January 9 Update

In This Week’s Update:

  • Medicaid Director Letter
  • Medicaid Innovation Award: Coffee Chat with Kentucky and West Virginia
  • New Report Highlights Gap in the No Surprises Act
  • Asian American and Native Hawaiian/Pacific Islander Adults Face Healthcare Access Challenges Related to Limited English Proficiency
  • State updates: CO, MN, NJ, NM, NY, OK, SC, TN & VA


CMS Issues Letter to State Medicaid Directors 

Last week, CMS released a State Medicaid Director Letter that provides guidance for states on the use of “in lieu of services and settings” in Medicaid managed care to address health-related social needs for people enrolled in Medicaid. The letter establishes the requirements and guardrails states must meet to ensure the use in lieu of services are cost effective, medically appropriate, preserve enrollee rights and protections, and fulfill the objectives of the Medicaid program.


Medicaid Innovation Award: Coffee Chat with Kentucky and West Virginia

The Robert Wood Johnson Foundation and the National Academy for State Health Policy (NASHP) will host a virtual coffee chat on January 10, 12:00 P.M. ET, with Medicaid leaders who received Medicaid Innovation Awards last fall for demonstrating unique approaches to improving the lives of Medicaid enrollees while advancing health equity. The coffee chat will feature leaders from Kentucky and West Virginia, along with NASHP executive director Hemi Tewarson, for an informal discussion about their state’s innovations which increase access and reduce health disparities in Medicaid. Kentucky implemented a range of measures during the COVID-19 pandemic to simplify Medicaid enrollment and increase access to coverage including targeted, data-driven marketing and outreach; a simplified application; and coordination with other state agencies. West Virginia launched a program for children in foster care that reduces fragmentation and provides a continuum of acute services, delivers needed services in an integrated and cost-effective way, and ensures quality across services. State leaders will provide tangible examples of how they supported innovations to increase access to care. Expert speakers include Lisa Lee, Commissioner of the Kentucky Department for Medicaid Services, and Susan Hall, Chief of Medicaid Managed Care at the West Virginia Department of Health and Human Services.


New Report Highlights Gap in the No Surprises Act

A blog post from the Georgetown Center on Health Insurance Reforms highlights a gap in the No Surprises Act (NSA) that puts consumers at a significant financial risk when they need emergency medical transport. On December 9, CMS announced the membership of the Advisory Committee on Ground Ambulance and Patient Billing. This committee was created by the NSA, legislation that instituted landmark federal protections against unexpected bills when patients receive unanticipated out-of-network care. While the NSA applies to services provided by physicians, hospitals, ambulatory care centers, and air ambulances, the federal law does not apply to ground ambulance services. Instead, the legislation established a committee charged with “reviewing options to improve the disclosure of charges and fees for ground ambulance services, better informing consumers of insurance options for such services, and protecting consumers from balance billing.” As the committee prepares to begin its work, there is evidence that ground ambulance remains a significant gap in the NSA’s consumer protections. SHVS has a resource page with materials for states where we have been tracking federal guidance related to implementation and oversight of the NSA.


Asian American and Native Hawaiian/Pacific Islander Adults Face Healthcare Access Challenges Related to Limited English Proficiency

A brief from the Urban Institute assesses the extent of limited English proficiency (LEP) among Asian American and Native Hawaiian/Pacific Islander (AANHPI) nonelderly adults and variation in LEP across AANHPI subgroups, using the most recently available data from the American Community Survey. Growing interest in addressing health equity is fueling efforts to better understand the unique challenges faced by AANHPI communities. A lack of language accessibility for AANHPI people who are not proficient in English, in particular, could restrict their access to health insurance and healthcare, especially for those who may have to navigate complicated systems to enroll in coverage. Findings show that overall, AANHPI adults have LEP at rates nearly as high as Latino/a adults. But while Spanish is frequently offered in health system settings and materials (e.g., the federal marketplace for purchasing health insurance coverage or state Medicaid resources) as a language option for people who do not speak English, the diverse languages spoken by AANHPI adults are rarely available. These findings show the need for greater language accessibility for AANHPI adults with LEP in healthcare and other settings, especially as some pandemic-related health insurance coverage protections expire and the need for clear communication from state health insurance agencies to enrollees continues to grow.


