December 9 Update

In This Week’s Update:

  • Helping States Implement Continuous Enrollment for Children
  • Preparing States to Conduct Ex Parte Renewals
  • State Efforts to Improve Access to Care
  • Oregon’s Cost Growth Target: Balancing Accountability and Flexibility
  • North Carolina’s Innovative Approach to Tackling Medical Debt
  • State updates: AZ, CA, DC, FL, MA, MN, NC, NJ, NY & UT

Helping States Implement Continuous Enrollment for Children
Last week, State Health and Value Strategies (SHVS) published a new toolkit to support states in leveraging 12-month and multi-year continuous enrollment (CE) for Medicaid and CHIP-eligible children and youth. The toolkit is designed to help states plan for implementation of CE policies, including the adoption of alternative payment models to encourage providers to embrace innovative pediatric care delivery practices and development of a quality improvement strategy to promote improved health and wellbeing outcomes for young children.

 

Preparing States to Conduct Ex Parte Renewals
In case you missed it, CMS issued a Center for Medicaid and CHIP Services Informational Bulletin on basic requirements for conducting ex parte eligibility renewals (or renewals based on reliable information available to the state) for Medicaid and CHIP enrollees. The guidance is a follow-up to its guidance on continued use of unwinding-related section 1902(e)(14) waivers and verifying financial eligibility, focusing on state implementation of federal ex parte renewal requirements and offering new state flexibility designed to increase ex parte renewal rates. Updates follow.

 

State Efforts to Improve Access to Care
Last week, SHVS published the latest post in our States of Innovation series. The series highlights what states are working on to achieve better, more affordable and more equitable health for all. This States of Innovation profiles state activity in November, which included states taking action on affordability and efforts to address costs, expanding access to care, and supporting mental and behavioral health and reproductive and women’s health.

Oregon’s Cost Growth Target: Balancing Accountability and Flexibility
Since 2019, Oregon’s Health Care Cost Growth Target Program has been a key strategy for keeping the state’s healthcare spending in line with wage and economic growth to improve the affordability of care for residents. A new blog post from the Oregon Health Authority (OHA) for the Milbank Memorial Fund discusses the next step: creating real accountability for healthcare payers and provider organizations. This month, OHA will launch a process involving new transparency measures, followed by financial penalties and required performance improvement plans for payers and providers that exceed the cost growth target with an acceptable reason, such as an investment in behavioral health spending.

North Carolina’s Innovative Approach to Tackling Medical Debt
On Monday, December 9 at 2:00 p.m. ET, Manatt Health will host a webinar featuring North Carolina’s Governor Roy Cooper, Secretary of the North Carolina Department of Health and Human Services Kody Kinsley, and other guests for a fireside chat describing the state’s approach to leveraging the Medicaid program to tackle the impact of medical debt. As a reminder, SHVS published a state spotlight, North Carolina’s Comprehensive Medical Debt Relief and Reform Incentive Program, which describes the initiative and highlights the opportunity as a model for other states.

State updates: AZ, CA, DC, FL, MA, MN, NC, NJ, NY & UT

  • Arizona – The state submitted a request to CMS to amend the state’s section 1115 waiver to expand coverage for former foster care youth. The Arizona Health Care Cost Containment System is required by HB 26 passed by the Legislature in 2022 to seek approval from CMS to provide continuous enrollment in Medicaid to youth formerly in the custody of the Arizona Department of Child Safety between the ages of 18 and 26.
  • California – Covered California, the state’s official health insurance Marketplace, announced the first-year results of its health plan accountability program, the Quality Transformation Initiative (QTI), aimed at improving healthcare outcomes and reducing disparities for members. The QTI establishes financial incentives for insurance companies by requiring payments for failing to meet specified benchmarks for measures that include blood pressure and diabetes control, colorectal cancer screening, and childhood immunizations.
  • District of Columbia – The DC Health Benefit Exchange Authority voted to make the treatment and long-term management of HIV free for enrollees in DC Health Link’s Essential Plans, the District’s standardized plans. Starting in plan year 2026 enrollees can get free primary care visits, laboratory tests, and generic HIV medications.
  • Florida – CMS approved Florida’s section 1115(a) demonstration, “Florida’s Children’s Health Insurance Program Eligibility Extension.” Approval of the demonstration will allow the state to increase the income eligibility threshold of its separate CHIP program from 210% to 300% of the federal poverty level.
  • Massachusetts – The state submitted a request to amend its section 1115 demonstration “MassHealth” to expand services for members enrolled in One Care and Senior Care Options (SCO) plans to live in their communities, as well as other changes to facilitate enrollment in SCO.
  • Minnesota – The Health Economics Program of the Minnesota Department of Health has released findings from the state’s transparency initiative on the federal 340B Drug Pricing Program. The report focuses on net 340B revenues generated in 2023 from discounted drugs purchased by participating healthcare organizations.
  • New Jersey
    • Governor Phil Murphy signed a bill into law requiring healthcare professionals to ensure all patients have the opportunity to develop a comprehensive, personalized postpartum care plan consistent with their unique and anticipated needs. The legislation requires healthcare professionals to offer pregnant patients a postpartum planning session as early as the first trimester of pregnancy. It also requires healthcare facilities to ensure that postpartum care information is provided to all patients receiving maternity care services prior to being discharged at the end of a pregnancy.
    • The New Jersey Department of Banking and Insurance issued a bulletin providing guidance to insurers on the implementation of a state law that caps out-of-pocket costs (OOP) for certain medicines to advance the affordability of prescription drugs. The guidance outlines requirements established by enacted legislation limiting OOP cost of insulin at $35 per month and capping OOP costs for EpiPens and asthma inhalers at $25 and $50 respectively for a month’s supply.
  • New York
    • Governor Kathy Hochul announced a statewide campaign to raise awareness of New York’s paid prenatal leave policy, which takes effect on January 1, 2025. The policy, signed into law in April, gives workers the ability to take paid leave for any pregnancy-related medical appointments.
    • Superintendent Adrienne A. Harris announced that the New York State Department of Financial Services has adopted new market conduct regulations to govern pharmacy benefit managers (PBMs) operating in the state. The adopted rules will help protect New Yorkers’ access to prescription drugs, prohibit business practices that increase the cost of drugs, and ensure that small independent pharmacies compete on a level playing field with large pharmacies affiliated with PBMs.
  • North Carolina – Governor Roy Cooper and North Carolina Health and Human Services Secretary Kody Kinsley celebrated the one-year anniversary of Medicaid expansion in the state by announcing nearly 600,000 North Carolinians, many of whom live in rural communities, have enrolled.
  • Utah – The state submitted a request to CMS to amend the state’s 1115 demonstration to provide traditional healing services to Medicaid enrollees who are members of an American Indian or Alaska Native (AI/AN) tribe.