January 13 Update

In This Week’s Update:

  • CMS’ Transforming Maternal Health Model
  • Final Rule to Remove Medical Debt From Credit Reports
  • New SHVS States of Innovation: December 2024
  • Medicaid Per Capita Cap Would Harm Millions of People
  • CMS’ COVID-19 Public Health Emergency Flexibilities
  • State updates: CO, IA, IL, MA, MI, MN, NY, OR, PA, VT, WA & WI

 

CMS’ Transforming Maternal Health Model
Last week, CMS announced the 15 states selected to participate in the Transforming Maternal Health (TMaH) model. TMaH is the newest CMS model designed to focus exclusively on improving maternal healthcare for people enrolled in Medicaid and CHIP, supporting states in the development of a whole-person approach to pregnancy, childbirth, and postpartum care to reduce disparities in access and treatment.

 

New SHVS States of Innovation: December 2024
State Health and Value Strategies (SHVS) published the latest post in its States of Innovation series. The series highlights what states are working on to achieve better, more affordable and equitable health for all. This States of Innovation profiles state activity in December, which included new initiatives to provide mental and behavioral health and in advance of the transition in federal administrations, the submission and approval of a significant number of waiver requests.

 

Medicaid Per Capita Cap Would Harm Millions of People
Recent proposals from congressional leaders would impose a per capita cap on federal Medicaid funding or, similarly, turn Medicaid into a block grant. These proposals would dramatically change Medicaid’s funding structure, deeply cut federal funding, and shift costs and financial risks to states. A new report from the Center on Budget and Policy Priorities discusses how faced with large and growing reductions in federal funding, states would cut eligibility and benefits, leaving millions of people without health coverage and access to needed care.

 

CMS’ COVID-19 Public Health Emergency Flexibilities
CMS published a report highlighting the agency’s Fiscal Year 2023 COVID-19 Public Health Emergency response and use of section 1135 waivers and other flexibilities. CMS uses emergency section 1135 waivers to ensure program participants have access to services during a national emergency and that providers have the flexibility to provide and be paid for services. The report focuses on six key areas, including vaccines and therapeutics, testing, telehealth, emergency reporting, surge capacity, and long-term care facilities. The report summarizes CMS’ policy response and synthesizes external feedback gathered from a variety of sources. It also includes discussions and recommendations on several cross-cutting issues, such as workforce capacity, healthcare disparities, quality improvement and patient safety, and process improvements in the execution of section 1135 waivers and flexibilities. A summary can be found on this fact sheet.

 

State Updates: CO, IL, IA, MA, MI, MN, NY, OR, PA, VT, WA, & WI

  • Colorado
    • Effective January 1, a new law went into effect to expand access to health coverage for pregnant people and children in Colorado, regardless of immigration status. The program offers comprehensive health benefits that include prenatal care, pediatric services, and other essential medical coverage. As a reminder, SHVS published an expert perspective which tracks state-funded coverage programs for non-citizens.
    • Colorado submitted a request to extend its section 1115 demonstration and continue providing approved components of the waiver, such as continuous eligibility for children ages zero to three, as well as continued authority for pending amendment requests such as reentry services for justice-involved individuals.
  • Illinois – Effective January 1, a new law went into effect that prohibits discrimination based on a person’s reproductive health decisions including fertility care and abortion. The law clarifies and extends existing protections in the Illinois Human Rights Act, ensuring Illinoisans have the right to engage in reproductive health decision-making without facing discrimination.
  • Iowa – Beginning January 1, 2025, eligible individuals can receive 12 months of postpartum coverage through Iowa Medicaid.
  • Massachusetts – Governor Maura Healey signed into law S.3012, which seeks to lower healthcare costs, cap prescription drug costs at $25, improve access to primary care and increase oversight of the healthcare industry to protect patients and providers.
  • Michigan – CMS approved a new section 1115 demonstration which will allow the state to provide limited pre-release demonstration coverage to certain incarcerated individuals under Medicaid, as well as for applicable youth and children who are or would be eligible for CHIP if not for their incarceration status, for up to 90 days. Michigan will provide pre-release services in state prisons, county jails, tribal correctional facilities, and juvenile facilities.
  • Minnesota
    • The Minnesota Department of Human Services published a report, Pathways to Racial Equity in Medicaid: Improving the Health and Opportunity of American Indians in Minnesota. The report seeks to answer two primary questions: What policies or structural changes should be prioritized in order to improve the health and opportunity of American Indians on Minnesota Health Care Programs? And how can Minnesota Medicaid more truly add value and support what Tribal Nations and American Indian communities are already doing to help members realize their full health and potential?
    • Beginning January 1, 2025, all children under age six who qualify for Minnesota Medicaid will have up to 72 months of uninterrupted coverage. Additionally, qualifying 19- and 20-year-olds will have ongoing Medicaid eligibility for 12 months.
  • New York – Governor Kathy Hochul announced that New York State and Public Partnership LLC are partnering with 11 independent living centers as part of the state’s plan to strengthen the consumer directed personal assistance program for New York’s homecare users.
  • Oregon – Oregon received approval of a waiver to test whether increasing access to affordable care for young adults with complex healthcare needs will improve health outcomes and reduce inequities. The Young Adults with Special Health Care Needs benefits extend Medicaid coverage, enhanced vision and dental services and the new health-related social needs climate and housing benefits to young adults ages 19 and 20 with special healthcare needs.
  • Pennsylvania
    • The Pennsylvania Insurance Department (PID) announced that through PID’s new independent external review process, 259 Pennsylvanians successfully appealed denied health service claims. In total, the external review process overturned 50.1% of appealed denials, helping to ensure more Pennsylvanians receive the health services they deserve.
    • CMS approved a new section 1115 demonstration, “Keystones of Health.” Approval of the demonstration gives Pennsylvania authority to provide limited pre-release Medicaid coverage to certain incarcerated individuals who are in state prisons and county jails up to 90 days prior to release. The demonstration also allows Pennsylvania to provide some housing and nutrition-related services to certain Medicaid enrollees based on a set of clinical and social risk criteria.
  • Vermont – CMS approved an amendment to Vermont’s section 1115 demonstration which grants the state authority to provide health-related social needs services and infrastructure support, and expand eligibility for the Substance Used Disorder Community Intervention and Treatment for eligible enrollees with incomes up to and including 225% of the federal poverty level.
  • Washington – The Washington Health Care Authority, Health Benefit Exchange, and the Department of Social and Health Services issued a community partner letter with information about immigrant health coverage programs in the state.
  • Wisconsin – The state submitted a request to CMS to amend the BadgerCare Reform 1115 waiver. Under the amendment, the state would expand reimbursement for acute inpatient stays in hospital-based institutions for mental diseases to include individuals diagnosed with serious mental illness or serious emotional disturbance.