December 5 Update

In This Week’s Update:

  • Medicaid Innovators
  • Medicaid Expansion’s Fiscal Impact
  • Essential Health Benefits Request for Information
  • Sugary Beverage Taxes and Public Health
  • The ACA’s Preventive Services Benefit is in Jeopardy: What Can States Do to Preserve Access?
  • State updates: CA, CO, CT, DE, MI, NC, NE, NJ, NY, OK, OR & WA

Wondering what states are doing to make the most of Medicaid? On Monday, Dec. 19 at 12:00 p.m. ET, RWJF and the National Academy for State Health Policy will host a virtual coffee chat with leaders from Arizona and California who received Medicaid Innovation Awards for their unique approaches to improving health outcomes while advancing health equity. Register.

Medicaid Expansion’s Fiscal Impact

This issue brief published by State Health and Value Strategies looks at the provision in the American Rescue Plan Act (ARP) of 2021 that provides states that implement expansion with a significant increase in Medicaid funding. The brief describes the ARP matching rate provision and assesses its fiscal impact for each of the states that have not yet expanded Medicaid, while comparing the available new federal dollars to the cost of expansion.


Also last week, SHVS published two new issue briefs:


Essential Health Benefits Request for Information

CMS released a request for information (RFI) on issues related to the ACA’s Essential Health Benefits (EHB). The agency is seeking public comment on how EHB benefits are defined, the scope of benefits covered, coverage of prescription drugs, and rules related to the substitution of benefits within EHB categories. CMS is asking state partners to comment on: 1) the role of states as the primary enforcers of the EHB and what, if any, additional federal guidance states may need; 2) whether EHB remains reflective of “typical” employer plans, or whether there have been changes in state markets in recent years requiring changes to the EHB standard; 3) whether there are significant barriers in benefit access for consumers, particularly with respect to behavioral health (including mobile crisis care), habilitative services, and the use of telehealth; and 4) recommendations for how the EHB can help advance health equity. 


Sugary Beverage Taxes and Public Health

The second episode of The Princeton Pulse podcast explores the effectiveness of levies on sugar-sweetened beverages, comparing experiences from South Africa and Philadelphia. Sometimes called “soda taxes” or “sugar taxes,” they are used as a policy tool to address rising rates of obesity and other non-communicable diseases, and the related social and economic costs. Studies show that drinking too much sugar contributes to obesity and increases the risk of diabetes, heart disease, and other serious illnesses. With that evidence in mind, more than 45 countries around the world have implemented sugary beverage taxes, on a national or subnational level. The theory behind these excise taxes is to reduce demand for the beverages, promoting healthier choices and ultimately, better health. At the same time, the levies can generate revenue to support other aspects of community health and wellbeing. Do these taxes actually work in terms of making people healthier? Can a regressive tax be progressive in its design and impact? Heather Howard discusses these issues with two guests who were instrumental in the adoption of sugar-sweetened beverage taxes: Dr. Karen Hofman, a pediatrician and research professor at the University of Witwatersrand, who helped South Africa become the first Sub-Saharan African country to implement this kind of tax; and Dwayne Wharton, a health equity advocate behind Philadelphia’s beverage tax.


The ACA’s Preventive Services Benefit is in Jeopardy: What Can States Do to Preserve Access?

Under the ACA, private plans are required to cover critical preventive services—like cancer screenings and vaccinations—without cost sharing. But this popular provision may be in jeopardy: a federal judge ruled earlier this year that much of this rule is unconstitutional, and there is reason to believe the Supreme Court may agree. In a new Commonwealth Fund To The Point blog post, researchers at Georgetown University’s Center on Health Insurance Reforms say that while states are barred by federal ERISA law from regulating the self-insured employer plans through which most covered workers get their health benefits, they aren’t totally powerless. The authors show that 15 states already have laws in place requiring individual-market insurers to cover, without cost sharing, the same categories of preventive services required by the ACA. With the litigation ongoing, other states can “make a difference for many” by acting promptly to do the same, they say. 


