December 19 Update

In This Week’s Update:

  • 2024 NBPP
  • New Urban Institute Report Estimates Impact of PHE Expiration 
  • State and Local Estimates of the Uninsured Population in the U.S. Using the Census Bureau’s 2021 American Community Survey
  • Discussion with Medicaid Innovators
  • State updates: CA, CO, MD, NC, NH, NM, NV & WA

2024 Notice of Benefits & Payment Parameters

Last week, CMS released the proposed Notice of Benefit & Payment Parameters for plan year 2024. Experts have been reviewing the proposed notice and SHVS has published an expert perspective focused on provisions of the proposed rule of interest to SBMs and state insurance regulators. For a more comprehensive summary of the proposed rule, Health Affairs Forefront has published several blog posts (see herehere and here). Comments on the proposed rule are due on January 30, 2023. 

Also last week, SHVS published an expert perspective, Communicating the PHE Unwinding: How States Are Collaborating With Community Partners, that highlights examples of how states are partnering with community organizations to support their outreach and engagement efforts to prepare for the end of the continuous coverage requirement. Also, this newly re-designed resource page includes PHE unwinding communications materials for states. The page has been re-organized so materials are grouped by communications phases. 

New Urban Institute Report Estimates Impact of PHE Expiration 

In a new report, The Impact of the COVID-19 Public Health Emergency Expiration on All Types of Health Coveragethe Urban Institute uses the latest available administrative data on Medicaid enrollment and recent household survey data to estimate health coverage when the Medicaid continuous coverage requirement ends. The report estimates that if the PHE expires in April 2023, 18 million people will lose Medicaid coverage. Of these 18 million, 3.8 million people will be uninsured, and approximately one million people will enroll in non-group coverage, mainly marketplace coverage with premium tax credits (PTCs). The report further estimates that 1.5 million former Medicaid enrollees will be eligible for PTCs but will not enroll, due to barriers such as higher premiums than Medicaid or limited coordination between Medicaid agencies and the marketplaces. The Urban report discusses several state-specific factors that could affect coverage transitions after the PHE ends, such as differences in marketplace take-up and differences in the number of inappropriate disenrollments from Medicaid.

State and Local Estimates of the Uninsured Population in the U.S. Using the Census Bureau’s 2021 American Community Survey

In order to support state and local outreach efforts, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) has developed state, county, and local estimates of the number of U.S. residents without health insurance and their demographic characteristics, using the most recent Census data avaliable from the 2021 American Community Survey (ACS). ASPE analyzed the population of uninsured individuals ages 0-64 by family income and results are avaliable at three levels of geography: state; Public Use Microdata Areas (PUMA), geographic areas within each state that contain no fewer than 100,000 people; and counties. It is important to note that the ACS fails to show the extent to which enrollment in Medicaid and CHIP has grown as a result of the continuous coverage requirement. A new issue brief from the State Health Access Data Assistance Center (SHADAC) analyzes the ACS and other federal surveys to identify the misalignment between self-reported Medicaid coverage captured in the ACS and enrollment counts from Medicaid/CHIP administrative data. The SHADAC issue brief points to a significant increase in the Medicaid undercount in the 2021 ACS, likely the result of Medicaid enrollees not being aware they were still enrolled in the program.

Discussion with Medicaid Innovators

On Monday, December 19, the Robert Wood Johnson Foundation (RWJF) and the National Academy for State Health Policy (NASHP) will host a virtual conversation with Medicaid leaders from Arizona and California. Both states received a RWJF-NASHP Medicaid Innovation Award for tailoring their Medicaid programs to take a whole-person approach to care delivery. Jacey Cooper, California’s Medicaid Director, and Jami Snyder, Medicaid Director in Arizona, will provide tangible examples of how they supported innovations that extend beyond clinical settings to address social determinants that affect health and wellbeing. Register for the webinar here.


