance for Needy Families participants. For more information on these time-limited targeted enrollment flexibilities, including considerations for other “off-menu” strategies that states may pursue, see State Health and Value Strategies’ recent expert perspective: Leveraging Section 1902(e)(14) Waiver Authority Amid Unwinding.  

 Recent Developments in Section 1115 Waiver Budget Neutrality Policy

Section 1115 of the Social Security Act permits the secretary of the Department of Health and Human Services to waive certain Medicaid program rules and provide federal funding for states to test innovative coverage and delivery system reforms that would further the objectives of the Medicaid program. CMS has a long-standing policy of requiring that Section 1115 demonstrations be “budget neutral” to the federal government, meaning that the cost to the federal government must be no more than the cost would have been in the absence of the demonstration. In recent months, CMS has stated an interest in addressing fundamental issues with its budget neutrality policy, such as the inability of states to adjust budget neutrality caps to allow for payment rate increases that otherwise would have been allowable under the Medicaid state plan or other authorities (e.g., directed payments). Two recent waiver approvals—an amendment in Kansas and an extension in Vermont—indicate that the administration has begun to take steps to address this issue. In a new Health Highlight, Manatt Health describes key features of each of these waiver approvals, and references a recent Health Affairs Forefront articleI co-authored with Cindy Mann and Anne Karl of Manatt Health on the challenges in the current approach to budget neutrality.

New Public Health Modernization Project: Building Linkages Between Public Health and the Healthcare System

The National Academy for State Health Policy (NASHP) is launching a learning collaborative to support states in expanding the impact and reach of cross-sector collaborations on key public health priorities. Participating states will examine opportunities and best practices for developing cross-sector governance structures, braiding resources from various funding streams, improving information exchange with key partners, and effectively engaging communities. NASHP will select up to five states teams through a competitive process to participate in a 12-month learning collaborative, featuring multi-state and individual technical assistance. Teams will be comprised of decision makers in public health, health and human services, Medicaid, and other state officials.  A Request for Applications is available here.

  • Colorado – The Department of Health Care Policy and Financing published its Fiscal Year 2022-23 Department Health Equity Plan. The report identifies four initial Health First Colorado (Colorado’s Medicaid program) health disparity areas of focus, including: COVID-19 vaccination rates, maternal care, behavioral health and prevention.
  • Connecticut – The state’s Medicaid program, HUSKY Health, will shift to paying for maternity care using a bundled payment in 2023, rather than paying fee-for-service. The plan to adopt a maternity bundle is part of Department of Social Services’ overarching goal to move toward paying for equitable care in a value-based way.
  • Florida – Florida health officials announced the expansion of a pilot substance use network of care, Coordinated Opioid Recovery. The program was piloted in Palm Beach County and will be expanding in up to twelve counties. The state also announced the appointment of a Statewide Director of Opioid Recovery.
  • Georgia –  On August 9, CMS informed the state of the suspension of Part II of Georgia’s waiver, the Georgia Access Model. On July 27, 2022, the state responded to a letter from CMS informing officials that its previously approved Section 1332 was at risk of being suspended, unless the state submitted a corrective action plan that would bring the waiver program into compliance with federal requirements.
  • Idaho – The state released a request for proposals for a quality improvement organization to provide services including utilization management, case management, and external quality reviews for the state Medicaid program.
  • Mississippi – The Mississippi Division of Medicaid announced its intent to award contracts for its Mississippi Coordinated Access Network (MississippiCAN) Medicaid program and the state Children’s Health Insurance Program (CHIP) to Centene/Magnolia Health Plan, Molina Healthcare, and TrueCare in partnership with CareSource.
  • New Jersey – Governor Phil Murphy and Acting Attorney General Matthew J. Platkin announced the allocation of $10 million in federal American Recovery Plan funds to continue funding for the State’s Hospital-Based Violence Intervention Programs (HVIPs), which directly help gun violence victims and serve to break the cycle of gun violence. A primary goal of the HVIP is to link hospitals with community-based organizations that are already working hard to assist victims and prevent the spread of violence.
  • New Mexico – Governor Michelle Lujan Grisham announced $15 million in Nurse Expansion funding, provided through the American Rescue Plan, to help improve New Mexico’s nurse training and education programs and address nursing shortages.
  • Oregon
    • Per HB 4035, the Oregon Joint Task Force on the Bridge Health Care Program was created to design a “bridge program” which could offer healthcare coverage to people leaving the Oregon Health Plan (Medicaid) at the end of the PHE. The task force recently convened to hear an updatefrom the Oregon Health Authority (OHA) on their planning for post-public health emergency eligibility renewals.
    • OHA released an annual progress report for Healthier Together Oregon (HTO), the State Health Improvement Plan. HTO is a strategic plan to advance health equity. The strategies in the plan are organized into eight implementation areas: equity and justice, healthy communities, housing and food, healthy families, healthy youth, workforce development, behavioral health and technology and health.