State updates: CA, CO, CT, DE, MI, NC, NE, NJ, NY, OK, OR & WA

  • California – The California Department of Health Care Services submitted an amendment to the CalAIM demonstration, proposing to implement changes to county-based plan models in the Medi-Cal Managed Care Program. The state is proposing to limit choice of managed care plans in metro, large metro, and urban counties in order to allow counties to participate in County Organized Health System or Single Plan managed care models. In order to maximize continuity of care and minimize member disruption, the state proposes to limit plan choice during the transition period and following the implementation of the models on January 1, 2024.
  • Colorado – A new program, OmniSalud, provides subsidized coverage options for people who are undocumented or DACA recipients. Since November 1, more than 5,700 people have used the program to enroll in a health insurance plan, and approximately 5,600 of those who have enrolled so far have qualified for state-funded financial help that reduces the cost of plans to $0.
  • Connecticut – Access Health CT Small Business announced it will waive the minimum number of employees typically required to enroll in a small group health insurance plan now through December 15. Small businesses can enroll in a group health insurance plan at any time of the year; however, they usually need a certain percentage of employees to participate in the plan. During this period, any small business with 50 or fewer employees in Connecticut can enroll in a group health insurance plan regardless of how many employees participate.
  • Delaware – The Delaware Division of Public Health announced the launch of a multimedia fentanyl campaign that targets youth, ages 14 through 25. The campaign aims to inform youth about what fentanyl is and that fentanyl can be found in various illicit drugs.
  • Michigan
    • The Michigan Department of Health and Human Services (MDHHS) is preparing to launch the MDHHS Doula Initiative in 2023, to begin reimbursing for doula services provided to Medicaid enrollees. In preparation for the launch, MDHHS is seeking applications for the Michigan Doula Advisory Council to inform the advancement of doula services. Applications must be submitted on or before December 15.
    • MDHHS announced a new effort to provide children in the state foster care and juvenile justice systems experiencing a behavioral health crisis with expanded access to services. MDHHS is asking congregate care providers to submit plans for placement in their facilities to address the needs of youth who must access mental health stabilization programs—meaning services to stabilize and treat youth dealing with serious mental health concerns, like suicidal thoughts. The department has issued a statewide request for proposals for new child-caring institution contracts and will begin implementing the new contracts in summer 2023.
  • Nebraska – To better serve Nebraskans living with mental and behavioral health issues, the Department of Health and Human Services (DHHS) is working to align focus areas to improve access to services cross-divisionally within DHHS. The four focus areas where DHHS will begin include: certified community behavioral health clinics, congregate healthcare settings, a standardized assessment to identify community-based support for individuals housed at Lincoln Regional Center, and level 1 screenings to document an individual’s potential disabilities or needs.
  • New Jersey
    • Governor Phil Murphy signed into law a bill that establishes 12 months continuous Medicaid eligibility for Medicaid and NJ FamilyCare enrollees. The bill additionally requires that the Commissioner of Human Services determine the means and method by which the annual eligibility redeterminations are to be conducted. Before passage of the legislation, New Jersey statute did not specify the frequency with which Medicaid and NJ FamilyCare eligibility redeterminations occurred.
    • The New Jersey Department of Banking and Insurance announced the release of a study on access to comprehensive reproductive healthcare that found a need for regulatory action to require coverage for abortion services under health benefits plans regulated by the department, and has begun the formal rulemaking process to implement the requirement. The department performed this study as part of the implementation of the Freedom of Reproductive Choice Act signed by Governor Phil Murphy earlier this year, which codifies the constitutional right to freedom of reproductive choice in New Jersey.  
  • New York
    • Governor Kathy Hochul announced more than $3.3 million to community-based healthcare providers that will increase access to mental health services for children and families across the state. Administered through the state Office of Mental Health, the federal funding is aimed at helping community-based service providers better serve children and youth who are dually diagnosed with mental illness and a developmental disability or substance use disorder. The grants are partly funded through the American Rescue Plan Act.
    • Superintendent of the Department of Financial Services (DFS) Adrienne A. Harris issued a mandatory request for information to health insurers to understand the scope and impact of their programs aimed at reducing health disparities. DFS is requesting information and documentation on race/ethnicity and language data collection efforts, health equity programs, and related workforce initiatives. This RFI will allow DFS to establish a foundation from which to build thoughtful, data-driven policies moving forward and evaluate the full impact of existing programming across the entire industry to ensure better outcomes for all New Yorkers.
  • North Carolina
    • The North Carolina Department of Health and Human Services (NCDHHS) released an updated North Carolina Dental Opioid Action Plan to provide clear steps and solutions for dentists and their staff, patients, families and communities to address the opioid epidemic. The state action plan represents the work of the Dental Opioid Workgroup which includes representatives from the North Carolina Dental Society, public health, dental specialty providers and multiple state and local partners.
    • NCDHHS launched a new website design in an effort to improve how the Department connects with people across the state. The new design highlights NCDHHS’ three strategic priorities: investing in behavioral health and resilience; supporting child and family well-being; and building a strong and inclusive workforce.
  • Oklahoma – The Oklahoma Health Care Authority released a request for proposals for the state’s SoonerSelect Children’s Specialty Program, which covers medical, behavioral, and pharmacy services for current and former foster children, justice-involved children, and children receiving adoption assistance. The state intends to award one contract, effective October 1, 2023, through June 30, 2024, with five, one-year renewal options.
  • Oregon
    • The Oregon Health Authority (OHA) submitted an amendment to its Section 1115 Substance Use Disorder Demonstration requesting to temporarily expand Oregon Health Plan (OHP) coverage to certain individuals with income from 138 to 200% of the federal poverty level currently enrolled in OHP. The amendment would allow those currently enrolled in OHP under the Families First Coronavirus Response Act to maintain enrollment until the state has established a Basic Health Care Program. The state is requesting that this amendment be effective on the first day of the month following the end of the COVID-19 public health emergency. The federal comment period will be open from November 30, 2022 to December 30, 2022.
    • OHA released a new report, which finds that the growth of healthcare costs in the commercial market in Oregon between 2013 and 2019 was largely due to price increases. In contrast, the growth of healthcare costs in Oregon’s Medicaid and Medicare Advantage markets was driven by increased utilization, or the number of services provided to patients.
  • Washington – The Washington Department of Health announced the launch of the Native and Strong Lifeline, which launches as part of the state’s 988 Suicide & Crisis Lifeline. The Native and Strong Lifeline is dedicated to serving American Indian and Alaska Native people. Calls are answered by Native crisis counselors who are Tribal members and descendants closely tied to their communities. They are fully trained in crisis intervention and support, with special emphasis on cultural and traditional practices related to healing.