February 13 Update

In This Week’s Update:

  • SHVS on Medicaid Unwinding
  • Medi-Cal Section 1115 demonstration
  • CMS’s 2020 Rule on Medicaid ‘Continuous Coverage’ Is Blocked as to Additional Dual-Eligible Enrollees
  • Remaining States Should Expand Medicaid to Maximize Coverage and Protect Against Funding Drop
  • Is Carve-In Financing of Medicaid Behavioral Health Services Better than Carve-Out?
  • State updates: AK, AZ, CA, CO, CT, KY, NC, ND, NV, NY, OK, OR, PA, VT, WA & WI

 

SHVS on Medicaid Unwinding

SHVS’ updated Federal Declarations and Flexibilities Supporting Medicaid and CHIP COVID-19 Response Efforts Effective and End Dates reflects HHS’s February 9 notice renewing the federal Public Health Emergency. This resource includes a timeline of key Medicaid unwinding provisions per the CAA.  

 

Medi-Cal Section 1115 demonstration

SHVS published an expert perspective on California’s recently approved request to amend the California Advancing and Innovating Medi-Cal Section 1115 demonstration. The perspective describes the amendment, a centerpiece of which is approval for California Medicaid to provide a targeted set of Medicaid services to youth and adults in state prisons, county jails, and youth correctional facilities for up to 90 days prior to release. By providing re-entry services to Medicaid-enrolled individuals who are incarcerated, California aims to build a bridge to community-based care for justice-involved enrollees.

 

CMS’s 2020 Rule on Medicaid ‘Continuous Coverage’ Is Blocked as to Additional Dual-Eligible Enrollees

A new SHVS expert perspective summarizes a recent federal court ruling that impacted CMS’ enforcement of an interim final rule (IFR) that narrowed CMS’ interpretation of the Medicaid continuous coverage requirement in the Families First Coronavirus Response Act (FFCRA).  In November 2022, a federal court in Connecticut ruled in Carr v. Becerra that CMS had acted impermissibly by issuing the IFR in November 2020. The court’s November 2022 order prohibited CMS from enforcing the IFR with respect to the five individual plaintiffs named in the lawsuit, all of whom lost access to “full” Medicaid benefits pursuant to the IFR after becoming eligible for a Medicare Savings Program. On January 31, 2023, the court broadened its order to include all Medicaid enrollees nationwide who had experienced a reduction in Medicaid benefits due to the IFR, as well as all enrollees who would otherwise experience such a reduction between the date of the order and March 31, 2023. The expert perspective discusses potential implications for states and enrollees.

 

Remaining States Should Expand Medicaid to Maximize Coverage and Protect Against Funding Drop

The unwinding of the Medicaid continuous coverage requirement will present challenges for all states, but particularly for the 11 non-expansion states. A Center on Budget and Policy Priorities (CBPP) report emphasizes the fresh reasons for states to expand Medicaid as we enter arguably the largest coverage event since the ACA’s enactment and implementation. Expanded Medicaid eligibility during the unwinding period helps prevent people—particularly parents with low incomes, young adults who aged out of Medicaid, and pregnant people who passed the postpartum period—from losing their Medicaid coverage and having no other affordable coverage option available to them. Newly expanding states can significantly lower their uninsured rate even in the face of broader Medicaid coverage losses nationwide and take advantage of a well-timed boost in federal incentive funding as the funding associated with the continuous coverage protection winds down. The report includes state-level data for each non-expansion state on the number of people estimated to become uninsured during the unwinding, how many could gain coverage with expansion, and new CBPP estimates for the additional federal funding available from the two-year American Rescue Plan incentive for states that newly expand Medicaid.

 

Is Carve-In Financing of Medicaid Behavioral Health Services Better than Carve-Out?

Until recently, many state Medicaid programs financed and managed behavioral health (BH) services for enrollees with serious mental illnesses (SMI) and others with high BH needs separately from other services in so-called carve-out arrangements. Carve-outs were seen as advantageous because they reduced the opportunities for actions by managed care organizations (MCOs) or enrollees that could skew the distribution of the SMI population across MCOs (that is, adverse selection) and ensured expert management and delivery of SMI services. A Health Affairs Forefront article examines the forces behind the trend toward BH carve-ins, discusses the evidence regarding the effectiveness of both models, and lays out design features likely to promote quality, integrated care in either a carve-in or carve-out setting.

