Dec. 4 Update

In This Week’s Update:

  • Proposed Notice of Benefit and Payment Parameters
  • New Unwinding Data From CMS
  • CMS resource on Transitional Medical Assistance
  • 2023 Annual Medicaid MCO Survey
  • Improving Data Sharing in Medicaid & CHIP Programs
  • State updates: AL, AZ, CA, CO, LA, MA, MD, MI, NC, NH, NM, NV, NY, OR, TN & VA

Proposed Notice of Benefit and Payment Parameters

State Health and Value Strategies published a new expert perspective on the proposed 2025 Notice of Benefit and Payment Parameters, the annual regulation which governs core provisions of the Affordable Care Act. This expert perspective highlights the provisions of the proposed rule of interest to states, including standards for State-Based Marketplaces, proposals for updating essential health benefits, and initiatives to ease the eligibility and enrollment process for consumers.

New Unwinding Data From CMSAlso this week, CMS released new unwinding data including enrollment figures for Medicaid, the Children’s Health Insurance Program (CHIP), and Medicare; the August 2023 Medicaid and CHIP Enrollment Trends Snapshot report; and updated state-reported unwinding data. This latest data release provides enrollment figures through August 2023 when just under 90 million individuals were enrolled in Medicaid and CHIP coverage, as compared to 70.9 million individuals in February 2020 (the month prior to the start of continuous enrollment) and 93.9 million in March 2023 (the final month that the continuous coverage requirement was in effect). Updates follow.


CMS Resource on Transitional Medical AssistanceIn case you missed it, CMS released on Wednesday, November 22, a set of frequently asked questions regarding Transitional Medical Assistance (TMA). The new guidance focuses on TMA considerations for states as they “unwind” the federal Medicaid continuous coverage requirement, and discusses the intersection of TMA with continuous eligibility for children.

2023 Annual Medicaid MCO Survey 

The results of the 2023 Annual Medicaid Managed Care Organization Survey, conducted by the Institute for Medicaid Innovation, are now available. The 11 areas of the survey are showcased in 11 fact sheets that detail the latest trends and best practices among Medicaid health plans. These findings represent 31 of the 41 states that currently have Medicaid managed care and range in size from small health plans to health plans that cover millions of lives over several different states. The findings from the survey are intended to equip Medicaid stakeholders with the information needed to accurately articulate the national narrative about Medicaid managed care.

Improving Data Sharing in Medicaid and CHIP Programs

Although Supplemental Nutrition Assistance Programs (SNAP) and Medicaid programs share similar income-related eligibility requirements, these programs face challenges sharing data to streamline enrollment processes. On December 5, a webinar hosted by the Center for Health Care Strategies (CHCS) will explore successful practices for data coordination between SNAP and Medicaid agencies gleaned from a 50-state survey and three state case studies. A speaker from South Carolina Medicaid will share experiences streamlining enrollment and re-enrollment processes during the unwinding of continuous eligibility for Medicaid. This webinar is a product of Improving Data Coordination Between SNAP and Medicaid, a national initiative led by CHCS in partnership with Benefits Data Trust, with support from the Robert Wood Johnson Foundation.


