February 5 Update

In This Week’s Update:

  • Assisting States During the Unwinding
  • Evaluating Waiver Flexibilities for Medicaid Renewals
  • Massachusetts Hospitals’ Historic Health Equity Commitment
  • Medicaid Non-Emergency Transportation
  • Contracting to Align Health and Social Care Ecosystems
  • Cell and Gene Therapy Access Model
  • State updates: CA, DC, IL, MA, MN, MO, ND, NE, NJ, OK, OR, PA & WI

Assisting States During the Unwinding
State Health & Value Strategies released an expert perspective to support states as they implement continuous enrollment (CE) for children to meet the requirements of the Consolidated Appropriations Act, 2023. The expert perspective includes questions and answers regarding eligibility for and exceptions to CE, transfers between Medicaid and CHIP during a CE period, and operationalizing CE.


Evaluating Waiver Flexibilities for Medicaid Renewals
An issue brief states can use to evaluate whether to take up additional section 1902(e)(14) waiver flexibilities to support the return to regular eligibility and enrollment operations following the expiration of the Medicaid continuous coverage requirement.


Massachusetts Hospitals’ Historic Health Equity Commitment
The Massachusetts Health & Hospital Association released a report, “One Year In: Massachusetts Hospitals’ Historic Health Equity Commitment.” Through an 1115 Medicaid waiver, Massachusetts hospitals have joined together with the state to embed a health equity effort at the point of care, make services more accessible, and reduce persistent disparities. The report outlines the commitment’s health equity goals, accountability measures, and funding structure and highlights hospitals’ year-one progress and previews what will be accomplished over the five-year period.


Spotlight on CMS’ Non-Emergency Medical Transportation Guidance
States are required to provide non-emergency medical transportation (NEMT) in their Medicaid programs but have flexibility in how they deliver these critical services. Many states are seeking ways to improve their programs to ensure timely access to services. On February 7, Manatt Health will host a webinar to review CMS’ recently released Medicaid Transportation Coverage Guide that provides a comprehensive review of the federal regulatory and sub-regulatory requirements and state flexibilities for providing NEMT to Medicaid enrollees. The webinar will provide an in-depth look at this CMS guidance, including new policies outlined and how they may benefit Medicaid enrollees. Additionally, Manatt Health will speak with state Medicaid agency leadership from Oregon, who will discuss changes the state is making to its NEMT program to improve access.


Contracting to Align Health and Social Care Ecosystems
A new toolkit created by the Camden Coalition, the Partnership to Align Social Care, and the Aging and Disability Business Institute offers a deep dive into leading contracting practices to effectively and efficiently address health-related social needs. Divided into four modules, each highlights the essential elements of contracting between healthcare and community partners, and features leading practices and resources from the field. The toolkit was developed with extensive input from community-based organizations, health plans, and health systems.


Cell and Gene Therapy Access Model
Last week, the Biden-Harris administration announced that sickle cell disease will be the first focus of the Cell and Gene Therapy Access Model, designed to increase access to cell and gene therapies and lower healthcare costs. The model, led by the CMS’ Innovation Center, will test outcomes-based agreements with manufacturers for groundbreaking cell and gene therapies. And in case you missed it, CMS released a set of frequently asked questions which provide guidance to state Medicaid programs as to what constitutes full benefits during the 12-month extended postpartum eligibility period and clarifies whether a state needs to submit a state plan amendment to amend its coverage. Updates follow.


