August 23 Update

In This Week’s Update:

  • HHS Plan for COVID-19 Boosters 
  • State updates: CO, DE, FL, IL, IN, MA, MD, MI, MN, NM, NY, NC, TN, WI & WY
  • COVID-19 and Delays in Seeking Health Care for Children   
  • How Insurers Can Advance Health Equity
  • Transforming Child Care Through Anti-Racism



HHS Plan for COVID-19 Boosters 

The U.S. Department of Health and Human Services announced a plan for administering COVID-19 booster shots this fall. The plan is contingent on final Food and Drug Administration evaluation and recommendations from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. Under the plan, a booster would be administered eight months after an individual’s second dose, beginning the week of September 20—at which point those individuals who were fully vaccinated earliest in the vaccination rollout will be eligible, including many health care providers, nursing home residents, and other seniors. 


Also, CMS announced it is developing, in collaboration with the CDC, an emergency regulation requiring staff vaccinations within the nation’s more than 15,000 Medicare and Medicaid-participating nursing homes. 


State Updates


  • Colorado
    • The Department of Health Care Policy & Financing (HCPF) released the Colorado Hospital Cost, Price and Profit Review that provides summary insights and identifies the urban hospitals whose prices exceed those of their national peers. Using the publicly available Medicare Cost Reports submitted by hospitals with more than 25 beds, Colorado hospitals rank first in total profits nationally, sixth highest for price per patient, and ninth highest in costs per patient.
    • The Colorado Department of Corrections, the Colorado Department of  Human Services and the Colorado Department of Public Health and Environment, announced that agency staff members and other state employees that interact with vulnerable populations and populations living in congregate living settings will be required to  be vaccinated against COVID-19.
  • Delaware – Governor John Carney signed House Bill 100, which expands mental health services in Delaware elementary schools by supporting schools hiring more full-time school counselors, school social workers, or licensed clinical social workers to provide direct care for elementary school students.
  • Florida – The Agency for Health Care Administration is submitting a request to renew Florida’s Long Term Care waiver, which operates under the authority of Sections 1915(b) and (c) of the Social Security Act, to CMS. The 30-day public notice and public comment period is from August 18, 2021 through September 16, 2021.
  • Illinois – Governor Pritzker signed House Bill 709 which expands protections for immigrant and refugee communities. Under the bill, the Department of Human Services, in consultation with the Department on Aging, the Department of Children and Family Services, the Department of Employment Security, and the Department of Public Health, will conduct a public information campaign to educate immigrants, refugees, asylum seekers, and other noncitizens residing in Illinois of their rights under the U.S. Constitution and Illinois laws that apply regardless of immigration status.
  • Indiana – Governor Eric J. Holcomb signed an executive order establishing a 15-member commission to examine Indiana’s public health system and make recommendations to improve its structure, funding and operations. The Governor’s Public Health Commission will be co-chaired by former state Senator Luke Kenley and Dr. Judy Monroe, who served as Indiana’s state health commissioner from 2005 to 2010 and now serves as president and chief executive officer of the CDC Foundation. State Health Commissioner Kris Box, M.D., FACOG, will serve as the commission’s secretary.
  • Maryland – Governor Larry Hogan announced new vaccination protocols for all nursing home and hospital staff. Effective August 18, all employees of the state’s 227 nursing homes and all employees of Maryland hospitals will be required to show proof of vaccination, or adhere to ongoing COVID-19 screening and testing.
  • Massachusetts – The Massachusetts Executive Office of Health and Human Services (EOHHS) announced its intent to submit a request to CMS to extend the MassHealth Section 1115 Demonstration waiver. The waiver extension will look to increase expectations for how accountable care organizations can improve care, expand access to primary and behavioral health outside of the fee-for-service delivery system, advance health equity with a focus on addressing health-related social needs, support funding for safety net providers, and maintain coverage through updated eligibility processes.
  • Michigan – To increase access to the COVID-19 vaccine, the Michigan Department of the Health and Human Services is partnering with 22 neighborhood testing sites across the state to offer COVID-19 vaccines in addition to testing. The testing sites were the result of Lieutenant Governor Garlin Gilchrist’s COVID-19 Racial Disparities Task Force. MDHHS is partnering with the neighborhood sites to make it easy and convenient for residents to get both vaccinated and tested.
  • New Mexico – Governor Michelle Lujan Grisham signed an executive order directing executive state departments to begin collecting voluntary self-identification information pertaining to sexual orientation and gender identity. The order will enhance the capacity of state agencies to address health disparities and identify and remove barriers to effective care for non-conforming and traditionally undeserved individuals, as well as enhance services and outreach.
  • New York – The New York State Department of Health released data from a study of vaccine effectiveness. The study, which was published by the Centers for Disease Control and Prevention (CDC), found that unvaccinated New Yorkers were eleven times more likely to be hospitalized and eight times more likely to be diagnosed with COVID-19 than those who were fully vaccinated.
  • North Carolina – The Department of Health and Human Services announced that North Carolina providers have administered more than 10 million doses of COVID-19 vaccine, with vaccinations trending upward as the highly contagious Delta variant of the virus spreads through the state. During the first week of August, overall doses administered for COVID-19 vaccines were up more than 16 percent and first doses increased more than 30 percent compared to two weeks prior.
  • Tennessee – The Tennessee Department of Mental Health and Substance Abuse Services is expanding OnTrack TN, the state’s First Episode Psychosis Initiative, to three new counties. Funding for the expansion is through federal COVID-19 pandemic response grants. OnTrack TN works with youth and young adults ages 15 to 30 who have experienced a first episode of psychosis. This comprehensive intervention model uses a team of mental health professionals and support services, focusing on helping people work toward recovery and meeting their personal goals. 
  • Wisconsin
    • The Wisconsin Department of Health Services (DHS) launched a new data webpage, COVID-19 Illness After Vaccination, which includes a visualization showing the rate of COVID-19 cases, hospitalizations, and deaths per 100,000 among individuals who are fully vaccinated versus individuals who are not fully vaccinated. These data are also presented by month, beginning in February 2021.
    • DHS announced it is collaborating with three health care providers in different areas of the state to pilot a “hub and spoke” program to treat eligible BadgerCare Plus and Medicaid members who have substance use disorders and at least one other health condition. The pilot sites will use the “hub and spoke” model to provide integrated services that give eligible members rapid access to comprehensive addiction and mental health treatment, primary care, and other needed supports to assist their recovery.
  • Wyoming – The Wyoming Department of Health (WDH) announced it is moving forward with proposals to update the state’s behavioral health system. A bill passed during the most recent session of the Wyoming Legislature requires WDH to consult with affected stakeholders as it develops a redesign plan for Wyoming’s behavioral health system.


