February 12 Update

In This Week’s Update:

  • New SHVS tools for health equity
  • Expanding Coverage to Non-Citizen Populations
  • Upcoming SHVS Webinar – Save the Date!
  • Approaches for Collecting Health Equity Data in Massachusetts
  • Updated State Medicaid and CHIP Telehealth Toolkit
  • High-Cost Drugs and the Medicaid Program
  • State updates: AZ, CA, CO, CT, HI, MN, NC, NJ, NM, NY, OR, WA & WI

New Tools to Advance Health Equity
Last week, State Health and Value Strategies (SHVS) and Health Equity Solutions developed two new interactive tools, the Health Equity Impact Tool (the Impact Tool) and the Health Equity Policy Tool (the Policy Tool).

    • The Impact Tool is a multi-part online evaluation for state agencies to examine their equity work at a high level. The Impact Tool guides states through the process of defining health equity goals, and identifying strengths, weaknesses, opportunities, and challenges related to meeting those goals.
    • The Policy Tool is a framework for reviewing and evaluating the impact on equity of current or proposed policies. The Policy Tool provides a template for asking key questions to assess the likelihood that a policy will promote equity or exacerbate inequities.

Upcoming SHVS Webinar – Save the Date!
SHVS is hosting a webinar to introduce two new interactive tools: the Health Equity Impact Tool (the Impact Tool) and the Health Equity Policy Tool (the Policy Tool). The Impact Tool is a multi-part online evaluation for state agencies to examine their equity work at a high level while the Policy Tool is a framework for reviewing and evaluating the impact on equity of current or proposed policies. During the webinar, experts from Health Equity Solutions will review how and why the tools were created and how to use the tools to understand the scope of equity work for a state agency. The webinar will also provide an overview of what to expect when completing the tools and how to leverage findings to develop goals and strengthen equity-focused policies and practices. Registration (required) at the following link: https://princeton.zoom.us/webinar/register/WN_H0Mq-166Q4O3w21qrw9qWg

Approaches for Collecting Health Equity Data in Massachusetts
The Massachusetts Executive Office of Health and Human Services, which houses the Massachusetts Medicaid program, convened two technical advisory groups to create a health equity data and accountability infrastructure for the state. A new SHVS expert perspective highlights the work undertaken to develop a voluntary, aligned approach for collecting self-reported demographic data and the creation of a framework for introducing accountability in value-based contracts for four categories of health equity measures.

Updated State Medicaid and CHIP Telehealth Toolkit
CMS released an updated State Medicaid & Children’s Health Insurance Program (CHIP) Telehealth Toolkit. This updated toolkit serves as a consolidated and comprehensive compilation of telehealth policies for states to consider when using telehealth to deliver Medicaid and CHIP benefits and services. The toolkit also includes information about telehealth platforms; billing best practices; best practices from states during and after the COVID-9 public health emergency; strategies to promote the delivery of accessible and culturally competent care via telehealth, including using telehealth in schools; strategies for telehealth in value-based care; evaluation strategies to understand how telehealth affects quality, outcomes, and cost; and strategies for communicating, training, and providing resources on telehealth for providers and for enrollees.

High-Cost Drugs and the Medicaid Program
While Medicaid drug spending is growing, it is increasingly driven by high-cost specialty drugs. According to a new policy brief from the Medicaid and CHIP Payment and Access Commission (MACPAC), in fiscal year 2021, Medicaid brought in net drug spending at $38.1 billion and drugs over $1,000 per claim accounted for less than 2% of utilization but more than half of Medicaid spending. MACPAC’s work has been focused on how to address states’ concerns about the growing costs associated with specialty drugs, as well as how to ensure that enrollees who could benefit from these new therapies would still have access to them. The policy brief has quick facts and a summary of MACPAC evidence and recommendations to date related to high-cost drugs and the Medicaid program.