State updates: CA, CO, MD, NC, NH, NM, NV & WA

  • California
    • Governor Gavin Newsom announced $480.5 million in awards for 54 projects to improve California’s behavioral health infrastructure for children and youth. As part of Governor Newsom’s Master Plan for Kids’ Mental Health, the investment provides grant funding to construct new facilities and expand existing facilities that help children, youth, transition-age youth, and perinatal individuals with a mental health and/or substance use disorder.
    • The Department of Health Care Services (DHCS) publicly issued quality measure ratings for all Medi-Cal managed care plans (MCPs), as part of a pledge to increase transparency and accountability for MCPs. DHCS is requiring immediate and concrete action from MCPs to improve their quality ratings. These efforts are aimed at improving health outcomes for millions of Californians.
  • Colorado – Connect for Health Colorado, the state’s official health insurance marketplace, hosted Get Covered Colorado Day, a day of action to encourage as many Coloradans as possible to enroll in 2023 health coverage during the annual open enrollment period.
  • Maryland – The Maryland Department of Health (MDH) and community partner Centro de Apoyo Familiar (CAF) partnered to provide free at-home COVID test kits, along with fresh food and toys for the upcoming holidays, to members of the Latino/a community during four CAF community events in December. MDH will co-sponsor two remaining CAF events this month, giving away more than 800 tests and important health information about how to stay COVIDReady with bivalent boosters for the holidays and beyond.
  • Nevada – The Nevada Division of Health Care Finance and Policy released a request for proposals for an external quality review organization for the state’s Medicaid managed care organizations and prepaid ambulatory health plans. The state plans to award one contract for a period of four years, beginning on July 1, 2023, with two, one-year renewal options. 
  • New Hampshire – The state submitted an amendment to its “Substance Use Disorder, Serious Mental Illness, and Serious Emotional Disturbance Treatment Recovery and Access” Section 1115 demonstration to cover removable prosthodontics for Medicaid enrollees age 21 and over in nursing facilities. 
  • New Mexico – The New Mexico Human Services Department submitted a five-year renewal application for the state’s Medicaid program to CMS under the new Medicaid name Turquoise Care. The renewal application also requests approval for targeted interventions to address the populations suffering from the greatest health disparities, which include: ensuring New Mexican children have continuous Medicaid coverage up to age six; expanding access to home visiting programs to support healthy pregnancies and babies; providing housing support following an inpatient or emergency visit; and expanding access to supportive housing to provide safe and stable housing to individuals more at-risk of adverse health outcomes.
  • North Carolina
    • The North Carolina Department of Health and Human Services and the Mecklenburg Sheriff’s Office are partnering to offer a new service at the Mecklenburg County Detention Center. The program serves defendants with a mental illness for whom the court has determined they are incapable to proceed to trial. The new program, called NC RISE, provides eligible defendants services, including behavioral health treatment, education about the court process and coordination of general healthcare.
    • The North Carolina Department of Health and Human Services launched a time-limited telemedicine program in partnership with StarMed Healthcare. Free telemedicine appointments to screen for COVID-19 treatment eligibility will be available, while funding allows, to North Carolinians who have tested positive for COVID-19 with an at-home test or other method. If the telemedicine provider determines a patient is eligible for oral antiviral treatment, such as Paxlovid, they can send a prescription to the patient’s chosen pharmacy or through a mail-order pharmacy.
  • Washington
    • The Washington Health Benefit Exchange announced that an average of 80% of enrollees in Washington Healthplanfinder, the state exchange, can save on their health premium by shopping and switching to a lower-cost plan. Customers can save an average of $1,300 annually ($110 monthly) for the same level of coverage for which they’re already paying.
    • The Washington Health Care Authority hosted a public forum on the Medicaid Transformation Project (MTP), the state’s Section 1115 Medicaid demonstration waiver. The forum provided an overview of MTP’s initiatives, this year’s successes and challenges, and an overview of the MTP renewal, called “MTP 2.0.” Stakeholders such as Apple Health (Medicaid) enrollees and partner organizations were encouraged to attend.