 

State updates: AK, AZ, CA, CO, CT, KY, NC, ND, NV, NY, OK, OR, PA, VT, WA & WI

  • Alaska – The Alaska Department of Health released a request for proposals (RFP) for its Medicaid Management Information System, which includes software development services, interfaces, and infrastructure hardware.
  • Arizona – The Arizona Health Care Cost Containment System posted a messaging toolkit and supporting materials for health plans, providers, and community organizations to use to amplify awareness about the return to regular Medicaid renewal processes which begin April 1, 2023.
  • California – Governor Gavin Newsom’s administration announced more than $400 million in grants to build upon and expand the state’s healthcare workforce and infrastructure. This represents part of the over $1 billion in healthcare workforce investments to strengthen and expand the state’s health and human services workforce contained in the recent budget.
  • Colorado – The Colorado Department of Health Care Policy & Financing is seeking responses from members and their families, case managers, providers, connectors, and other advocates on an Equitable Access Survey on Medicaid Home and Community-Based Services (HCBS). The goal of the survey is to understand more about member and provider experiences pertaining to awareness and outreach, enrollment, and use of HCBS.
  • Connecticut – Access Health CT, the state’s official health insurance marketplace, announced the launch of the 2023 Broker Academy Program, which creates a pathway to license health insurance brokers by recruiting from, and building the skillsets of those who live and work in historically underserved communities.
  • Kentucky – The Kentucky Health Benefit Exchange, the state’s official health insurance marketplace, announced that Kentucky will begin annual Medicaid renewals in April 2023 and will continue renewals over 12 months.
  • New York – New York State of Health, the state’s official health insurance marketplace, released for public comment a Section 1332 waiver which seeks to increase access to high quality, affordable health insurance for low- and moderate-income individuals. Approval of the waiver would allow for the expansion of the state’s Essential Plan to New Yorkers up to 250% of the federal poverty level.
  • Nevada – The Nevada Division of Health Care Financing and Policy announced that Nevada will begin initiating unwinding-related renewals in April 2023.
  • North Carolina – North Carolina submitted an application to amend its Section 1115(a) demonstration titled, “North Carolina Medicaid Reform Demonstration.” With this amendment request, the state seeks to extend Medicaid eligibility to parents and caretaker relatives of children/youth in foster care who are making reasonable efforts to comply with a court-ordered plan of reunification, allowing them to maintain coverage while the child/youth is in foster care. Additionally, the state proposes to expand eligibility for the Children and Families Specialty Plan to include additional Medicaid-eligible enrollees.
  • North Dakota – North Dakota Health and Human Services announced that starting April 1, 2023, North Dakota will begin regular Medicaid renewals.
  • Oklahoma – The Oklahoma Health Care Authority (OHCA) announced that eligibility renewals will resume beginning in spring 2023. Currently, OHCA plans to first notify impacted members in February.
  • Oregon – The Oregon Department of Human Services announced the first Medicaid renewal and request for information letters will be mailed April 1, 2023.
  • Pennsylvania
    • The Pennsylvania Department of Human Services announced a return to normal Medicaid eligibility processes after April 1, 2023.
    • The Pennsylvania Department of Revenue and Pennie, the state’s official health insurance marketplace, have teamed up to allow uninsured tax filers to get covered outside of open enrollment. When completing their state income tax return, individuals can indicate interest in getting covered through Pennie, and will receive a notice that includes an access code for claiming their new Pennie account, an estimate of potential financial savings on coverage, and a 60 day enrollment window to shop for coverage.
  • Vermont – The Vermont Agency of Human Services released an RFP for technical assistance in the planning, implementation, and development of a Medicaid Supportive Housing Assistance Program, which will take effect in 2024. Services would include an engagement plan for pre-tenancy supports, tenancy-sustaining supports, and community transition services.
  • Washington – Washington Health Benefit Exchange released its 2023 Enrollment Preview Report. Nearly 231,000 customers signed-up for a health plan, including 37,000 new customers. The marketplace had the highest net enrollment gain and the new Cascade Care Savings program resulted in the highest percentage of subsidized customers the state has had.
  • Wisconsin – The Wisconsin Department of Health Services announced a multimedia campaign to ensure all state residents know of the 988 Suicide and Crisis Lifeline to support people experiencing a suicidal, mental health, or substance use crisis. The campaign will include television ads, billboards, broadcast radio, streaming audio and video services, social media, and online ads designed to connect with populations at higher risk for mental health and substance use emergencies, including members of the Black, LGBTQIA+, and Indigenous communities; teens; middle-aged men; and veterans.