January 17 Update

In This Week’s Update:

  • SHVS Summary of CMS Letter to State Medicaid Directors
  • A Playbook for Implementing a State Cost Growth Target
  • Millions of Uninsured People Can Get Free ACA Plans
  • How Sharing Data Builds More Efficient and Effective Benefits Systems
  • State updates: AZ, CA, DC, GA, KS, LA, MA, MN, ND, NE, NJ, NY, RI & WA


SHVS Summary of CMS Letter to State Medicaid Directors

Last week, State Health and Value Strategies published a summary of CMS’ recently released State Medicaid Director Letter on how states can use “in lieu of” services (ILOS) authority, including to address social drivers of health. The letter establishes the requirements and guardrails states must meet to ensure the use of ILOS are cost effective, medically appropriate, preserve enrollee rights and protections, and fulfill the objectives of the Medicaid program. 


A Playbook for Implementing a State Cost Growth Target

More and more states are building the infrastructure needed to gain transparency into statewide healthcare spending through cost growth target programs. A new playbook from the Milbank Memorial Fund explains how all states can move toward sustainable healthcare cost growth. The playbook is informed by the experience of six states participating in the Peterson-Milbank Program for Sustainable Healthcare Costs who received technical assistance from Bailit Health. This resource offers guidance on activities and steps required to implement a growth target and covers program planning, development, and sustainability, public-private stakeholder engagement, establishing the target methodology and value, measuring performance against the target, understanding the drivers of spending growth, and accountability and action to slow spending growth. A webinar on January 18 will feature the playbook, state officials from Rhode Island and Oregon, and January Angeles of Bailit Health.


Millions of Uninsured People Can Get Free ACA Plans

About 5 million uninsured people across the country could get coverage through an ACA marketplace health plan with virtually no monthly premium if they enroll soon, a new KFF analysis finds. Despite most uninsured people being eligible for some form of assistance, either through Medicaid or ACA subsidies, 28 million people remained uninsured in 2021. Many uninsured people do not even shop for health coverage, often because of perceptions of high costs. In reality, though, millions of uninsured people are eligible for free plans. KFF previously estimated that almost half of uninsured people could get health coverage for free either through Medicaid or with ACA subsidies that were enhanced by the American Rescue Plan (and continued for another three years by the Inflation Reduction Act). Using similar methods and updating the analysis with 2023 ACA premiums and subsidy amounts, KFF now finds that about 5 million uninsured people are eligible for an ACA marketplace plan that is essentially free. This does not include uninsured people who previously fell in the family glitch and who may now be eligible for free plans, so the number of people eligible for a free plan may be slightly higher, though most people in the family glitch were already insured.


How Sharing Data Builds More Efficient and Effective Benefits Systems

When conducted with appropriate and responsible safeguards, data sharing is a powerful tool that government agencies and other key sectors can deploy to ensure that eligible people receive assistance efficiently and equitably. This kind of data sharing exists all over the country—innovative pilots and long-sustained efforts are occurring in agencies and institutions in states nationwide. On Wednesday, January 25, Benefits Data Trust (BDT) will host a webinar featuring government officials leading impactful and innovative data sharing efforts. The webinar will also introduce BDT’s newest resource: “Data Sharing to Build Effective and Efficient Benefits Systems: A Playbook for State and Local Agencies.” This Playbook is designed to help additional agencies and sectors use data sharing to illuminate who is not accessing benefits, better connect under-enrolled populations to vital assistance, and make the system more efficient for administering agencies and participants alike.


