August 16 Update

In This Week’s Update:

  • New SHVS resource: Health Equity Language Guide for State Officials
  • CMS Issues Guidance for Programs Post-Pandemic 
  • State updates: AZ, CA, CO, MD, MO, NJ, OH, OR, PA, SC, UT & WI   
  • Innovation at CMS: A Vision for the Next 10 Years
  • Discrimination and Adverse Health Care Consequences
  • Latest Enrollment Data During SEP


Health Equity Language Guide for State Officials

State Health and Value Strategies published the Health Equity Language Guide for State Officials. The Guide consists of three tools to help state officials determine the language used to discuss race and health equity. It also includes definitions and explanations of words and phrases, how to think about their usage, and examples of how they might be applied. The Guide is a living document that will continue to be updated to reflect and respond to evolving terminology. As states define health equity terms within their own state policy documents, the Guide intends to be a helpful, complementary resource for such work. 


CMS Issues Guidance for Programs Post-Pandemic 

CMS released a State Health Official (SHO) letter intended to assist states in their planning efforts to resume routine Medicaid, CHIP, and BHP operations for the eventual end of the COVID-19 public health emergency (PHE). Specifically, this SHO provides updated guidance that extends the timeframe for states to complete pending eligibility and enrollment work to up to 12 months after the PHE ends and requires states to complete a redetermination of eligibility after the PHE for all beneficiaries before taking any adverse action. This requirement is a departure from the earlier guidance allowing states to terminate coverage at the end of the PHE if the individual had been found ineligible within six months of the end of the PHE. The updated guidance reiterates states’ obligations to conduct full redeterminations and provide beneficiaries ample time to respond to relevant requests. The guidance also encourages states to employ eligibility and enrollment strategies that promote continuity of coverage and reduce processing delays. The guidance did not indicate whether the federal PHE will be extended; HHS has previously indicated that it expects to continue the PHE through the end of this year and will provide states with notice before its termination.  


Related resource:  Strategies for States to Drive Equitable Vaccine Distribution and Administration


  • Arizona – The Arizona Health Care Cost Containment System (AHCCCS) announced new date-specific payment rates for COVID-19 vaccine administration. For dates of service on and after August 9, 2021, the AHCCCS fee-for-service rate for COVID-19 vaccine administration is $83.00 to administer each dose (single and two-dose series) of the vaccine, an increase from prior rates.
  • California – The California Department of Public Health launched a new advertising campaign called “Tell Your Story” in response to the latest high school vaping data from its 2019-20 California Student Tobacco Survey. The campaign features real stories from young people and highlights their journey to quit vaping. It also educates youth and young adults about the harmful health effects of vapes and connects them with evidence-based resources to quit, especially as they’re exposed to increased social pressure in school environments.
  • Colorado – The state’s extension of its Section 1332 waiver for reinsurance was approved by the Departments of Health and Human Services and Treasury for an additional five years. Colorado is the first state to receive a reinsurance waiver extension.
  • Maryland – The governor announced “Don’t Wait, Vaccinate,” a new campaign to encourage parents and guardians to get their children caught up on routine vaccinations before the new school year begins. The state is working with pediatricians and other health care providers to prioritize well-child visits, and local health departments are standing up vaccination clinics to help safely welcome children back to school.
  • Missouri – Following the recent court ruling, the Missouri Department of Social Services (DSS) will begin allowing individuals to apply for the MO HealthNet program and has outlined the next steps to expand Medicaid. The state is currently working through administrative hurdles, including adequate appropriations, staffing capacity, and computer software changes to begin enrolling the expanded population. DSS will start making eligibility determinations once MO HealthNet’s software is updated. Until the necessary funds are appropriated, DSS will reassign existing employees from their current assignments and responsibilities to receive and evaluate MO HealthNet applications.
  • New Jersey – The state’s acting governor signed legislation creating a two-year “Restorative and Transformative Justice for Youths and Communities” pilot program in the Juvenile Justice Commission at the Office of the Attorney General. This legislation appropriates $4.2 million to assist with reintegrating young people released from juvenile facilities back into their communities, aiming to prevent repeated involvement with the youth justice system. This program will develop innovative restorative and transformative justice continuums of care in four target cities and will include two components: 1) community-based enhanced reentry wraparound services and 2) restorative justice hubs. Community-based enhanced reentry wraparound services will include various social support services, such as employment assistance and mentoring services. Restorative justice hubs will be physical spaces within the community where youth and families can heal, reconnect, build healthy relationships, and help resolve local conflicts through dialogue instead of punitive measures.
  • Ohio – The Ohio Department of Medicaid announced COVID-19 vaccination rates are on the rise among Ohioans who are supported by Medicaid. As of August 8, 804,286 Ohioans with Medicaid have been fully vaccinated or have had their first shot, with 37,213 Medicaid members initiating vaccination in the last two weeks alone.
  • Oregon – The Department of Consumer and Business Services announced that nearly 20,000 Oregonians have enrolled in health coverage through the Oregon Health Insurance Marketplace since the COVID-19 special enrollment period started April 1, 2021. Additionally, more than 78 percent of Oregonians have been determined to be eligible for financial help through the Marketplace.
  • Pennsylvania – The governor commemorated the two-year anniversary of Pennie, the state-based health exchange. More than 335,000 consumers have enrolled for coverage through Pennie and, due to the American Rescue Plan, the average premiums after subsidies have dropped by half since the beginning of the year.
  • Wisconsin – A report published by the Wisconsin Department of Health Services (DHS) shows the state’s opioid epidemic worsened during the COVID-19 pandemic. In response, DHS unveiled new strategies to prevent and reduce further harm.
  • Ohio, Utah, and South Carolina – CMS sent letters to these states revoking their respective community engagement requirements due to risk of “coverage losses and harm to beneficiaries” as a result of the COVID-19 pandemic.


