January 30 Update

In This Week’s Update:

  • Text Messaging Flexibility to Support Unwinding
  • Section 1115 Demonstrations
  • Can Employer-Sponsored Insurance Be Saved? A Review of Policy Options: Price Regulation
  • State Medicaid Innovations to Support Home Visiting Services
  • Strengthening Marketplace Network Rules for Essential Community Providers
  • State updates: AL, CA, CO, IL, KS, MD, MI, ND, NM, NV, NY, OH, VA, WA, WI & WY


Text Messaging Flexibility to Support Unwinding

Last week, the Federal Communications Commission issued a ruling that provides states with new flexibility to support enrollee outreach and communication efforts as part of their processes to unwind the Medicaid continuous coverage requirement. State Health and Value Strategies just published an overview of the ruling, which permits state agencies and their partners to send text messages and make phone calls to individuals about enrollment-related issues not only for Medicaid but also for other state-run health insurance programs, including marketplace coverage. For more information about the importance of text messaging as a communication and outreach strategy, see this expert perspective and find template text messages in English and Spanish on this unwinding communications resource page. SHVS also continues to support states as they plan and prepare for the unwinding through this one-stop resource page.


Section 1115 Demonstrations

In the past six months, CMS has approved renewals and/or amendments to several long-standing section 1115 demonstrations, showcasing the Biden administration’s priorities for use of 1115 authority. Last week, SHVS published an issue brief, Recent Section 1115 Demonstration Approvals Highlight CMS and State Priorities, which describes how the recent demonstration approvals in Arizona, Arkansas, Massachusetts, Oregon, and Vermont highlight how states and CMS are leveraging 1115 demonstrations to implement new coverage strategies; address social drivers of health; strengthen the primary care and behavioral health delivery systems; institute value-based payment initiatives; and advance health equity. This related Health Affairs Forefront article, co-authored by Heather Howard at State Health and Value Strategies and Cindy Mann and Anne Karl of Manatt Health, focuses on how these recent demonstration approvals unveiled a new approach to budget neutrality that addresses many of the prior challenges that existed. The new budget neutrality policy will allow states more flexibility to test and sustain programs aimed at increasing coverage, improving access, and advancing health equity. 


Can Employer-Sponsored Insurance Be Saved? A Review of Policy Options: Price Regulation

Employer-sponsored insurance (ESI) provides critical coverage for 160 million individuals; however, the adequacy of many of these plans is in decline, leaving many workers and their families with high out-of-pocket costs. In a new blog post from the Georgetown Center on Health Insurance Reforms, the authors propose policy options designed to improve the affordability of ESI, the state of the evidence supporting or refuting the proposed policy changes, and opportunities for adoption. Employers acting alone will not be able to reverse the decline in adequacy of health plans. Policy change is needed, but assessing what policies will work is challenging. This blog post, the second in a series on ESI, assesses the evidence for direct and indirect regulation of provider prices and options for policymakers.


State Medicaid Innovations to Support Home Visiting Services

A blog post from the National Academy for State Health Policy (NASHP) looks at how states are implementing home visiting services to improve the health and well-being of women, children, and their families. The Maternal, Infant, and Early Childhood Home Visiting program, administered by the Health Resources and Services Administration in partnership with the Administration for Children and Families, is the primary source of federal funding for evidence-based home visiting programs. States also leverage other state and federal funding, including Medicaid and the Children’s Health Insurance Program, to support select home visiting services, and can enhance access to home visiting services especially for families with incomes below the federal poverty level. NASHP worked with states such as Alabama and Montana to provide targeted technical assistance on how their Medicaid programs can expand coverage of home visiting services.


Strengthening Marketplace Network Rules for Essential Community Providers

Provider networks are a core feature of equitable healthcare, and networks that are too limited create barriers to care, particularly for low-income people who cannot afford to go out of network. As described in a new blog post from the Commonwealth Fund, if rules to include essential community providers (ECPs) in marketplace plan networks are not strengthened, safety-net providers (SNPs) may face financial trouble because of the loss of revenue. If marketplace plans exclude SNPs and require ECPs included in the network to accept deep discounts for covered care, this could increase SNP financial struggles, which may be exacerbated by the end of the Medicaid continuous coverage requirement, as well as the special COVID-19 supplemental grants for SNP operations. These policy shifts further elevate concerns about healthcare access in underserved communities and call into question the proposed rule that would allow the exclusion of ECPs, as well as deeply discounted payments.


