January 25 Update

In This Week’s Update:

  • New Administration’s Health Care Actions
  • Public Health Programming Resumes Following COVID-19
  • State Updates: CA, DC, MA, MN, NY, NC, WA
  • Other State Updates: CO, MN, NC, PA
  • The ACA in Maryland
  • Leveraging Value-Based Payment Approaches to Promote Health Equity
  • Tracking State Allocations of Vaccines

New Administration’s Health Care Actions

Following his swearing in on Wednesday, President Biden signed several executive orders related to health care, specifically the COVID-19 pandemic, and released a National Strategy for the COVID-19 Response and Pandemic Preparedness. A Kaiser Health News podcast, What the Health, analyzes President Biden’s plan to address COVID-19, and the new administration’s health care agenda.

As states work to distribute the vaccine, State Health & Value Strategies published an expert perspective last week, Ensuring Equity: State Strategies for Monitoring COVID-19 Vaccination Rates by Race and Other Priority Populations, which reviews what data states are currently reporting publicly related to vaccine administration, and includes an interactive map that explores the extent to which all 50 states are reporting vaccine administration data breakdowns by age, gender, race, ethnicity, provider type, and level of geography.

Public Health Programming Resumes Following COVID-19

State Health and Value Strategies (SHVS) hosted a webinar on guidance released by the Centers for Medicare & Medicaid Services (CMS) on resuming normal operations after the Public Health Emergency. SHVS also released a companion issue brief, CMS Guidance to States on Resuming Public Health Program Operations Post the COVID-19 Public Health Emergency. 

COVID-19 Updates: CA, DC, MA, MN, NY, NC, WA

  • California – Covered California, the state-based exchange, teamed up with Bay Area mayors to encourage all Californians to sign up for health insurance and take safety precautions during the current surge in COVID-19 infections. The effort comes as a record 1.6 million Californians had either renewed their coverage or selected a plan during open enrollment for health insurance coverage starting Jan. 1, 2021, including nearly 320,000 in the Greater Bay Area. The total represents an increase of almost 200,000 (14%) over the same time period last year.
  • District of Columbia – DC Health Link, the District’s official health insurance marketplace, hosted a week of action to accelerate outreach efforts to promote, educate and motivate Hispanics to enroll in quality, affordable health insurance, especially during the pandemic.
  • Massachusetts  
    • The Massachusetts Health Connector, the state-based marketplace, is extending open enrollment until March 23, providing additional time for state residents to access affordable, quality health insurance, particularly those hurt by the economic impacts of COVID-19.
    • The Baker-Polito Administration announced the expansion of more vaccine locations in the Commonwealth to boost the capacity to administer vaccines. Massachusetts is launching the COVID-19 CDC Pharmacy Partnership – Phase 1 with CVS Health and Walgreens pharmacies. The program began last week and will deliver a total of 10,000 doses to at least 15 CVS Health and Walgreens pharmacies a week for eligible residents in the Phase One priority groups.  
  • Minnesota – MNsure, the state-based based marketplace, announced that more than $500,000 from the Coronavirus Relief Fund will be used to provide equipment and technology to help at-risk American Indians access primary care and supportive services that keep them safe at home. Blood pressure monitors, pulse oximeters, and technology that supports telehealth and behavioral health visits will be provided to elders from Indigenous communities in Minnesota to protect them at home until they can be vaccinated.
  • New York – As part of New York’s ongoing response to the COVID-19 pandemic, Gov. Andrew M. Cuomo announced that the open enrollment period for uninsured New Yorkers will be extended through March 31, 2021. New Yorkers can apply for coverage through NY State of Health (the state-based marketplace) or directly through insurers.
  • North Carolina – The North Carolina Departments of Transportation and Health and Human Services announced that approximately $2.5 million in Coronavirus Relief Funding is being distributed to local transit agencies across the state to help pay for rides for individuals who need transportation assistance to receive a COVID-19 vaccine.
  • Washington – Gov. Jay Inslee announced an updated statewide vaccine distribution and administration plan to increase the number of Washingtonians vaccinated and establish infrastructure capable of supporting mass vaccinations in the coming months. Included in the plan is the Washington State Vaccine Command and Coordination Center, a new statewide public-private partnership to boost vaccine distribution efforts. The collaboration includes Washington corporations, labor unions, health care groups, and government entities.

