December 21 Update

In This Week’s Update:

  • New CMS Model on Dual-eligibles
  • Webinar: Supporting Children and Youth with Special Health Care Needs During COVID-19
  • COVID-19 State Updates: CA, CT, MI, NC & OR
  • Other State Updates: CO, MA, MI, MO, OH, OR & WA
  • SCOTUS Medicaid Work Requirements Cases
  • COVID-19 Vaccine Distribution: Legal Issues and Challenges
  • Technology Opportunities for the ACA Marketplaces


New CMS Model on Dual-eligibles

Last week the Centers for Medicare & Medicaid Services (CMS) announced a new opportunity to enable Medicaid Managed Care Organizations (MCOs) to better serve enrollees who are dually eligible for Medicare fee-for-service and Medicaid managed care. Eligible Medicaid managed care entities can participate as MCO-based Direct Contracting Entities (DCE) under the existing Professional and Global Direct Contracting Options model. In early 2021, the Innovation Center expects to release a Request for Applications (RFA) for all Professional and Global DCE types, including MCO-based DCEs. This will be the first Direct Contracting RFA to include MCO-based DCEs. MCO-based DCEs will begin participating in the model in January 2022.


Webinar: Supporting Children and Youth with Special Health Care Needs During COVID-19

Last week State Health and Value Strategies (SHVS) hosted a webinar, Supporting Children and Youth with Special Health Care Needs During COVID-19. The webinar explored strategies for state Medicaid agencies to enforce coverage requirements and make permanent the temporary regulatory flexibilities that have expanded access to services during the pandemic. SHVS has posted the slide deck and recording on its website.


COVID-19 State Updates: CA, CT, MI, NC & OR

  • California – Covered California will extend the open-enrollment deadline of Dec. 15 to give consumers through Dec. 30 to sign up for coverage that begins on Jan. 1 to help ensure Californians get the care they need in the face of the increasing health crisis. The unprecedented extension comes as COVID-19 infections and deaths are surging across California and the country.
  • Connecticut – Access Health CT announced an extension for the 2021 Annual Open Enrollment period until Jan. 15, 2021 as a result of the COVID-19 health crisis, providing more time for Connecticut residents to get covered. In addition, Access Health CT customers who enrolled in a plan for 2021 now have the option to keep it or find a new plan.
  • Michigan – The Michigan Department of Health and Human Services (MDHHS) launched a COVID-19 Vaccine Dashboard to help Michiganders track information about the vaccine across the state. The COVID-19 Vaccine Dashboard includes data from the Michigan Care Improvement Registry on the number of providers enrolled to provide the vaccine, the amount of vaccine received, and doses administered. The dashboard will be expanded over the coming weeks to include vaccination coverage rates by age and race.
  • North Carolina
    • The North Carolina Department of Health and Human Services (NCDHHS) will offer more than 300 no-cost, walk-up, or drive-through COVID-19 testing events over the next two weeks, including testing in partnership with new retailers in seven counties across the state. Retailers in seven counties are offering testing Dec. 18-20 and Dec. 26-27 in the parking lots of select Agri Supply, Carlie C’s IGA, Home Depot, Piggly Wiggly, and Wegmans stores.
    • NCDHHS has selected 17 school districts and 11 charter schools to participate in a pilot program to deploy COVID-19 rapid testing in K-12 public schools where any in-person instruction is happening. NCDHHS sent the selected districts and schools more than 50,000 federally funded rapid antigen tests. Students and staff will have access to more than 200 school-based testing locations across 17 counties as part of the pilot.
  • Oregon – The Oregon Health Authority (OHA) finalized its recommendations for who will be the first to receive doses of new COVID-19 vaccines. With a focus on health equity, the plan adds more granularity to federal recommendations and outlines specific populations within the broad groups—and in a wide range of health settings—that should be the focus for vaccination given the limited availability of the vaccine.