State updates: AL, CA, CO, IL, KS, MD, MI, ND, NM, NV, NY, OH, VA, WA, WI & WY

  •  California – CMS approved a first-of-its-kind section 1115 demonstration amendment in California that will provide a set of critical pre-release services and improve access to critically needed care for people returning home from jails and prisons. Medi-Cal will be able to cover substance use treatment before a Medicaid enrollee is released from jail, prison, or a youth correctional facility. Additionally, the state will be able to help connect the person to community-based Medicaid providers 90 days prior to their release to ensure they can continue their treatment after they return to the community.
  • Colorado
    • The Colorado Department of Health Care Policy & Financing issued an update to community partners on the return to renewals following the end of the Medicaid continuous coverage requirement, which includes information on the state’s timeline for unwinding continuous coverage, with noticing beginning in March and renewals due in May. The notice also invited community partners to attend a January 25 webinar to learn how the state is refining operational plans, timelines, communication toolkits, websites, partner FAQs, and other materials. Finally, the Department announced that a new “Take Action on Your Renewal” toolkit will be released in February 2023 and will include language for email, newsletters and social media communications.
    • Connect for Health Colorado, the state’s marketplace, reported that 201,758 Coloradans enrolled in a health insurance plan during the open enrollment period for 2023 coverage, an increase of approximately 3,000 plan enrollments above last year’s total. Additionally, 10,416 people enrolled in health insurance through Colorado Connect, the majority of which were from the OmniSalud Program for Coloradans who are undocumented.
  • Illinois – Governor J.B. Pritzker signed a healthcare omnibus bill that changes the definition of rural emergency hospitals, expands eligible provider types for applied behavior analysis, and extends a fee waiver for providers to include podiatrists. The bill also allows county nursing homes to participate in the nursing home tax and assessment and provides one-time emergency funding for mental health and substance use disorder crisis intervention services.
  • Kansas – Governor Laura Kelly announced a new youth mental health hospital to begin providing care in the state. The facility will provide both inpatient and residential treatment for youth in need of intensive services to help them stabilize, build resilience, and develop coping skills so they can return home as soon as safely possible to continue outpatient treatment in their community.
  • Maryland – The Maryland Health Benefit Exchange announced a record number of 182,166 Marylanders enrolled in coverage for 2023. Enrollment grew from a year ago by nearly 3% for individuals who self-identified as Black, by 9% for Latino/a residents, and by nearly 13% for Latino/a young adults ages 18 to 34.
  • Michigan – The Michigan Department of Health and Human Services launched a new tool, the Michigan Substance Use Vulnerability Index (MI-SUVI), to help stakeholders target efforts to address substance use issues specifically facing their communities. Previously, overdose mortality data alone was relied on to identify areas with higher substance use and did not consider a community’s access to resources. MI-SUVI uses data on access to services, social vulnerability and substance use burden to create a county-level vulnerability score or index.
  • Nevada – Nevada Health Link announced that 96,379 Nevadans enrolled in health insurance plans during this year’s open enrollment, 18,117 of which were new enrollees.
  • New Mexico – The New Mexico Human Services Department (HSD) released the 2023 Primary Care Council Strategic Plan and the Primary Care Payment Model Provider and Clinician Readiness Assessment, to transform primary care delivery in the state. HSD is seeking public comment on the strategic plan and the readiness assessment. The council is also seeking participation from clinicians and providers for upcoming workshops on primary care Medicaid payment reform. 
  • New York – Governor Kathy Hochul announced the availability of up to $7.5 million for state-certified providers and other treatment programs to establish low threshold buprenorphine services to address opioid use disorder. The grants will be the first to tap New York state’s Opioid Settlement Fund and will help develop up to 15 programs offering this safe, effective treatment for opioid use disorder.
  • Ohio – Governor Mike DeWine and Ohio Department of Medicaid Director Maureen Corcoran launched Comprehensive Maternal Care (CMC)—a community-based, statewide program aimed at improving the health and well-being of moms, infants, and families covered by Medicaid. To participate, obstetrical practices are required to measure and engage with patients and families through advisory councils or other means to hear firsthand accounts of how access to care, cultural competence, and communication methods affect patient outcomes. Practices must use patient input to improve the patient experience and reduce disparities.
  • Virginia – The Virginia Department of Medical Assistance Services announced that some Virginia Medicaid members will receive renewal information in the mail beginning March 18, 2023, with disenrollments starting no earlier than April 30, 2023. The bulletin asks advocates to assist Medicaid members to understand the renewal process and complete any actions required as soon as possible.
  • Washington – The Washington State Health Care Authority issued a notice about the end of Medicaid continuous coverage and the state’s expected timeline, with renewals beginning April 1, 2023.
  • Wisconsin – The Wisconsin Department of Health Services launched a survey asking the public to share thoughts on how to use a second round of opioid settlement funds, to provide guidance on where money should be spent to reduce harms associated with opioid use disorder. Approximately $8 million will be available to support existing or new projects and programs in communities across Wisconsin. People can make their recommendations through the survey until February 17, 2023.
  • Wyoming – The Wyoming Department of Health announced that Lee Grossman will be the new state Medicaid director and senior administrator of the Division of Healthcare Financing. Jan Stall has been serving in these roles on an interim basis since last January and intends to retire in March.
  • Alabama and North Dakota – CMS approved Medicaid and CHIP postpartum coverage expansions in Alabama and a Medicaid postpartum coverage expansion in North Dakota through the American Rescue Plan (ARP). Nationally, more than 439,000 people across 28 states and the District of Columbia now have access to Medicaid and CHIP coverage for a full 12 months following pregnancy—up from just 60 days before the ARP. As a reminder, SHVS published an issue brief that examines the ARP postpartum coverage extension.