State updates: AZ, CA, CO, CT, HI, MN, NC, NJ, NM, NY, OR, WA & WI

  • Arizona
    • The Arizona Health Care Cost Containment System (AHCCCS) has selected 57 healthcare providers to receive incentive payments over the next five years to integrate healthcare services for Medicaid-eligible incarcerated individuals prior to their release from jail or prison. Selected providers will create co-located, integrated clinics where primary care and behavioral health providers deliver services to justice-involved individuals.
    • AHCCCS has released a request for proposal to solicit vendors for the administration of the Housing and Health Opportunities (H2O) program. The H2O program is a new effort to enhance and expand housing services and interventions for specific populations of AHCCCS members who are experiencing homelessness or at risk of becoming homeless.
  • California
    • The Department of Health Care Services (DHCS) posted the first iteration of a public-facing California Advancing and Innovating Medi-Cal (CalAIM) dashboard to demonstrate the impact, progress, and key opportunity areas of CalAIM. The data will be updated regularly and will expand to include additional quality measures, demographic data, and initiatives as the data become available.
    • Governor Gavin Newsom has signed into law S.B. 339, making medication preventing HIV available to residents without a prescription. The bill authorizes pharmacists to furnish preexposure prophylaxis, PrEP, as well as postexposure prophylaxis, if specified conditions are met. The California State Board of Pharmacy has until October 31, 2024 to implement the bill.
  • Colorado – The Colorado Department of Health Care Policy & Financing released four statutorily required hospital transparency reports. These reports provide policymakers, businesses, healthcare purchasers, and communities with critical insights that drive the cost of hospital care.
  • Connecticut – Governor Ned Lamont announced the state will cancel roughly $650 million in medical debt for an estimated 250,000 residents. Residents whose medical debt equals 5% or more of their annual income or whose household income is up to 400% of the federal poverty level are eligible. The state will leverage $6.5 million in COVID-19 funds from the American Rescue Plan Act (ARP) to satisfy the debt.
  • Hawaii – Hawaii submitted a five-year extension request for its Medicaid section 1115(a) demonstration, “Hawaii QUEST Integration.” The demonstration extension aims to implement new authorities, including continuous eligibility for children ages zero through five and continuous two-year eligibility for children ages 6 through 18, pre-release services for justice-involved individuals, nutrition supports, and contingency management. The federal public comment period will be open through March 6, 2024.
  • Minnesota – The Minnesota Department of Human Services (DHS) is requesting an amendment from CMS to its Prepaid Medical Assistance Program Plus waiver to expand the 12-month continuous eligibility policy for children under 19 required by the Consolidated Appropriations Act, 2023 to include 12 months of continuous eligibility for 19- and 20-year-olds, and continuous eligibility for children up to age six. Additionally, DHS requests to amend the Minnesota Prepaid Medical Assistance Project Plus section 1115 demonstration to provide Medicaid eligibility for former foster care youth who turned 18 prior to January 1, 2023, and are under the age of 26.
  • New Jersey – The New Jersey Department of Health released the Maternal Health Hospital Report Card, a yearly report of maternal healthcare provided at licensed acute general care hospitals.
  • New Mexico – CMS approved a proposal from New Mexico for community-based mobile crisis intervention teams to provide Medicaid crisis services. This approval marks 15 states that have expanded access to community-based mental health and substance-use crisis care through the ARP. As a reminder, SHVS published an expert perspective on the enhanced payment available through the ARP for community-based mobile crisis services.
  • New York – Department of Financial Services Superintendent Adrienne A. Harris announced new proposed market conduct regulations to govern pharmacy benefit managers operating in the state to strengthen consumer protections and address anti-competitive conduct. The Department is also inviting submissions of comments, data, or evidence from the public regarding network adequacy requirements, formulary changes, drug manufacturer rebates and aberrant quantity/product list restrictions.
  • North Carolina
    • The North Carolina Department of Health and Human Services (NCDHHS) announced the launch of its Child Behavioral Health dashboard. The information shared through this publicly available tool will help the department as well as behavioral health providers, policymakers, and stakeholders to identify and address gaps and disparities in behavioral health services for children.
    • NCDHHS released a request for proposal for an organization that will help manage the Children and Families Specialty Plan. The statewide health plan will ensure access to comprehensive physical and behavioral health services for Medicaid-enrolled children, youth and families served by the child welfare system.
  • Oregon – The Oregon Health Authority released a new report, which details that Oregon needs nearly 3,000 additional adult residential mental health and substance-use treatment beds to close gaps in today’s system of care and meet the state’s future demand for treatment. State officials will release a final version of the report that will provide a complete analysis and a proposed funding strategy in June 2024.
  • Washington – At the direction of the legislature, the Washington Health Care Authority (HCA) will expand healthcare coverage to more Washingtonians, regardless of citizenship status. HCA hosted a webinar about the Apple Health Expansion program which discussed eligibility, covered services, as well as other available programs.
  • Wisconsin – Governor Tony Evers signed a package of five bipartisan bills aimed at improving access to dental healthcare, particularly in rural communities, and bolstering the dental workforce. Governor Evers also signed Executive Order #220 to create the Governor’s Task Force on the Healthcare Workforce, which will be charged with studying the workforce challenges facing the state’s healthcare systems.