Worries about the Coronavirus Caused Nearly 1 in 10 Parents to Delay or Forgo Needed Health Care for Their Children

According to a new fact sheet by the Urban Institute, though children face a lower risk of getting severely ill from COVID-19 than adults, many families have avoided getting health care for their children during the pandemic for fear that their children could be exposed to the coronavirus. Data from the Urban Institute’s April 2021 Health Reform Monitoring Survey indicate parents’ worries about exposure to the virus continued affecting children’s receipt of care in spring 2021, even as COVID-19 case rates fell from their peak. In April 2021, nearly 1 in 5 parents (19.4 percent) reported they had delayed or forgone care for their children under age 19 in the past 12 months over concerns about exposure to the virus; nearly 1 in 10 (9.2 percent) delayed or did not get care for their children in the past 30 days for this reason. Parents with family incomes below 250 percent of the federal poverty level were more likely than those with higher incomes to report delaying or forgoing care for their children in the past 30 days. Not receiving needed care can adversely affect children’s health in the short and long terms.


How Insurers Can Advance Health Equity Under the Affordable Care Act

The ACA includes many requirements that advance health equity in the commercial coverage market and has contributed to significant progress in narrowing racial and ethnic health disparities. While health insurers alone cannot close disparities, insurance stakeholders play a key role and have committed to doing more to address systemic racism. A new blog post by the Commonwealth Fund highlights several ACA requirements that have not been fully utilized by insurers—resulting in gaps that exacerbate disparities. Strategies include addressing provider contracting and network and benefit designs, as well as fully complying with nondiscrimination standards. Insurers and regulators can do more to turn commitment into action.


Transforming Child Health Care Through Anti-Racist, Family-Driven Approaches

The child health care field is embracing a shift from the traditional child-focused model of well and sick visits to a more upstream preventive, holistic, and anti-racist focus on children, their families, and the systems and communities they interact with regularly. Despite a growing desire to improve care delivery, many practices face barriers, such as time and funding resources, which prevent the scale and spread of practice transformation. The Center for Health Care Strategies, with support from the Robert Wood Johnson Foundation, is hosting a webinar on August 25 that will explore the need to transform child health care from three unique perspectives — a pediatrician, a family advocate, and a children’s health clinic director. The featured speakers serve as advisors for CHCS’ Accelerating Child Health Transformation initiative, which seeks to accelerate the adoption of key strategies necessary to advance anti-racist and family-centered pediatric practice. They will highlight key strategies for child health care transformation: (1) adopting anti-racist practices and policies to advance health equity; (2) co-creating equitable partnerships with patients, families, and medical care teams; and (3) identifying family strengths and health-related social needs to promote resilience.