State updates: CA, DC, IL, MA, MN, MO, ND, NE, NJ, OK, OR, PA & WI

  • California – Covered California announced an extended deadline of February 9 to sign up for coverage for 2024. The deadline extension provides consumers the time and assistance they need following recent disruption to Covered California’s service center, which affected accessing representatives over the phone.
  • District of Columbia – The DC Health Benefit Exchange Authority (DCHBX) Executive Board voted to adopt a new benefits design to address health disparities for patients with heart disease and cerebrovascular disease. Starting in plan year 2025, individuals covered by a standard plan will no longer have copays, coinsurance, and deductibles for visits with their primary care doctor for cardiovascular and cerebrovascular care. The DCHBX Executive Board also removed cost sharing for all generic prescription drugs and services related to the prevention and treatment of cardiovascular and cerebrovascular disease, as well as for laboratory tests and imaging.
  • Illinois – The Illinois Department of Human Services released a progress report on the Illinois Children’s Behavioral Health Transformation Initiative. The report details progress toward each of the recommendations in the Blueprint for Transformation: A Vision for Improved Behavioral Healthcare for Illinois Children, which was commissioned by Governor JB Pritzker in February 2022.
  • Minnesota – The Minnesota Department of Commerce and DHS, in consultation with the Department of Health and MNsure, were directed by the state’s legislature to complete an actuarial and economic analysis of different public option models, including a public option that expands MinnesotaCare. The Department of Commerce published the recently completed report and recommendations to the state’s legislature.
  • Missouri – The Missouri Department of Health & Senior Services will host in-person town hall meetings across the state to gather feedback from local individuals on aging in Missouri. The meetings aim to ensure that Missouri’s Master Plan on Aging, a multi-sector initiative aimed at countering age and disability discrimination and ensuring access to person-centered programs and services, reflects the needs and wishes of its citizens.
  • Nebraska – The Department of Health and Human Services (DHHS) Division of Developmental Disabilities is releasing $506,000 in mini-grants to 36 providers of Medicaid Home and Community-Based Services (HCBS). Through these mini-grants, DHHS aims to enhance the current workforce, thereby expanding the availability of HCBS services and improving the quality of services.
  • New Jersey – Commissioner Sarah Adelman announced the Department of Human Services has issued more than 132,000 doses of the opioid overdose antidote naloxone during the first year of its program allowing residents to obtain the medication free and anonymously at participating New Jersey pharmacies.
  • North Dakota – North Dakota Health and Human Services (HHS) is incentivizing new healthcare graduates and established health professionals to choose North Dakota as their career location through the department’s latest healthcare recruitment initiative, Love You to Stay. Through the initiative, partnering agencies connect healthcare professionals to promising career opportunities in North Dakota. In addition, health professionals serving rural areas and underserved populations can participate in North Dakota Health Service Corps student loan repayment programs.
  • Oklahoma – SoonerCare members moving to SoonerSelect, Oklahoma’s new comprehensive health delivery system, can now choose their SoonerSelect health plans as of February 1. In addition to traditional SoonerCare benefits, each plan offers extra value-added benefits. Members must select a health plan by March 10; otherwise, the Oklahoma Health Care Authority will enroll them in a plan on their behalf.
  • Oregon – Governor Tina Kotek, Multnomah County Chair Jessica Vega Pederson, and Portland Mayor Ted Wheeler each declared a 90-day state of emergency to address the public health and public safety crisis driven by fentanyl in Portland’s Central City. The tri-government fentanyl emergency declarations direct the city, county and state to commit available resources to a unified response, which includes standing up a command center where state, county and city employees will convene to coordinate strategies and response efforts.
  • Pennsylvania – The Pennsylvania Department of Human Services submitted its section 1115 demonstration waiver application, titled “Bridges to Success: Keystones of Health for Pennsylvania” to CMS. The waiver would provide Medicaid continuous coverage for children from birth, or when a child first enrolls in Medicaid, through the last day of the month in which they turn six years of age.
  • Wisconsin – Governor Tony Evers signed Executive Order #220 to create the Governor’s Task Force on the Healthcare Workforce. The task force will be charged with studying the workforce challenges facing the state’s healthcare system, including recruitment and retention, identifying ways to improve patient care and alleviate the burdens on the healthcare workforce, exploring educational and training pathways to grow a sustainable healthcare workforce, and creating an action plan with solutions related to workforce development, industry innovation, education, and training for consideration in the governor’s 2025-27 biennial budget.
  • Massachusetts, Oregon & Pennsylvania – As state Marketplaces published final numbers following the end of open enrollment, Massachusetts reported over 72,000 people enrolled in new health insurance plans, an increase of 40% compared to last year. In Oregon, enrollment increased by 2.4% over last year and in Pennsylvania nearly 435,000 Pennsylvanians enrolled, an increase of 17% compared to last year.