August 7 Update

In Last Week’s Update:

  • CMS Unwinding Data Release
  • Misleading Marketing as Millions Search for Coverage
  • Interventions to Avoid Choice Errors in the ACA Marketplace
  • The Intersection of Housing and Health
  • State updates: AK, AL, CA, CT, DE, MA, MI, MN, MS, NM, NY, PA & WI

CMS Unwinding Data Release

This week, State Health and Value Strategies published an expert perspective that analyzes the first release of state-reported unwinding data from CMS. The expert perspective summarizes the data release, provides a timeline for CMS’ continued release of unwinding data, and highlights the importance of context and the imperative for stakeholders to tread carefully when making interpretations about the data. As a reminder, SHVS has created a one-stop resource page to support states as they plan for and implement unwinding. 


Misleading Marketing as Millions Search for Coverage

secret shopper study conducted by researchers at Georgetown University suggests that former Medicaid enrollees searching for new health plans on the private market are facing aggressive and misleading marketing of limited benefit products that fail to protect consumers from the steep cost of healthcare. The study conducted in June 2023 indicates that online searches for health insurance led to websites and solicitations from sales representatives promoting limited benefit products, rather than the Affordable Care Act (ACA) Marketplace. Using profiles for two different people losing Medicaid who would be eligible for a Marketplace plan with a $0 premium and no deductible, the study found that not one of the 20 sales representatives directed consumers to the $0 premium/$0 deductible plan; more than half of the sales representatives tried to sell limited benefit products; representatives frequently made false statements that concealed the restrictions in limited benefit products; and many representatives used aggressive sales tactics, such as suggesting plans that would be unavailable if the consumers did not commit to a plan over the phone.


Interventions to Avoid Choice Errors in the ACA Marketplace

During the 2022 open enrollment period, Covered California, the state’s official health insurance Marketplace, compared two interventions designed to reduce choice errors among low-income households enrolled in bronze plans that were eligible for zero-premium cost-sharing reduction (CSR) silver plans with more generous benefits. The study, published in Health Affairs, included a randomized controlled trial intervention that used letter and email reminders to encourage consumers to switch plans, and a quasi-experimental crosswalk intervention that automatically enrolled eligible households from bronze plans into zero-premium CSR silver plans with the same insurers and provider networks. The nudge intervention led to a 26% increase in CSR silver plan take-up relative to the control group, but nearly 90% of households remained in non-silver plans. The automatic crosswalk intervention resulted in an 822% increase in CSR silver plan take-up compared to the control group, with more than 90% of households enrolled in CSR silver plans. These findings can inform health policy debates on the relative effectiveness of approaches to reduce choice errors among low-income households in the Marketplace.


The Intersection of Housing and Health

In a new episode from the Medicaid Leadership Exchange, public officials from Wisconsin and Arizona share how their state’s Medicaid programs are partnering with the housing sector to tackle the challenges faced by people experiencing homelessness. The conversation explores how these two states are using innovative program and policy mechanisms to develop solutions like rental assistance, housing consultation, and other support services that address the housing needs of Medicaid members, and ultimately their health. This episode of the Medicaid Leadership Exchange features Amy Pulda, Homelessness Services Manager, Wisconsin Department of Health Services; Elizabeth Da Costa, Director of Housing, Arizona Medicaid Agency; and Mark Larson, Senior Vice President, Leadership and Capacity Building, Center for Health Care Strategies. It is hosted by Gretchen Hammer, Principal, Public Leadership Group and Consultant, National Association of Medicaid Directors.


