February 1 Update

In This Week’s Update:

  • New Executive Order on Medicaid and the ACA
  • New SHVS Publications
  • COVID-19 Updates: CA, NC, UT, WI
  • Other State Updates: AL, AZ, CO, DE, FL, KY, NJ, PA, TX
  • Attitudes & Values Around Health and Race Amid COVID-19
  • SBM Experiences with 2020 COVID-19 SEPs
  • Implementing Pharmacist Contraceptive Prescribing


New Executive Order on Medicaid and the ACA

Last week President Biden signed an Executive Order on Strengthening Medicaid and the Affordable Care Act. As part of the order, the Biden-Harris Administration will open a marketplace Special Enrollment Period (SEP) for the COVID-19 public health emergency to allow individuals and families in states with marketplaces served by the HealthCare.gov platform to enroll in 2021 health insurance coverage. Beginning Feb. 15, 2021 and through May 15, 2021, these marketplaces will be available to all marketplace-eligible consumers who are submitting a new application or updating an existing application. The Executive Order also includes a provision for agencies to examine policies or practices that may undermine protections for people with preexisting conditions, including complications related to COVID-19, under the Affordable Care Act. A fact sheet about this Executive Order is available here. California, Colorado, New Jersey, and Washington announced SEPs mirroring President Biden’s action.

New SHVS Publications

State Health and Value Strategies published two new expert perspectives this week:

COVID-19 Updates: CA, NC, UT, WI

  • California – Gov. Gavin Newsom signed an executive order to help maximize the number of health care professionals and providers administering vaccines. The order confirms that existing law—which protects certain health care professionals and providers from legal liability when they render services at the request of state or local officials during a state of emergency—protects those health care professionals and providers when they participate in the state’s vaccine administration program.
  • North Carolina
    • The North Carolina Department of Health and Human Services (NCDHHS) has expanded its vaccine data dashboard to provide information about vaccine doses promised to and received by the state. Users will also be able to see the percent of doses received that have been administered. 
    • NCDHHS also launched a new online tool to help North Carolinians know when they will be eligible to get their vaccine. Find My Vaccine Group walks users through a series of questions to determine which vaccine group they are in. People can then sign up to be notified when their group can get vaccinated.
  • Utah – A new report from the Utah Department of Health explores the impact the COVID-19 pandemic is having on Utahns’ mental and behavioral health. While the long-term consequences of the pandemic will take time to understand, preliminary data suggest no significant increases in suicides, mental distress, or drug overdoses thus far. Public health experts believe the state’s existing mental health and substance use resources may be an integral reason why suicides and drug overdoses have not increased.
  • Wisconsin – The Department of Health Services released new and improved features to case activity metrics on its COVID-19 Disease Activity Dashboard. The enhancement includes showing case activity levels by county as a scatterplot instead of a chart. This allows users to more easily see case activity level, case burden, and trajectory in counties at the same time, and get more information from one visual.

