January 8 Update

In This Week’s Update:

  • Preserving Coverage for Children
  • New Toolkit to Help States Address Health-Related Social Needs
  • How Colorado Is Working to Make Drugs More Affordable
  • Can Medicaid Payment and Purchasing Strategies Advance Health Equity?
  • State Medicaid Actions to Ensure Access to Gender-Affirming Care
  • State updates: AZ, CA, IL, MD, MN, MO, NC, ND, NE, OR, PA & UT


Preserving Coverage for Children

In case you missed it, the Centers for Medicare and Medicaid Services (CMS) recently released a suite of Medicaid unwinding-related guidance that includes a focus on ensuring eligible children maintain Medicaid and CHIP coverage. On Thursday, January 18 at 12:30 p.m. ET, State Health and Value Strategies (SHVS) is hosting a webinar that will review high-value strategies outlined in CMS’ guidance that states can implement to promote continuity of coverage for children, and discuss key considerations for state policymakers. Please register for the webinar and feel free to share the registration information with interested state colleagues.

States are increasingly leveraging their Medicaid programs to transform healthcare delivery and address health-related social needs (HRSN). SHVS published an expert perspective and updated toolkit that identify approaches states are taking, through their Medicaid managed care programs, to address HRSN. States interested in implementing specific strategies can use the toolkit to develop managed care procurements or update and operationalize key contract provisions. Updates follow.


How Colorado Is Working to Make Drugs More Affordable

Prescription Drug Affordability Boards (PDAB) are independent entities established to analyze the high cost of drugs and identify effective ways to lower costs in order to increase access to affordable drugs. The National Academy for State Health Policy spoke with Colorado’s Prescription Drug Affordability Director Lila Cummings about the Board’s trailblazing work. A blog post of the interview highlights what the board has accomplished so far, how consumer and partner perspectives are incorporated into the work, what the work looks like moving forward, and insights for states that are considering creating a PDAB.

Can Medicaid Payment and Purchasing Strategies Advance Health Equity?

Medicaid is an important player in advancing health equity because of its large footprint in the U.S. healthcare system and importance as a source of coverage for people with disparities. As Medicaid programs increasingly articulate health equity and disparity reductions among their goals, careful consideration of how health equity can be incorporated into purchasing and payment decisions is warranted. A report from the Urban Institute examines four payment purchasing strategies that states have at their disposal to drive health equity in Medicaid: managed care contracting, benefits and care delivery model design, payment reforms, and section 1115 waiver demonstrations. This report identifies key considerations, limitations, and lessons to inform Medicaid policy and practices based on examples from Minnesota, North Carolina, Ohio, and Oregon.

State Medicaid Actions to Ensure Access to Gender-Affirming Care

The transgender community experiences stark health disparities resulting from discrimination, violence, stigma and a lack of culturally competent providers. Compared with the general U.S. population, transgender individuals suffer from more chronic health conditions related to substance-use, mental illness, sexual and physical violence, and earlier onset of disabilities. A new brief from Manatt Health describes state Medicaid actions to ensure access to gender-affirming care. Some states provide comprehensive coverage through their Medicaid programs, while other states have explicit Medicaid policies that exclude gender-affirming care for minors and/or adults. States looking to ensure and enhance access to gender-affirming care can pursue strategies described in this brief and continue to learn from one another on how to create a more inclusive healthcare delivery system.


State updates: AZ, CA, IL, MD, MN, MO, NC, ND, NE, OR, PA & UT

  • Arizona – The Arizona Health Care Cost Containment System announced it has met the requirements of the state statute to determine Medicaid eligibility for members who had maintained coverage during the pandemic.
  • California
    • The Department of Health Care Services (DHCS) announced a new law allowing adults ages 26 through 49 to qualify for full-scope Medi-Cal, regardless of immigration status beginning January 1. This initiative, called the Ages 26 through 49 Adult Expansion, is modeled after the Young Adult Expansion, which provided full scope Medi-Cal to young adults 19 through 25, and the Older Adult Expansion, which provided full scope Medi-Cal to adults 50 years of age or older.
    • DHCS announced it has received federal approval of its managed care organization (MCO) tax waiver application. The MCO tax is estimated to provide $19.4 billion in net non-federal funding over a 3.75-year tax period. The revenue will allow DHCS to move forward with targeted provider rate increases. Effective January 1, 2024, rates for primary care, maternity care (including OB/GYNs and doulas), and non-specialty mental health services increased to at least 87.5% of Medicare rates.
  • Illinois – The Illinois Department of Healthcare and Family Services announced the approval of 11 applications to proceed towards certification in the Supportive Living Program for Dementia Care Settings. The Supportive Living Program is a Medicaid alternative that offers services at a lower cost than a nursing home and can prevent or delay the need for nursing home care. The program operates through a home and community-based services waiver approved by CMS.
  • Maryland – Governor Wes Moore signed an executive order establishing the Longevity Ready Maryland Initiative, directing the Department of Aging to prioritize the wellbeing of older people, people living with disabilities, and caregivers. The Department of Aging is directed to develop a plan that will coordinate and build upon existing state efforts to tackle challenges throughout the lifespan, including a robust care workforce, adequate caregiver support, and equitable healthcare.
  • Minnesota – The Minnesota Department of Human Services eliminated the asset limit for Medical Assistance for Employed Persons with Disabilities (MA-EPD). Effective January 1, 2024, people are eligible for MA-EPD with no limit to the amount of assets they own.
  • Missouri – The Missouri HealthNet Division and the St. Louis Integrated Health Network are jointly sponsoring an event to launch Group Prenatal Care on January 12, 2024. Group prenatal care models are designed to improve patient education and include opportunities for social support while maintaining the risk screening and physical assessment of individual prenatal care.
  • Nebraska – The Nebraska Department of Health and Human Services will host a public hearing on proposed changes to improve dental care. The proposed changes include removing the annual dental benefit maximum; reimbursement for each step of denture treatment, rather than when the process is complete; covering asymptomatic wisdom tooth extraction; and reimbursement of select services provided by public health dental hygienists.
  • North Carolina
  • North Dakota – The North Dakota Department of Health and Human Services announced several state Medicaid plan changes effective January 1, 2024, including a 3.2% inflationary increase for all nursing facility services and a 3% inflationary increase for psychiatric residential treatment facility services.
  • Oregon
    • Governor Tina Kotek announced a $25 million partnership with coordinated care organizations (CCOs) across the state, with a focus on expanding youth behavioral health services. The state and CCOs developed a plan to reinvest surplus Medicaid dollars into Oregon communities. This partnership will support behavioral health projects that serve the youth, meet the greatest need, and are geographically diverse.
    • The Oregon Health Authority’s Ombuds Program, which serves as the advocate for Oregon Health Plan (OHP) members, released a report detailing top concerns from OHP members specific to child and youth mental health. The report makes recommendations to improve mental health services and supports for children, youth and families across Oregon.
  • Pennsylvania – The Pennsylvania Insurance Department announced it will allow insurers to ask applicants to voluntarily provide demographic data on insurance applications in an effort to promote equity initiatives. Insurers will need to inform applicants that the demographic data questions are optional, why the data is being collected, and how the data will support equitable coverage efforts.
  • Utah – Effective January 1, 2024, the state of Utah will offer medical and dental benefits for non-U.S. citizen children, called State CHIP. Children of working families may be eligible if they do not have other health insurance and cannot qualify for Medicaid or the traditional CHIP program due to citizenship status. A special open enrollment for State CHIP began on January 1, 2024.