 

Other State Updates: CO, MN, NC, PA

  • Colorado – Connect for Health Colorado, the state-based marketplace, announced that nearly 180,000 Coloradans signed up for a health insurance plan by the end of the open enrollment period. This is about eight percent above last year’s end of open enrollment total. Of those customers who enrolled in a 2021 plan, 69 percent qualified for financial help to reduce their monthly premium.
  • Minnesota – MNsure, the state-based marketplace, is reminding residents who face difficulty affording their insulin to apply for the Minnesota Insulin Safety Net Program. Residents who are in urgent need can apply for the Urgent Need Program to receive a 30-day supply of insulin immediately for no more than $35.
  • North Carolina – The North Carolina Department of Health and Human Services announced that Legal Aid of North Carolina will provide Medicaid managed care Ombudsman services for the state’s Medicaid enrollees. Beginning this spring, Legal Aid will partner with the Charlotte Center for Legal Advocacy and Pisgah Legal Services to educate and inform enrollees about the state’s move to managed care through outreach events, a public website, and a toll-free phone number.
  • Pennsylvania – The Interagency Health Reform Council, charged with evaluating the Commonwealth’s health care payment and delivery systems, presented its Health Care Reform Recommendations to the governor. Among the recommendations is the creation of a Health Value Commission to institute a health care cost growth benchmark and several recommendations aimed at addressing health equity.

 

The ACA in Maryland: A Case Study in Successful Bipartisan Innovation

The Affordable Care Act sets up a structure with key roles for both federal and state policymakers. Federal regulations and subsidies are interwoven into a health insurance system that remains primarily a state responsibility, with additional options for state roles. It is not surprising, then, that different states have seen different market outcomes in terms of costs and enrollment. From establishing a state-based marketplace to a temporary Maryland supplemental reinsurance program, Maryland has taken steps to make health insurance more affordable. This case study describes the measures taken by the state to improve affordability and coverage, identifies unique program design features, and discusses their bipartisan appeal as experienced in Maryland. Maryland’s efforts can serve as a helpful framework for other similarly situated states seeking to address pressing health coverage affordability issues.

 

Leveraging Value-Based Payment Approaches to Promote Health Equity

Value-based payment (VBP), which many payers are already using to improve health outcomes and support more efficient care, can be an effective tool in designing equity-focused payment and contracting models. The development of equity-focused VBP approaches to support care delivery transformation is an important lever that can help payers advance health equity and eliminate disparities in health care. A new report, authored by the Center for Health Care Strategies and the Institute for Medicaid Innovation, identifies six connected strategies to guide payers, including Medicaid agencies and managed care organizations, in developing equity-focused VBP approaches to mitigate health disparities at the state and local levels. These strategies include: (1) articulating an equity goal; (2) assessing the payment and care delivery environment; (3) selecting performance measures; (4) setting performance targets; (5) designing the payment approach; and (6) addressing operational challenges.

 

Phased Allocation Of COVID-19 Vaccines: State And Territorial Approaches

The National Governors Association (NGA) is tracking via a regularly updated resource state and territorial plans for the phased allocation of COVID-19 vaccines. Because the initial supply of COVID-19 vaccines is limited, governors are focused on prioritizing certain high-risk populations for vaccine allocation through a transparent and equitable process. The resource outlines state and territorial approaches according to Phases 1a-c, 2, and 3; however, state phases or tiers may vary from this structure (e.g., additional phases or more condensed phasing) and such variations are noted where applicable for individual states. State planning for allocation to critical populations across phases, including guidance for providers and the public, will continue to evolve and NGA will update the resource to reflect additional details as they are released.