State updates: AK, AL, CA, CT, DE, MA, MI, MN, MS, NM, NY, PA & WI

  • Alaska – Governor Mike Dunleavy signed legislation which allows individuals to be licensed to operate an adult care home and receive payment under Medicaid for providing assisted living services for elderly adults and adult foster children in a home-like environment. Alaskans struggling with complex medical needs will be able to remain in their home cared for by family members who are trained and paid to provide care.
  • Alabama – The state submitted a request for a new five-year Medicaid section 1115(a) demonstration entitled “Alabama Substance Use Disorder Demonstration” which proposes to cover treatment and recovery services provided to Medicaid-enrolled individuals in institutions for mental diseases for opioid-use disorder and substance-use disorder (SUD) services. As part of this demonstration, Alabama is also proposing to extend limited Medicaid coverage to qualified low-income individuals without health insurance screened as meeting the criteria for SUD in specific areas of the state.
  • California – CMS approved a state plan amendment to eliminate asset tests for Medicaid eligibility in California, effective January 1, 2024. 
  • Connecticut – Governor Ned Lamont and Connecticut Department of Children and Families (DCF) Commissioner Vannessa Dorantes celebrated the opening of a new children’s urgent crisis center in the state, one of four centers opening statewide. Licensed by DCF, the centers function as walk-in clinics, providing youths and their families with immediate access to resources while they are experiencing a behavioral health crisis, to divert youths and their families from visiting emergency rooms to address behavioral health crises.
  • Delaware – The Delaware Division of Public Health announced updates to the “Mental Health & Substance Use” section of the My Healthy Community Dashboard. The updates present trends in prescription drug dispensing in Delaware and include a color-coded matrix to identify communities that may be at higher risk of opioid-use disorder. The rate of prescriptions for high dose and extended-release opioids are indicators of a high need for treatment. 
  • Massachusetts – The Healey-Driscoll Administration announced it is seeking public comment on an amendment it will submit to CMS for proposed changes to MassHealth’s section 1115 demonstration. The proposed amendment would expand continuous eligibility to all adult members over the age of 19 and chronically homeless members aged 65 and older for 12 and 24 months respectively. It would also include 90 days of pre-release MassHealth coverage for justice-involved individuals and state subsidies for an increased number of individuals who purchase insurance through the Health Connector. As a reminder, SHVS published an expert perpsective on the guidance issued by CMS on the opportunity to use section 1115 demonstrations to support reentry for justice-involved populations.
  • Michigan – Michigan Department of Health and Human Services Director Elizabeth Hertel joined other health leaders to discuss with stakeholders how the state is increasing access to behavioral health services. The roundtable discussion focused on the nearly $364 million in investments for behavioral health services included in Governor Gretchen Whitmer’s fiscal year 24 budget.
  • Minnesota – MNsure, the state’s official health insurance Marketplace, announced that help is available for undocumented Minnesotans struggling to pay for insulin. Minnesotans can now use an Individual Taxpayer Identification Number (ITIN) as an accepted form of identification for the Minnesota Insulin Safety Net Program. This change provides a pathway to access the program for those who do not have a valid Minnesota identification card, driver’s license or permit, or tribal-issued identification. For minors under the age of 18 who need help affording insulin, a parent or legal guardian can use an ITIN as an accepted form of identification.
  • Mississippi – Mississippi Division of Medicaid (DOM) announced CMS approved a state plan amendment that will allow DOM to continue the 15% increase for Prescribed Pediatric Extended Care facilities that were made effective October 1, 2022, beyond the end of the federal public health emergency.
  • New Mexico – Governor Michelle Lujan Grisham announced that providers may apply for the $80 million from the Rural Health Care Delivery Fund created earlier this year as part of the governor’s commitment to expanding healthcare in New Mexico. The funding initiative will assist in defraying operating losses for new and expanded health services across rural parts of the state. Applications are open to qualified Medicaid providers who offer care including primary care, behavioral health and maternal and child health services.
  • New York – The New York State Department of Health announced that the state Medicaid program will continue to provide comprehensive coverage of telehealth through December 31, 2024. More than 80% of New Yorkers surveyed reportedly used telehealth during the past two years and nearly half of telehealth users report using therapy to treat mental health.
  • Pennsylvania – Pennsylvania Insurance Commissioner Michael Humphreys announced the Pennsylvania Insurance Department is seeking public input as it considers updating the Commonwealth’s essential health benefits (EHB) benchmark plan. An EHB benchmark plan establishes the minimum essential health benefits that individual and small group health insurance plans must offer, pursuant to the Affordable Care Act.
  • Wisconsin – The Wisconsin Department of Health Services (DHS) announced a new phone line is now available statewide, UpliftWI, built by Mental Health America of Wisconsin under a grant from DHS for people experiencing mental health and substance-use concerns. Callers will speak to certified peer specialists who have navigated their own mental health and substance-use challenges, completed a training course and passed a state exam to support others.