Innovation At The Centers For Medicare And Medicaid Services: A Vision For The Next 10 Years

A new Health Affairs blog post written by CMS Administrator Chiquita Brooks La-Sure and other CMS leaders lays out a path for the next ten years of value-based care within the Center for Medicare and Medicaid Innovation. The team of leaders undertook a review of the last ten years of Innovation Center’s work and concluded the need for a shared vision of the health system that the agency is collectively striving toward; they explicitly acknowledge health equity as a central goal for this vision. This focus aligns with President Biden’s executive order charging each agency within the administration to advance racial equity and justice for underserved communities. The leaders also received feedback from stakeholders on what the vision for the ideal health system could look like and the roles that CMS and the Innovation Center should play. The result of this combined public-private dialogue is a strategy refresh that will drive the country’s delivery system toward meaningful transformation. It includes an unwavering focus on equity, paying for health care based on value instead of the volume of services provided, and delivering person-centered care that meets people where they are.


Most Adults Who Feel Treated or Judged Unfairly by Health Care Providers Report Adverse Consequences

Black and Hispanic adults report experiencing discrimination when seeking health care at higher rates than white adults, which raises the question: How might these reported experiences adversely affect health care? The Urban Institute published a fact sheet on its December 2020 Well-Being and Basic Needs Survey, which asked respondents about the consequences of and actions they took in response to being treated or judged unfairly because of their race or ethnicity at a doctor’s office, clinic, or hospital in the past 12 months. Among the 3.2 percent of nonelderly adults who reported feeling treated or judged unfairly in these settings, more than three-quarters (75.9 percent) reported such treatment or judgment disrupted their receipt of health care. This includes 39.0 percent who delayed care, 34.5 percent who looked for a new health care provider, and 30.7 percent who did not get needed care. These new data highlight the need for greater attention to policies and practices that can improve health care quality and interactions with health care providers and staff for all patients, particularly for Black patients, 1 in 13 of whom reported these experiences on the Well-Being and Basic Needs Survey. This fact sheet is part of a body of work exploring perceptions of discriminatory experiences in health care and other settings. See this related publication for more information.  


Latest Enrollment Data During the Special Enrollment Period    

New data released by CMS shows more than 2.5 million people enrolled in health coverage on and state Marketplaces during the Biden-Harris Administration’s 2021 Special Enrollment Period (SEP), which will close on August 15. Additional data released by CMS shows that a record high of nearly 81.7 million people are now receiving coverage through Medicaid and the Children’s Health Insurance Program (CHIP) as of March 2021. The SEP report also shows the impact of additional affordability subsidies provided by the American Rescue Plan (ARP). For example, data shows that families are seeing average savings of $40 per person per month on premiums due to the ARP’s premium credits, and more than a third of customers have found coverage for $10 or less per month. The report also shows that the ARP is also helping lower out-of-pocket costs for new customers enrolling in coverage since April 1, with the median plan deductible falling by nearly 90 percent, from $450 to $50. Additionally, consumers who received or are approved to receive unemployment compensation for any week beginning in 2021 may be able to find even lower-cost plans and save extra money on out-of-pocket expenses through due to the ARP’s enhanced tax credits. In the final week of July, experienced a 64 percent week over week increase in people signing up for coverage, the second-highest week of enrollment since February 15.