August 24 Update

In This Week’s Update:

  • Risk Adjustment Based on Social Factors
  • Cost-sharing Reduction Payments and the ACA
  • COVID-19 State Updates: NC, OR, PA, WA & WI
  • Other State Updates: MN, NE, NH, OR & UT
  • Federal Executive Orders on Economic Relief
  • The “Bermuda Triangle” of COVID-19 Testing
  • Racial Disparities in COVID-19


Risk Adjustment Based on Social Factors

Last week, State Health and Value Strategies (SHVS) published a new issue brief, Risk Adjustment Based on Social Factors: State Approaches to Filling Data Gaps. The brief examines examples from two state Medicaid programs and one nonprofit quality measurement and reporting organization of the data sources they use to identify patients’ social risk factors when risk-adjusting payments or quality measure performance. The brief highlights both their approaches to risk adjustment based on social risk factors and how each entity filled their gaps in data on social risk factors.


Cost-sharing Reduction Payments and the ACA

Also last week, SHVS published a new expert perspective highlighting implications for state insurance regulators of the recent federal Court of Appeals ruling on cost-sharing reduction reimbursement mandated under the Affordable Care Act.


COVID-19 State Updates: NC, OR, PA, WA & WI

  • North Carolina – The North Carolina Department of Health and Human Services (NCDHHS) announced its selection of an additional vendor to continue to address surging COVID-19 testing capacity in the state. The selected vendor will provide turnkey testing sites and will leverage in-house laboratory capacity to provide timely testing results. As with all NCDHHS-supported testing sites, there will be no copays or cost-sharing for anyone seeking testing, including North Carolinians who are uninsured.
  • Oregon – The Oregon Health Authority is soliciting grant applications from not-for-profit organizations statewide, Oregon’s nine federally recognized Tribes, and the Urban Indian Health Program. The grants will be funded with $45 million in federal CARES Act coronavirus relief funds and are intended to address the disproportionate effect the COVID-19 pandemic has had on Oregon’s tribal communities and communities of color.
  • Pennsylvania – The Secretary of Health issued an order requiring nursing homes, personal care homes, assisted living residences, and private intermediate care facilities to develop, implement, and adhere to policies and procedures to procure and distribute personal protective equipment to staff providing direct care to COVID-19-positive residents by Thursday, August 27.
  • Washington – Governor Jay Inslee issued an update to Proclamation 20-57, “Concerning the Health of Agricultural Workers,” to require agricultural employers to test their workforce broadly when health officials identify an outbreak that passes certain thresholds. SHVS has updated its expert perspective Essential Workers in Challenging Environments: How States Are Working to Protect Farmworkers to reflect this latest development.
  • Wisconsin – To support residents in making safer choices, the Department of Health Services has launched a new Decision Tool for Individuals and Families. The Decision Tool aims to help people assess risk and determine the best course of action to keep themselves, their families, and their communities safe, and is designed to give Wisconsinites necessary information to make choices that will help stop the spread.


Other State Updates: MN, NE, NH, OR & UT

  • Minnesota – MNsure, the state’s official health insurance marketplace, announced that its open enrollment will run from Sunday, November 1 through Tuesday, December 22. Minnesota’s enrollment period will be seven days longer than the federal open enrollment period, giving Minnesotans an extra week to enroll in health care coverage.
  • Nebraska – The Nebraska Department of Health and Human Services Division of Behavioral Health (DBH) is seeking input from key stakeholders and the public to assist with the development of a strategic plan. The feedback will be incorporated into a systemic needs assessment that will lead to the development of a new three-year strategic plan for DBH beginning in 2021.  
  • New Hampshire – The New Hampshire Insurance Department announced that the proposed rate for the second-lowest cost silver plan has decreased 21.2 percent compared to 2020. The Insurance Department is attributing the premium rate decreases for plan year 2021 in part to overall market trends, and in part to the approval of the Department’s Section 1332 Waiver. SHVS continues to track Section 1332 waivers.
  • Oregon – The Vaping Public Health Work Group issued recommendations to address the epidemic of vaping-related illness and youth vaping in Oregon. The work group’s membership includes doctors and experts in pulmonology, pediatrics, and public health, as well as state legislators and state agency representatives.
  • Utah – The state submitted an application to amend its demonstration to pay for services to Medicaid beneficiaries who receive inpatient psychiatric treatment or residential mental health treatment in an Institution for Mental Diseases with more than 16 beds. The federal public comment period will be open through September 17, 2020.


New Federal Executive Orders on Economic Relief

On Saturday, August 8, President Trump issued four executive orders and memoranda aimed at providing economic relief, two of which have notable implications for state officials:

  • The first is a memorandum directing the Federal Emergency Management Agency to use Disaster Relief Fund dollars to continue a portion of the enhanced unemployment benefits authorized by the CARES Act that expired on July 31. This approach would require states to cover 25 percent of the cost; states did not have to assume any portion of the enhanced benefit funded by the CARES Act. While the memorandum asserts that states should be able to do so without difficulty, governors—faced with significant budget and revenue shortfalls—have called on Congress to provide them with the flexibility to use the $150 billion to make up for these shortfalls, suggesting that at least some states have not yet allocated their funds pending congressional action, and have asked for $500 billion in additional funding.
  • The second is a memorandum directing the Secretary of the Treasury to defer (not forgive) the withholding, deposit, and payment of certain Social Security taxes for wages between September 1 and December 31. The taxes implicated by the memorandum do not appear to include the Medicare tax (the deferral order seemingly only applies to the Old-Age, Survivors, and Disability Insurance tax), but policy experts speculate that once the President has altered one tax, it is a very small step to also alter the Medicare tax. Even without changes to the tax structure, the future of the Medicare program will be an important policy issue in the months ahead; the 2020 Medicare Trustees Report projects that the Hospital Insurance (Part A) Trust Fund will become insolvent in 2026.


Marketplace Pulse: The Bermuda Triangle of COVID-19 Testing

A new blog post by Kathy Hempstead at the Robert Wood Johnson Foundation explores the current landscape of COVID-19 testing in the United States and highlights how widespread testing has fallen into the “Bermuda Triangle” in the absence of a national financing or distribution strategy. The post also features a variety of funding strategies to purchase and universally disseminate testing at the population level.


Racial Disparities in COVID-19: Key Findings from Available Data and Analysis

Over the course of the COVID-19 pandemic, there has been a growing focus on the disproportionate burden on people of color, particularly as availability of data to understand racial disparities has increased. A new brief by the Kaiser Family Foundation summarizes key findings from data and analyses examining COVID-19 related cases, deaths, hospitalizations, and testing by race and ethnicity as of early August 2020 to provide increased insight into these disparities. Overall, the findings highlight the importance of considering how COVID-19 relief and response efforts will address inequities, including in decisions related to distribution of treatments and vaccines once they become available. Prioritizing equity will be key for addressing the current gaps in COVID-19 and health care more broadly and preventing widening of disparities in the future.