State updates: AL, AZ, CA, CO, LA, MA, MD, MI, NC, NH, NM, NV, NY, OR, TN & VA 

  • Alabama – CMS approved a community-based mobile crisis state plan amendment that allows Alabama to create mobile crisis intervention teams to provide Medicaid crisis services. 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.
  • Arizona – The Arizona Health Care Cost Containment System submitted a request to CMS to increase the income eligibility limit for KidsCare (the Children’s Health Insurance Program in Arizona) to 225% of the federal poverty level. If approved by CMS, Arizona could enroll nearly 10,000 more children in KidsCare. The current income limit is capped at 200% of the federal poverty level.
  • California
    • Governor Gavin Newsom signed Assembly Bill 483, which will expand access to school-based health and mental health services by making it easier for schools to participate in the Local Education Agency Billing Option Program and receive federal Medicaid reimbursement for health services provided to Medi-Cal eligible students.
    • California launched two new programs, the Reproductive Health Service Corps to increase and diversify the reproductive healthcare workforce, and the Pharmacists Comprehensive Abortion and Reproductive Health Empowerment (Pharmacists CARE) Initiative to support training pharmacists to provide reproductive care.
    • Colorado – The Colorado Division of Insurance released an updated gender-affirming care insurance coverage guide for plan year 2024. Colorado began explicitly including gender-affirming care services in its benchmark health insurance plan for essential health benefits in 2023.
    • Louisiana – The Louisiana Department of Health (LDH) released its annual Outcomes Report which showed that LDH was successful in completing 91.1% of its 45 goals and 92.5% of its 253 deliverables outlined in the fiscal year 2023 LDH business plan. The goals were selected from a range of policy priorities and include addressing chronic disease; improving maternal health; expanding Medicaid policies that address environmental health risks; expanding the behavioral health system’s capacity; and improving services for citizens with developmental disabilities, among others.
    • Maryland – Governor Wes Moore announced a new four-year partnership to provide Marylanders with more equitable access to contraceptive care. In partnership with the Maryland Department of Health, Upstream USA will begin offering contraceptive care resources to healthcare providers, including free technical assistance, training and education in settings where most women already receive their healthcare.
    • Massachusetts – The Healey-Driscoll administration and the Reproductive Equity Now Foundation announced the launch of the Medication Abortion Toolkit for Public Colleges and UniversitiesThe toolkit is designed to assist Massachusetts’ public colleges and universities in preparing medication abortion readiness plans to provide, or make referrals for, medication abortion on college campuses in accordance with a new state law.
    • Michigan – Governor Gretchen Whitmer and Michigan Department of Insurance and Financial Services Director Anita Fox announced new licensing requirements for pharmacy benefit managers to help reduce the cost of prescription drugs for Michiganders. The new licensing requirements are a result of a package of prescription drug bills signed into law last year.
    • Nevada – The Nevada Department of Health and Human Services Division of Health Care Financing & Policy has announced a public comment period for the state’s section 1332 innovation waiver application. The waiver would establish a state-based reinsurance program, a quality incentive payment program, and a “Practice in Nevada” incentive program for healthcare providers. The public comment period will be open through December 20 and the waiver will be submitted to CMS for federal approval on January 1, 2024.
    • New Hampshire – The New Hampshire Department of Health and Human Services will hold a series of public forums to solicit stakeholder feedback on New Hampshire’s home and community-based services system for older adults and people with disabilities.
    • New Mexico – The New Mexico Human Services Department (HSD) announced the successful implementation of a $409 million increase in reimbursement rates for most Medicaid healthcare providers. This change is the result of a rate benchmarking study that HSD conducted in 2022. Claims for reimbursement have been automatically reprocessed with the rate increases retroactive to July 1.
    • New York – Governor Kathy Hochul announced that more than $5.1 million was awarded to support 137 school-based mental health clinic satellites throughout the state, including 82 at high-needs schools. Administered by the New York State Office of Mental Health, the funding is part of the governor’s $1 billion landmark plan to transform the state’s mental healthcare system.
    • North Carolina
      • The state submitted an application to extend its section 1115(a) demonstration titled, “North Carolina Medicaid Reform Demonstration” for another five-year period. The state is seeking extensions of ongoing managed care authorities, an expansion of and refinements to the Healthy Opportunities Pilot program, and authority for four new initiatives in line with the state’s overarching goals. The new initiatives will streamline Medicaid enrollment for children and youth, improve care for justice involved individuals, and invest in behavioral health.
      • The North Carolina Department of Health and Human Services announced eligible hospitals in the state will begin receiving payments through the Healthcare Access and Stabilization Program (HASP). Nearly $2.6 billion in funds will be distributed to 102 hospitals across the state. Earlier this year, state leaders authorized Medicaid expansion and HASP as part of a broader strategy to support access to care for low-income North Carolinians.
      • Oregon – CMS approved the state’s request for a five-year extension of its Medicaid section 1115 demonstration, “Oregon Contraceptive Care,” which authorizes the state to provide family planning services for eligible individuals. CMS is also authorizing two-year continuous eligibility for those enrolled to align this demonstration with the Oregon Health Plan demonstration and support consistent coverage and continuity of care, regardless of income fluctuations or other changes. In addition, that extension requires the state to provide non-emergency medical transport for the demonstration populations beginning January 1, 2025.
      • Tennessee – The state requested to amend their Medicaid section 1115 demonstration entitled “TennCare III.” The proposed amendment would expand coverage of parents and caretaker relatives of dependent children, cover a supply of diapers for infants and young children enrolled in TennCare, and enhance the home and community-based services available to individuals with disabilities under the demonstration.
      • Virginia
        • The Virginia Department of Medical Assistance Services (DMAS) will host a virtual forum on language and disability access on December 5. A panel discussion will explore how language and disability access training can enhance accessibility for individuals with limited English proficiency and people with disabilities. Additional information will include tips for implementing civil rights training within organizations.
        • In April 2022, Virginia Medicaid launched its new community doula services for pregnant members. A new doula video explains how Virginia Medicaid members can use the doula benefit services and why they should consider using the services. Members can find more information about benefits and services available to pregnant and postpartum enrollees on the DMAS website for pregnant women.