Dec. 16 Update

In This Week’s Update:

  • Supporting State Beneficiary Advisory Councils
  • New CMS Advisory Opinion: Imposing Work Requirements
  • Combating Climate Change’s Health Effects
  • Updates to CMS’ Health-Related Social Needs Framework
  • State updates: AR, CA, CO, KY, MI, NC, OR, WI & WV

 

Supporting State Beneficiary Advisory Councils
Last week, State Health and Value Strategies (SHVS) published a new toolkit to support states as they implement committees to engage people with lived experience of the Medicaid program. The Beneficiary Advisory Council State Toolkit: Establishing a Governance Process is designed to assist states as they develop a governance model for their Beneficiary Advisory Council (BAC), identify key steps and timelines for implementation and assign roles and responsibilities for state staff implementing the BAC.

New CMS Advisory Opinion: Imposing Work Requirements 
Also last week, the HHS Office of the General Counsel released an advisory opinion which concludes that CMS lacks the authority to approve section 1115 Medicaid demonstrations that impose work requirements as a condition on Medicaid eligibility. Under federal law, 1115 waivers are approvable only if they promote Medicaid objectives. Consistent with multiple prior court decisions, the advisory opinion identifies Medicaid’s “core objective” as providing health coverage. Work requirements conflict with that objective, the opinion concludes, because they “restrict access to medical assistance.” Updates follow.

 

Combating Climate Change’s Health Effects
With scientists warning that 2024 will likely beat 2023 as the hottest year on record, there is growing acknowledgment that climate change—and especially extreme heat—presents a top threat to global public health. Certain populations experience the effects of climate change more severely, including communities of color, and Medicaid has an important opportunity to meaningfully invest in communities by mitigating the health impacts of climate change and extreme heat. In a new Health Affairs Forefront article, Rebecca Lopez and Heather Howard highlight state efforts like those in Oregon, where Medicaid enrollees may qualify for climate-related supports such as air conditioners and air filters. Other states are taking action through interagency planning and occupational heat protections.

Updates to CMS’ Health-Related Social Needs Framework 
On December 10, 2024 CMS released an updated CMCS Informational Bulletin (CIB) that refines CMS’ descriptions of opportunities for states to cover clinically appropriate and evidence-based services and supports that address health-related social needs (HRSN) in Medicaid and the Children’s Health Insurance Program (CHIP). SHVS published an expert perspective summarizing the new CIB. The December 2024 bulletin supersedes earlier guidance and updates the framework, reflecting the expanded experience of CMS and the 10 states with approved section 1115 demonstrations for HRSN services (as of November 2024). The CIB reiterates Medicaid and CHIP’s existing mechanisms for addressing HRSN, which include state plan authorities, section 1915 home and community-based services authorities, managed care in lieu of services and settings, section 1115 demonstrations, and CHIP Health Service Initiatives.

State updates: AR, CA, CO, KY, MI, NC, OR, WI & WV

  • Arkansas – The Arkansas Department of Human Services announced that St. Bernards Medical Center will open the first Maternal Life360 HOME in Arkansas this month. Life360 HOMEs are an innovative program that support individuals with high-risk pregnancies through home-visiting services during pregnancy and for up to two years after birth. The intensive supports available through this program are aimed at improving health outcomes and HRSN like food security and housing, and as a result, the long-term health and wellbeing of birthing individuals and babies.
  • California – The California Department of Health Care Services announced the statewide launch of California’s Community Assistance, Recovery, and Empowerment (CARE) Act, a new pathway to safety and wellbeing for people with untreated or undertreated schizophrenia who are at risk of hospitalization, homelessness, and incarceration. CARE aims to help the system of care meet the needs of people who have fallen through the cracks with robust and comprehensive services, including behavioral health services, stabilization medications, and housing.
  • Colorado – Kevin Patterson, chief executive officer of Connect for Health Colorado, the state’s official health insurance Marketplace, released a statement confirming Deferred Action for Childhood Arrivals (DACA) recipients’ ability to enroll in a qualified health plan through the health insurance Marketplace. The statement is in response to a federal court’s December 9 decision which placed on hold DACA recipients’ ability to enroll in a QHP through the Marketplace in the 19 states involved in the lawsuit. The statement from Colorado confirms that Colorado is not affected by the decision.
  • Kentucky – CMS approved a five-year extension of Kentucky’s section 1115 demonstration, “TEAMKY.” This extension continues previously approved authorities and includes two amendments that allow Kentucky to provide (1) medically necessary short-term inpatient treatment services for Medicaid eligible adults with serious mental illness residing in settings that qualify as institutions for mental diseases, (2) episodic housing interventions under a (HRSN) initiative, and (3) recovery residence support services, which are non-clinical activities necessary to support enrollees recovering from substance-use disorder (SUD).
  • Michigan – The Michigan State Police and Michigan Department of Health and Human Services (MDHHS) are launching a Safety Net Partnership to aid Michigan residents who have immediate and urgent needs. The Partnership empowers troopers across the state to provide $25 pre-paid Visa and Mastercard gift cards to individuals they encounter while on patrol when there is a clear and apparent need. Troopers also have access to a supply of items that includes child car seats, portable cribs, diapers, formula, adult briefs, and cold weather outerwear, along with information to connect those in need to more permanent assistance programs through MDHHS.
  • North Carolina
    • CMS approved a five-year extension of North Carolina’s section 1115 demonstration, “North Carolina Medicaid Reform Demonstration.” This extension continues previously approved authorities and also provides new authority for continuous eligibility for children, an enhanced home and community-based benefit, health information technology incentive-based programs, workforce initiatives, coverage for foster care youth who turned 18 years old from other states, designated state health programs, and the reentry demonstration initiative.
    • The North Carolina Department of Health and Human Services released a toolkit aimed at assisting other states seeking to tackle the burden of medical debt. The toolkit is informed by North Carolina’s Comprehensive Medical Debt Relief and Reform Incentive Program. As a reminder, SHVS has an expert perspective mapping state efforts to cancel medical debt and prohibit medical debt reporting.
  • Oregon
    • Following a statewide listening tour, Oregon Health Authority (OHA) announced it will roll out a series of locally requested policy, regulatory, and administrative changes. These changes seek to boost transparency, accountability, and support for communities. A new report describes 16 efforts state officials are pursuing to respond to the challenges they heard, including reducing administrative burdens on mental health and substance-use programs and supporting traditional health workers to bill Medicaid for services.
    • OHA launched Oregon Health Forward, an alliance of three major efforts that will advance OHA’s goal to eliminate health inequities by 2030. These initiatives include: OHA’s Strategic Plan, a statewide Call to Action to advance health for all, and an organized effort to strengthen transparency, accountability, and belonging within OHA.
  • West Virginia – CMS approved a five-year extension of West Virginia’s section 1115 demonstration, “Evolving West Virginia Medicaid’s Behavioral Health Continuum of Care.” The extension continues previously approved authorities and provides new authorities, such as certain housing supports under the HRSN framework, post-overdose response teams called Quick Response Teams, recovery-related support services to help individuals with SUD manage their symptoms that interfere with employment, and the reentry demonstration initiative.
  • Wisconsin – Starting February 1, 2025, the Wisconsin Department of Health Services will launch a new initiative to provide housing support services to Wisconsin Medicaid members experiencing housing insecurity who are also affected by substance-use or mental health conditions. The services available include support with initial setup expenses, like security deposits, pest control, and utility activation.