August 19 Update

In This Week’s Update:

  • HHS Announces Lowers Prices for 10 Medicare Drugs
  • Helping States Understand the Impact of Medicaid Policy Changes
  • Upcoming SHVS Webinar
  • State Notice of Funding Opportunity for the Cell and Gene Therapy Access Model
  • The Impact of Enhanced Premium Tax Credits by Race and Ethnicity
  • CDC Data Shows Need for Safer and More Supportive Schools
  • State updates: AZ, DE, GA, LA, NC, NV, NY, TX, WI & WY

 

Drug Price Negotiations
Last week, HHS announced that it has reached agreement for new, lower prices for 10 drugs covered under Medicare Part D. Under the Inflation Reduction Act, CMS was granted authority to negotiate with drug companies to lower the prices for certain high-cost prescription drugs. Roughly nine million people enrolled in Medicare use at least one of the 10 drugs selected for negotiation. The new prices will go into effect for people with Medicare Part D prescription drug coverage beginning January 1, 2026.

 

 

Upcoming SHVS Webinar – New CMS Guidance: CAA Requirements for the Provision of Medicaid and CHIP Services to Incarcerated Youth
Monday, August 19, 2024, 3:00 to 4:00 p.m. ET
SHVS will host a webinar on CMS’ recently released State Health Official (SHO) letter detailing implementation guidance on the Consolidated Appropriations Act, 2023 (CAA) requirements that states provide specific services for children and youth eligible for Medicaid and the Children’s Health Insurance Program and involved in the juvenile justice system. During the webinar, experts from Manatt Health will provide a detailed overview of CMS’ guidance in the SHO letter and discuss key operational and policy considerations for states.
Registration: https://princeton.zoom.us/webinar/register/WN_uBPRB_RzRiiQ9bYF9Hq2nA

 

State Notice of Funding Opportunity for the Cell and Gene Therapy Access Model
CMS released the State Notice of Funding Opportunity (NOFO) for the Cell and Gene Therapy (CGT) Access Model, which will initially focus on gene therapies for sickle cell disease. The NOFO invites states to apply for Cooperative Agreement funding to support participation in the CGT Access Model, which is open to all states, the District of Columbia, and Puerto Rico. To be considered for Cooperative Agreement funding, applicants must apply to participate in the model through the State Request for Applications and apply for funding through the NOFO. Both applications are due by February 28, 2025. The anticipated award date is July 1, 2025. More information about the NOFO and model can be found on the CGT Access Model webpage and in the Frequently Asked Questions.

 

The Impact of Enhanced Premium Tax Credits by Race and Ethnicity
new brief from the Urban Institute estimates coverage of the non-elderly population in 2025, with and without the enhanced premium tax credits (PTC) set to expire under the Inflation Reduction Act, by race and ethnicity to gauge the impact of the more generous credits. Findings show that under enhanced PTCs, Black and Hispanic people will be enrolled in the nongroup market at higher rates than White people and account for a larger share of nongroup enrollment than White people. Black and Hispanic people will see greater reductions in the percent uninsured, particularly in non-expansion states. Gains for Black and Hispanic people will likely be reversed after 2025 if Congress does not extend the enhanced PTCs.

 

CDC Data Shows Need for Safer and More Supportive Schools
New CDC data highlights improvements in mental health among some U.S. teens, including decreases in the percentage of students feeling persistently sad or hopeless. However, the report also highlights concerning increases in the percentage of teens reporting experiences of school-based violence and absenteeism due to safety concerns. The report provides a detailed analysis of the health behaviors and experiences of high school students across the nation, comparing 2021 and 2023 Youth Risk Behavior Survey data. The report also provides 10-year data trends by sex, race and ethnicity, and sexual and gender identity.

 

State updates: AZ, DE, GA, LA, NC, NV, NY, TX, WI & WY

  • Arizona
    • The Arizona Health Care Cost Containment System (AHCCCS) launched an interactive dashboard to share monthly member eligibility data. The Eligibility Dashboard reports on Arizona’s Medicaid and CHIP application activity and contains detailed information including demographics and application types (initial applications, changes, and renewals).
    • AHCCCS distributed $2.5 million to four community health centers for on-call maternity care services in rural communities which often have little to no maternity care available. The initiative is funded by Senate Bill 1720 which appropriates $7.5 million through June 30, 2026.
  • Delaware – The U.S. Departments of Health and Human Services and Treasury approved Delaware’s application to extend its State Innovation Waiver known as the Delaware Health Insurance Individual Market Stabilization Reinsurance Program for an additional five years through 2029. Actuarial analysis submitted as part of the waiver extension application projected that in plan year 2025, statewide premiums will be on average 15.3% lower for individual health insurance coverage when compared to the without-waiver baseline.
  • Georgia – CMS approved Georgia’s transition to a State-Based Marketplace, known as Georgia Access, which will go live as the official health insurance Marketplace on November 1, 2024.
  • Louisiana – The Louisiana Department of Health is seeking public comment on its Reentry 1115 Waiver application to improve access to pre- and post-release services for Medicaid-eligible individuals who are incarcerated.
  • Nevada – CMS approved a state plan amendment (SPA) for mobile crisis services in Nevada. This is the 19th mobile crisis SPA approved. As a reminder, SHVS published an expert perspective on the enhanced payment available through the American Rescue Plan Act for community-based mobile crisis services.
  • North Carolina
    • Governor Roy Cooper and Health and Human Services Secretary Kody H. Kinsley announced that all 99 eligible hospitals in North Carolina have signed on to the state’s medical debt relief incentive program. Hospitals will now implement programs that will relieve past medical debt and put in place forward-looking policies that mitigate the accumulation of debt. It is estimated that nearly 2 million low- and middle-income North Carolinians will have more than a decade of existing medical debt relieved. For more information on state efforts to cancel medical debt, see a recent Health Affairs Forefront article and the SHVS expert perspective which tracks state cancellation efforts and prohibitions on medical debt reporting.
    • The North Carolina Department of Health and Human Services announced Blue Cross Blue Shield NC was selected to operate the Children and Families Specialty Plan (CFSP), a single, statewide managed care plan that will provide Medicaid-enrolled children, youth, and their families in the child welfare system with integrated and coordinated healthcare. The CFSP is designed to support this population by providing healthcare and mental healthcare coverage that follows the person and works across multiple systems.
  • New York – As part of the state’s amended section 1115 demonstration waiver, three Workforce Investment Organizations will receive awards totaling up to $646 million over the next three years to implement the Career Pathways Training Program, which will recruit and train new health, mental health, and social care workers across New York.
  • Texas – Governor Greg Abbott announced the Texas Health and Human Services Commission (HHSC) is awarding $3.3 million in grant funding to improve maternal care in rural hospitals currently not providing labor and delivery services. The HHSC Rural Hospital Maternal Care Operations Grant provides qualifying hospitals a one-time payment of $35,000 to purchase neonatal equipment, supplies, and training for emergency labor and delivery services.
  • Wisconsin – The Wisconsin Department of Health Services announced the Wisconsin Tobacco Quit Line has expanded its text-based Live Vape Free program to include young adults ages 18 to 26. The program supports young Wisconsinites on the path to ending their use of nicotine and vape products and will provide people over age 18 with two weeks of free nicotine replacement therapy if medically eligible.
  • Wyoming – The Wyoming Department of Health is seeking feedback on priorities for its Maternal and Child Health (MCH) Unit. Community representatives and family members from across the state are invited to participate in focus groups and respond to a survey, which will help determine the final priorities included in Wyoming’s MCH State Action Plan.