State updates: AZ, CA, DC, GA, KS, LA, MA, MN, ND, NE, NJ, NY, RI & WA 

  • Arizona – Carmen Heredia was appointed Director of the Arizona Health Care Cost Containment System, Arizona’s Medicaid program, following Jami Snyder’s departure. Heredia previously served as CEO at a community health and behavioral health provider organization.
  • California – The Department of Healthcare Services awarded $52 million to providers of medication-assisted treatment services. These funds will support the prevention, assessment, diagnosis, and treatment of opioid and substance use disorders, as well as recovery.
  • District of Columbia – DC Health Link hosted its eighth Annual Hispanic Health Leadership Symposium. Panelists discussed the health issues that most impact the Latino(a) community, healthcare access and resources for the immigrant community, and the value of and access to health insurance.
  • Georgia
    • Georgia established a state health insurance exchange called Georgia Access, which directs individuals to brokers and health insurance company websites. Individuals can still purchase exchange coverage using the federal HealthCare.gov website.
    • The Georgia Department of Community Health released a request for statements of qualifications from Medicaid managed care plans for the state’s Georgia Families, the state’s Medicaid program, and Georgia Families 360 program, the state’s Medicaid program for children in foster care or out of home placement.
  • Kansas – The state submitted a request to extend for five years its Medicaid Section 1115 demonstration entitled “KanCare.” The extension application proposes to transition features of the KanCare program out of the Section 1115 demonstration and into more permanent federal authorities such as state plan amendments and Section 1915(b) waivers. The application also seeks to continue three current KanCare features which need Section 1115 authority, including: 12-months continuous eligibility for certain low-income parents or caretaker adults; federal financial participation for services provided in an Institute for Mental Disease to Medicaid enrollees with a substance use disorder; and continuous eligibility for children enrolled in KanCare under CHIP who turn 19 during the public health emergency.
  • Louisiana – Governor John Bel Edwards announced a series of events to mark the seven-year anniversary of the expansion of Medicaid in Louisiana, noting that the state’s uninsured rate fell from 22.7% before Medicaid expansion to 9.4% in the first seven years of expansion.
  • Massachusetts – Massachusetts selected 20 Community Partners across the Commonwealth as partners for the 17 MassHealth Accountable Care Organizations (ACOs). Community Partners work together with ACOs to support MassHealth members with significant behavioral health and complex long-term services and supports needs. Over the last three years, the Community Partners program has shown a 21% reduction in ER visits, a 30% reduction in behavioral health admissions, and a 20% reduction in risk-adjusted total cost of care.
  • Minnesota – MNsure Chief Executive Officer Nate Clark announced his plan to retire on March 15, 2023 after over four years leading Minnesota’s health insurance marketplace. Libby Caulum, MNsure senior director of public affairs, was named acting CEO, effective March 16, 2023.
  • Nebraska – The Nebraska Department of Health and Human Services will soon launch a new feature of the iServe Nebraska portal called Explore Benefits, an anonymous, mobile-friendly, pre-screening tool to help Nebraskans identify benefits for which they may qualify.
  • New Jersey
    • The Murphy administration announced funding for reproductive healthcare providers as part of ongoing efforts to expand protections for and access to reproductive healthcare in New Jersey. The funding includes 0% interest loans for upgrades at reproductive healthcare facilities and grants for security enhancements.
    • Human Services Commissioner Sarah Adelman detailed how individuals will soon be able to anonymously obtain naloxone for free at participating pharmacies at any time. Under the initiative, those age 14 and over will be able to request and obtain naloxone for free without having to provide a name, reason, or a prescription.
  • New York – Governor Hochul announced a multi-year plan to expand mental healthcare. The plan includes increasing operational capacity by 1,000 beds for inpatient psychiatric treatment, creating 3,500 units of housing to serve New Yorkers with mental illness, increasing insurance coverage for mental health services, expanding outpatient services, and creating systemic accountability for hospital admissions and discharges to better address the needs of individuals suffering with mental illness. These proposals, over time, will reflect more than $1 billion in investment in mental health.
  • North Dakota – The North Dakota Health and Human Services’ Medicaid program extended postpartum healthcare coverage for eligible enrollees from 60 days to 12 months, to help address health needs after birth.
  • Rhode Island – Rhode Island submitted a request to extend the state’s Section 1115 waiver demonstration, which covers the entire Medicaid program, effective January 2024 through December 2028. The extension would build on the existing demonstration’s elements of equity and access while implementing new focused enhancements, such as housing stabilization and pre-release supports for incarcerated individuals.
  • Washington – The Washington Health Benefit Exchange announced it has selected Ingrid Ulrey as the organization’s next Chief Executive Officer. Most recently, Ulrey was Regional Director for the U.S. Department of Health and Human Services’ Region 10—which encompasses Washington, Oregon, Idaho and Alaska and the 272 federally-recognized tribes within them.