Other State Updates: AL, AZ, CO, DE, FL, KY, NJ, PA, TX

  • Alabama – The Alabama Medicaid Agency released a request for proposals for a quality improvement organization to review prior authorizations and records of institutional, hospice, and other facilities for the state’s Medicaid population.
  • Arizona – The Arizona Health Care Cost Containment System, Arizona’s Long Term Care System team, recently launched a new digital resource for Tribal providers. The Tribal ALTCS Case Management Digital Tool Box (DTB) is a centralized resource of the forms, tools, lists, and policies that Tribal Arizona Long Term Care program employees need in order to perform their work. The DTB includes a dedicated quarterly report submission portal and a training center with video and slide deck presentations, among other resources.
  • Colorado – The Colorado Department of Health Care Policy & Financing released an Invitation to Negotiate, soliciting multiple vendors to help operationalize Colorado’s Canadian Drug Importation Program including aspects such as compliance, safety, and prescription drug distribution. The Colorado General Assembly passed SB19-005, authorizing the Department to seek approval from the federal government to establish an importation program.
  • Delaware – The Delaware Division of Public Health and the Delaware Healthy Mother and Infant Consortium awarded mini-grants totaling more than $145,500 to four local organizations to help reduce disparate birth outcomes and save infant and maternal lives.
  • Florida – The Centers for Medicare & Medicaid Services (CMS) approved a 10-year extension of Florida’s Section 1115 Managed Medical Assistance Medicaid managed care program waiver through June 2030. The state had requested a two-year extension. The extension includes $1.5 billion in Low Income Pool funding for hospitals that provide charity care.
  • Kentucky – Gov. Andy Beshear announced Kentucky hospitals will receive an additional $800 million to $1 billion annually. The Kentucky Cabinet for Health and Family Services received approval Jan. 14 from CMS on a new directed payment initiative that increases inpatient Medicaid payments for Kentucky hospitals. Pending Kentucky General Assembly legislative approval, payments could begin in March.
  • New Jersey
    • Gov. Phil Murphy signed Executive Order Number 217, which directs the Office of Health Care Affordability and Transparency to convene an Interagency Health Care Affordability Workgroup to identify opportunities administration wide and across the public and private sectors to advance shared goals of improved health care affordability, accessibility, and transparency. The executive order further directs the Department of Banking and Insurance, with partner agencies, to develop plans for the implementation of both health care cost growth benchmarks and health insurance affordability standards to ensure increased oversight and accountability in the health care system and to support efforts to stem the tide of rising health care costs. The order will also create a Health Care Affordability Advisory Board comprised of health care industry stakeholders, consumer advocates, and policy leaders to guide the development and implementation of the cost growth benchmarks.
    • First Lady Tammy Murphy and national public health expert Dr. Vijaya Hogan released the Nurture NJ 2021 Strategic Plan, a strategy to reduce New Jersey’s high rates of maternal and infant mortality and eliminate the racial disparities responsible for these deaths. The Plan includes over 70 specific, actionable recommendations for maternal health stakeholders across all sectors.
  • Pennsylvania – Department of Human Services (DHS) Secretary Teresa Miller announced the release of DHS’ first Racial Equity Report. The report details ongoing efforts underway by DHS and its partners to promote diversity, equity, and inclusion through this work in order to be a partner in correcting systemic racism and inequities.
  • Texas – The Texas Health and Human Services Commission received federal approval for a 10-year extension to September 2030 of its Texas Healthcare Transformation and Quality Improvement Section 1115 demonstration waiver. The waiver includes reimbursement for safety-net hospitals with federal dollars for uncompensated care provided to uninsured patients.


Survey: Attitudes, Views and Values around Health, Equity and Race Amid COVID-19

The Robert Wood Johnson Foundation published the findings from a national, ongoing survey that explores deep-rooted views of those with low and middle incomes, with a focus on people of color, health, equity, and race. The survey measures the attitudes of the same group of respondents over a year with four waves of collection. Between COVID-19 and calls for racial justice, 2020 appeared to be a turning point for tackling the root causes of inequities in health. Findings from the first and second waves of the survey show that many people—even those who may have been hit hardest by the pandemic and long-standing inequities—still do not see systemic racism as a barrier to good health. Respondents’ willingness to risk their own health to return to “normal” has actually gone up slightly over time. But, many see COVID-19 as a moment for change, with improving access to health care as the shift they most want to see.


Many States with COVID-19 Special Enrollment Periods See Increase in Younger Enrollees

A new blog post by the Commonwealth Fund highlights the enrollment experiences of state-based marketplaces (SBM) that opened COVID-19 SEPs last year. Preliminary enrollment data from the SBMs’ SEPs in 2020 indicate that reducing barriers to SEPs may actually attract younger and subsequently healthier enrollees. Efforts to cast a wide net by creating a broad SEP for the uninsured and investing in marketing and consumer assistance paid off. Most SBMs saw an increase in SEP sign-ups in the first half of 2020 compared to the same period in 2019, with some experiencing a 40 percent increase. Several SBMs that launched marketing campaigns saw a higher share of young adults using SEPs. The relative increase in younger enrollees in these SBMs appears to contradict claims that reducing SEP barriers inevitably leads to adverse selection; younger enrollees are crucial to a balanced risk pool.


Implementing Pharmacist Contraceptive Prescribing: A Playbook for States and Stakeholders

A new paper prepared by Manatt, with support from Arnold Ventures, highlights for state policymakers legislative, regulatory, reimbursement, and operational strategies to increase access to contraception by effectuating pharmacist prescribing. The paper reviews different types of laws that authorize pharmacist prescribing and outlines strategies to assure effective implementation. State boards of pharmacy are most commonly charged with leading implementation and ongoing oversight of policies, but the strategies listed in the paper and described in more detail in Manatt’s playbook could be implemented by any state regulators charged with leading implementation.