Other State Updates: CO, MA, MI, MO, OH, OR & WA

  • Colorado
    • The Colorado Division of Insurance is inviting stakeholders to a newly formed workgroup to advise in the evaluation of the state’s benchmark health insurance plan and any changes that should be made to it for the 2023 plan year. The benchmark plan is the plan used to set minimum standards for essential health benefits within the state for individual and small group plans. Colorado last updated its benchmark plan in 2015 for the 2017 plan year.
    • Connect for Health Colorado, the official health insurance marketplace for Coloradans, has formally launched a Public Benefit Corporation (PBC). The PBC will offer health care ancillary products and services across the state as well as work to increase Coloradans’ health literacy. The new organization will be a wholly owned subsidiary of Connect for Health Colorado and will be a separate entity from Connect for Health Colorado. 
  • Massachusetts – The Massachusetts Executive Office of Health and Human Services announced it is seeking feedback on a Medicaid Section 1115 demonstration waiver renewal request, which it plans to submit to CMS in the summer of 2021. The current waiver expires on June 30, 2022.
  • Michigan – MDHHS is inviting the public to comment on the Michigan Breastfeeding Plan. The first-ever Breastfeeding Plan was released in 2017. MDHHS wants to ensure public feedback is received regarding the next iteration of the Michigan Breastfeeding Plan. The Michigan Breastfeeding Plan will be released in early 2021.
  • Missouri – The Missouri Department of Social Services is soliciting public comments on the state’s Comprehensive and Community Support Medicaid waiver renewal applications, as well as the Children with Developmental Disabilities and Partnership for Hope waiver amendment applications. The end of the public comment period is Jan. 11, 2021.
  • Ohio – The Ohio Department of Medicaid (ODM) was awarded the Pacesetter Prize by The SCAN Foundation in recognition of its continued efforts to improve the lives of older adults, people with disabilities, and family caregivers across the state. ODM was specifically recognized for its leadership in transitioning people who need long-term services and supports out of institutions and back into the community.
  • Oregon
    • OHA published a report that evaluates and compares proposed delivery models for a public option. The report was produced as a result of legislation signed into law in 2019 which directed the state to engage in an analysis to help policymakers develop policies around a public option or Medicaid buy-in model for Oregon.
    • OHA’s Climate and Health in Oregon 2020 report says natural disasters such as extreme storms, floods, and wildfires continue to worsen, and disproportionately affect communities of color, tribal communities, and lower-income people in the process. The report fulfills a directive to OHA in Gov. Kate Brown’s Executive Order on Climate Change, which directs state agencies to reduce greenhouse gas emissions and protect the most vulnerable communities in Oregon from adverse effects of rapidly accelerating climate change.
  • Washington – Washington Healthplanfinder, the state’s official health insurance marketplace, announced that as of Dec. 16 about 210,000 Washingtonians have signed up for 2021 coverage, including almost 30,000 new customers. Among new customers, 41 percent have selected a Cascade Care plan. Cascade Care plans cover more services prior to meeting a deductible, including primary care visits, mental health services, and generic drugs.


Supreme Court Takes Up Medicaid Work Requirements Cases

On Dec. 4, the Supreme Court agreed to consider two cases—Gresham v. Azar and Philbrick v. Azar—challenging whether the U.S. Department of Health and Human Services (HHS) may approve, and states may implement, Section 1115 waivers that condition Medicaid eligibility on work requirements. Waivers in Arkansas and New Hampshire have been on hold since they were struck down by the D.C. District Court; those rulings were upheld on appeal. At least for now, work requirements are not in effect in any state, due to a combination of factors. However, the Supreme Court’s decision to consider the cases could impact the future of work requirements in at least a dozen states and could have broader implications with respect to the types of Section 1115 waivers HHS has the discretion to approve. Under the Supreme Court’s standard briefing schedule, an initial brief from HHS will be due on Jan. 18—just a few days before Inauguration Day, meaning the Trump Administration is expected to file the brief. However, it is the Biden Administration that will inherit the case, and the policy actions it takes could influence its trajectory. The incoming Biden Administration will need to quickly develop its policy stance on Medicaid work requirements with respect to waivers already approved by the Trump Administration as well as waivers pending CMS approval. The Biden Administration could make its position known relatively quickly, but given the briefing timeline and the court’s typical schedule for oral arguments, it is unlikely the Supreme Court will hear oral arguments prior to autumn 2021, meaning a decision could come as late as summer 2022.


COVID-19 Vaccine Distribution: Legal Issues and Challenges

On Dec. 10, the Network for Public Health Law held a webinar that examined the legal issues arising from devising equitable and efficient vaccine allocation plans, including the relevance of ongoing emergency declarations, potential legal challenges to allocation plans, and available liability protections for manufacturers and health care practitioners. The webinar also provided an overview of the process used by governmental agencies when considering recommending a novel vaccine. Those interested can view the slide deck and recording on the Network for Public Health Law website.


Technology Opportunities for the ACA Marketplaces

With support from the Robert Wood Johnson Foundation, Manatt Health published a new issue brief that explores the evolution of the Affordable Care Act Marketplaces from a technology perspective, drawing from interviews conducted with state Marketplace leaders, technology companies, and consumer advocates. The brief is intended for states that are considering a transition to a state-based marketplace (SBM) status as well as a broader audience interested in the role of Marketplaces in expanding and enhancing coverage. It is divided into three sections, covering the history of the Federally Facilitated Marketplace (FFM) and SBM tracks, the technology opportunities available today, and the choices states have given the current state of technology. The paper also includes a series of recommendations and considerations on what the Biden Administration could do to make the FFM a better partner for the states and how states can best navigate their options within the FFM and SBM tracks as those tracks evolve.