January 23 Update

In This Week’s Update:

  • New SHVS unwinding materials
  • Promising Practices to Foster Meaningful Health System and Community Partnerships
  • Mothers’ Mental Health Challenges Predated the COVID-19 Pandemic
  • Realizing the Promise of All-Payer Claims Databases
  • State updates: AR, CO, MI, MN, NC, NE, NJ, OR, SC, SD, UT & WA


New SHVS unwinding materials 

Last week, State Health and Value Strategies published several resources related to transitions to employer-sponsored insurance (ESI) during the unwinding of the Medicaid continuous coverage requirement. According to recent estimates from the Urban Institute, of the roughly 18 million people expected to lose Medicaid coverage when the continuous coverage requirement ends, 9.5 million are expected to enroll in ESI. These new SHVS resources highlight the role states can play in connecting people with ESI:


Also last week, SHVS published new and updated resources on the continuous coverage unwinding, including:


As a reminder, SHVS has created a single-stop resource page to support states as they plan for unwinding and consolidated all our template communication materials for states in one place where they can be easily downloaded to customize.



Promising Practices to Foster Meaningful Health System and Community Partnerships

Health systems increasingly recognize the value of fostering partnerships with communities that are built on trust, meaningful relationships, and community ownership. This is critical for communities of color, where members historically have not had a voice in healthcare decision-making. The Center for Health Care Strategies is hosting a webinar, made possible by the Robert Wood Johnson Foundation, that will explore opportunities to achieve engagement and trust between safety-net health systems and communities drawn from emerging best practices across the country. The webinar will feature a panel discussion with representatives from health systems and community-based organizations who will share first-hand experiences on developing more community-driven and accountable health systems.


Mothers’ Mental Health Challenges Predated the COVID-19 Pandemic

To better support the mental health and well-being of mothers and children in the aftermath of the pandemic, it is important to understand the patterns that existed before the crisis. In a new report, the Urban Institute analyzes the national patterns of self-reported symptoms of anxiety and depression among custodial mothers of children younger than 18 using data from the 2019 National Health Interview Survey. The analysis finds that many mothers reported symptoms of anxiety and depression even before increases in the stressors facing families in America, such as the COVID-19 pandemic and economic downturn. The report also shows that many mothers, including those with insurance coverage, were already reporting unmet needs for mental health services. Given the effects of maternal well-being on children in both the short and long terms, better supporting the mental health needs of mothers could also help support children as they continue to grapple with the consequences of the pandemic on their mental and physical health.


Realizing the Promise of All-Payer Claims Databases

Although the healthcare industry is foundational to the health and well-being of our nation and is powered by data, the policymakers, regulators and other public stakeholders charged with overseeing its efficacy often lack comprehensive and timely information about its operations and performance. In a new paper developed with the support of the Robert Wood Johnson Foundation, Manatt Health describes the value of all-payer claims databases (APCDs), powerful repositories of healthcare claims and encounter data that can offer unique insights into local market dynamics and operations. The brief describes the value of APCDs in informing an emerging discussion among the federal government, states and health data leaders about the future of our systems of health and proposes investing in and building from our state health data infrastructure to develop national health data capacity.


State updates: AR, CO, MI, MN, NC, NE, NJ, OR, SC, SD, UT & WA


  • Arkansas – The Arkansas Department of Human Services released a request for information for a potential Medicaid managed care module of the state’s planned replacement of its Medicaid management information system (MMIS). Among other requirements, the solution must automate assignment and management of Medicaid enrollees across multiple managed care organizations, support the centralized management and oversight of the state’s financial management requirements, and provide integration with existing MMIS modules and systems.
  • Colorado – The Colorado Department of Health Care Policy & Financing released three hospital transparency reports covering fiscal years 2014 through 2021. The reports document Colorado hospital reserves, the impact of the $1.2 billion in federal stimulus received in 2020, and the gap between rural, independent, and multiple-system financials. These reports also identify opportunities to improve community impact from the $965 million in community investments that Colorado’s not-for-profit hospitals make in lieu of paying taxes.
  • Michigan – The Michigan Department of Health and Human Services (MDHHS) Bureau of Aging, Community Living and Supports is inviting the public to join community conversations online and throughout the state to discuss the needs of older adults. MDHHS is seeking input regarding the needs and gaps in programs and services that affect quality of life for older residents. MDHHS will use information gathered during the community conversations and from survey responses to identify priorities for the department in support of the health and well-being of Michigan’s older adult population and to support development of Michigan’s next three-year State Plan on Aging.
  • Minnesota – MNsure announced nearly 130,000 Minnesotans found comprehensive coverage for 2023, making the open enrollment period one of the most successful to date for the state’s health insurance marketplace. This year, 57% of MNsure enrollees will save money with advanced premium tax credits, and on average, MNsure enrollees will save $6,220 in 2023.
  • Nebraska – The Nebraska Department of Health and Human Services announced that, in preparation for the resumption of Medicaid redeterminations, Nebraska Medicaid will take extra steps to reach its members including traditional letters, phone calls, and other outreach in partnership with its health plans. In partnership with provider and advocacy organizations, Nebraska Medicaid will be providing written materials in coordination with the organizations who have helped develop the materials for provider’s offices and other locations. Social media will also be used for outreach.
  • New Jersey – Governor Phil Murphy signed legislation that will allow pharmacists to dispense self-administered hormonal contraceptives to patients without requiring a prescription. Access to contraception without a prescription will not be limited to New Jersey residents, as New Jersey pharmacists will be permitted to provide contraceptives to patients regardless of the patient’s residency.
  • North Carolina – The North Carolina Department of Health and Human Services announced that nearly 24,000 services have been delivered to nearly 3,000 Medicaid enrollees as part of the Healthy Opportunities Pilots since the program began in March 2022. The pilot program addresses non-medical drivers of health including food, housing, transportation, and interpersonal violence/toxic stress.
  • Oregon –The Oregon Health Authority (OHA) has received federal approval to significantly increase Medicaid behavioral health services reimbursement paid through coordinated care organizations (CCOs). The federal approval requires CCOs to increase pay to providers for behavioral health services provided on or after January 1, 2023. This approval and the additional funding will enable OHA to invest Medicaid funds to improve access to services, support the behavioral health workforce, incentivize culturally and linguistically specific services, and increase support for integrated treatment of co-occurring substance use and mental health disorders.
  • South Carolina – The South Carolina Department of Health and Human Services announced that after the public health emergency (PHE) ends, it will continue and make permanent the following temporary flexibilities: COVID-19 testing without copays and the application of caries arresting medicament. Flexibilities that will remain for a year after the PHE ends include COVID-19 vaccination without a copay, suspension of an annual limit of 12 ambulatory care visits, and waiver of copays for all evaluation and management codes.
  • South Dakota – The South Dakota Department of Social Services released a request for information regarding implementation of a third-party administrator (TPA) for the state’s Medicaid expansion population. The TPA would handle prior authorization, provider claims processing and payment, customer service and support, and data analytics and reporting.
  • Utah – The state submitted two requests to amend its Medicaid Reform 1115 Demonstration: the first request is to provide state plan covered physical and behavioral health services in an integrated model through a contracted local mental health authority and the second request is to provide long-term services and supports to behaviorally complex individuals.  
  • Washington – The Washington Health Benefit Exchange announced a new special enrollment period available to individuals and families who make up to 250% of the federal poverty level for Cascade Care Savings, the state’s new state-funded premium financial assistance program. Individuals earning up to $33,975 annually or a family of three earning up to $57,575 may qualify for the Cascade Care Savings special enrollment period, which includes access to plans as low as $0.