State updates: CO, MN, NJ, NM, NY, OK, SC, TN & VA

  • Colorado – The Department of Health Care Policy & Financing is seeking member feedback through a member case management agency survey, which provides stakeholders an opportunity to participate in the case management agency selection process while maintaining the integrity of the competitive process and state procurement law. The survey consists of five questions targeting key areas of importance that long-term services and supports and home and community-based services stakeholders need most from their case management agency.
  • Minnesota – The Department of Human Services is hosting the “SUD Shared Solutions Summit” during which participants will begin work on a three- to five-year strategic action plan to improve Minnesota’s substance use disorder treatment system. Organizers held two listening sessions and hosted a survey to help inform the summit’s planning and sessions will focus on key themes identified during the listening sessions.
  • New Jersey
    • The New Jersey Department of Banking and Insurance announced that requirements for comprehensive abortion coverage among insurers in the individual and small employer markets will take effect for the start of the 2023 plan year on January 1, 2023. The department issued a study in November that found the need for regulatory action to require coverage for abortion services without exceptions under health benefit plans regulated by the department.
    • As of January 1, 2023, children under 19 may now apply for NJ FamilyCare, the state’s Medicaid and CHIP program, regardless of their immigration status. All other requirements for NJ FamilyCare still apply.
  • New Mexico – The state submitted a Section 1115 demonstration application to extend Centennial Care 2.0, which is set to expire on December 31, 2023. Under the five-year extension, the state seeks to continue its existing authorities and programs and requests authority to, among other items, provide continuous eligibility for children up to age six; expand the home visiting programs; expand access to supportive housing; provide Medicaid services for high-need justice-involved populations 30 days prior to release; and provide a $500 budget per Native American member per year for traditional healing services.
  • New York
    • New York’s Acting Medicaid Director, Amir Bassiri, joined the Rockefeller Institute of Government’s latest podcast episode of Policy Outsider to examine how New York is using a Section 1115 waiver to address health equity issues. Discussion included how the waiver works, the goals the waiver seeks to accomplish, strategies for achieving those goals, and a vision for the future of Medicaid.
    • The state submitted a Section 1115 demonstration amendment that seeks to authorize federal Medicaid matching funds for reimbursement for services delivered to enrollees residing in Institutions for Mental Diseases with behavioral health diagnoses including serious mental illness, serious emotional disturbance, and substance use disorder.
  • Oklahoma – The state submitted a five year extension request for their current Section 1115 demonstration entitled “Sooner Care” to be effective January 1, 2024, through December 31, 2028. The demonstration has operated since 1996 and the state is requesting to extend approval of the demonstration subject to the same Special Terms and Conditions, waivers, and expenditure authorities currently in effect.
  • South Carolina – The South Carolina Department of Alcohol and Other Drug Abuse Services and Governor Henry McMaster announced a new partnership involving the state’s three research universities that will significantly improve the state’s ability to identify and treat South Carolinians suffering from substance use disorder. University researchers, with technical and administrative assistance from the state agencies, will work together to utilize available data to design effective interventions to improve access to treatment and effectively target assistance to regions of the state that are struggling the most.
  • Tennessee – TennCare, the state’s Medicaid program, issued a press release following passage of the Consolidated Appropriations Act, 2023 stating that it will be required to reverify the eligibility status of everyone receiving TennCare or CoverKids benefits beginning April 1, 2023. TennCare estimates that more than 1.7 million Tennesseans will be impacted by the process.
  • Virginia – The Department of Medical Assistance Services announced the rebranding of Virginia’s Medicaid program. Cardinal Care is Virginia Medicaid’s new name for all health coverage programs for all Medicaid members. The new name and brand were launched on January 1, 2023. The goal of Cardinal Care is to create a clearer, straighter path to care for all Medicaid members.