In This Week’s Update:

• Upcoming SHVS webinar
• SHVS Launches New States of Innovation Page
• Designing a Health-Related Social Needs Strategy in Medicaid
• Who Benefits From Enhanced Premium Tax Credits in the Marketplace
• Medicaid and Maternal Health Policies in New CMS Proposed Regulation
• State updates: CA, CT, IL, IN, KY, NC, NJ, OR, PA, RI, UT, VT & WA

Upcoming SHVS Webinar
On Monday, July 15 at 2:00 p.m. ET, State Health and Value Strategies (SHVS) will host a webinar on the revisions to the Office of Management and Budget’s (OMB) Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity. During the webinar, experts from the State Health Access Data Assistance Center and Health Equity Solutions will review the new OMB standards for race and ethnicity data collection and discuss the implications for state health equity efforts as well as program operations. Please be sure to register for the webinar (which is required) and feel free to share the registration information with other interested state colleagues.

SHVS Launches New States of Innovation Page 
Last week, SHVS launched a new webpage to host its States of Innovation series, where the posts can be filtered by topic and state. The series profiles the latest health news at the state level, highlighting what states are working on to achieve better, more affordable, and more equitable health for all. The latest post, States of Innovation: June 2024, includes state efforts to engage the community, advance health equity, new action on maternal health, and more. Updates follow.

 

Designing a Health-Related Social Needs Strategy in Medicaid
With increasing support and guidance from CMS and its federal partners, states are using a variety of Medicaid levers to address individuals’ health-related social needs (HRSN). This is still a new and emerging priority for many state Medicaid programs and there is no one-size fits all approach to offering HRSN to members. A tool from the Center for Health Care Strategies presents foundational decision points for states in defining an approach to address HRSN, with a focus on three key areas: coverage, accountability mechanisms, and infrastructure to support partnerships with community-based organizations. The tool also features practical examples detailing how nine states are approaching decisions related to HRSN services.

 

Who Benefits From Enhanced Premium Tax Credits in the Marketplace
Enhanced premium tax credits (PTCs) were a key element of the American Rescue Plan Act passed by Congress in March 2021, which aimed to expand and stabilize health insurance coverage during the COVID-19 pandemic. The Inflation Reduction Act of 2022 then extended the enhanced PTCs through 2025, and as a result, Marketplace enrollment during the 2024 open enrollment period jumped by 5 million people, or 31%. A brief from the Urban Institute estimates the impact of the enhanced PTCs on coverage for 2025, the last year in which they are authorized under current law. Findings project that 7.2 million more people will receive subsidized Marketplace coverage under the enhanced PTCs and there will be four million fewer uninsured people in 2025 relative to a policy under the original PTCs.

 

Medicaid and Maternal Health Policies in New CMS Proposed Regulation
CMS released a proposed Medicare payment rule that included important maternal health and Medicaid policies, including creating a minimum standard for hospital obstetrical services. For the first time ever, CMS is proposing a hospital “condition of participation,” requiring Medicare-participating hospitals to meet certain quality and safety standards for the obstetrical care they provide. CMS also proposes to codify the requirements of the Consolidated Appropriations Act, 2023 to require 12 months of continuous eligibility for children under the age of 19 enrolled in Medicaid and CHIP. For CHIP, CMS also proposes to remove failure to pay premiums as an optional exception to continuous eligibility. The proposed rule also includes Medicaid reimbursement for services furnished outside of a freestanding clinic by Indian Health Service/Tribal clinics. In addition, at state option, federal reimbursement would also be available for services provided by behavioral health clinics and services provided by clinics located in rural areas.

 

State updates: CA, CT, IL, IN, KY, NC, NJ, OR, PA, RI, UT, VT & WA

• California – The California Department of Health Care Services (DHCS) will partner with California Black Media to host six community engagement events throughout the month of July. DHCS leadership and representatives from Medi-Cal managed care plans will meet with newspaper publishers and business, faith, and community-based leaders in the Black community to discuss new Medi-Cal benefits and services and how Black media outlets can help share information with Medi-Cal members and their families.
• Connecticut – Beginning July 1, Connecticut expanded the state-funded health coverage program for non-citizen children from age 12 to age 15. Children who are enrolled in the program prior to age 16 may be eligible for continuous enrollment through age 18. As a reminder, SHVS is tracking state-funded affordable health coverage programs for non-citizens here.
• Indiana – The Indiana Family and Social Services Administration announced that Indiana PathWays for Aging launched for more than 123,000 eligible individuals aged 60 and over. PathWays for Aging is a Medicaid managed care program designed to provide choice for those members who want to age in their homes or communities.
• New Jersey – Governor Phil Murphy signed the Fiscal Year 2025 budget into law, which includes a total of over $34 million to advance nine different recommendations in the Nurture NJ Maternal and Infant Health Strategic Plan. This investment includes: $23 million to expand Family Connects NJ, the statewide universal nurse home visitation program; $3.2 million for the operation of the newly established Maternal and Infant Health Innovation Authority; $2.9 million to become the first state in the nation to cover delivery fees for online WIC purchases; and more.
• North Carolina – Governor Roy Cooper and the North Carolina Department of Health and Human Services (NCDHHS) announced new actions to lessen the burden of medical debt for approximately two million low-income North Carolinians. NCDHHS submitted a request to CMS to approve a set of conditions hospitals must meet to be eligible to receive an enhanced amount of Medicaid funds, including relieving existing medical debt and establishing policies to prevent the accumulation of medical debt. As a reminder, SHVS authored an expert perspective mapping state efforts to cancel medical debt and prohibit medical debt reporting.
• Oregon – Beginning July 1, Oregon began offering free health coverage to people in more income categories through a new benefit called the Oregon Health Plan (OHP) Bridge, the state’s Basic Health Program, for people with incomes between 138 and 200% of the federal poverty level. OHP Bridge will have no member costs and an estimated 100,000 people are anticipated to qualify for the program.
• Pennsylvania – Governor Josh Shapiro signed SB739 into law, expanding access to telemedicine services by requiring health insurers and managed care plans to pay for covered healthcare services provided through telemedicine. The law also sets telehealth accessibility standards for Medicaid and the Children’s Health Insurance Program.
• Rhode Island – Governor Dan McKee signed a bill into law that supports reproductive and gender affirming healthcare in Rhode Island. The new law provides legal shielding for healthcare providers administering gender-affirming or reproductive care. Another bill Governor McKee signed into law eliminates pre-authorization for HIV prescriptions.
• Vermont – A 2022 law, Act 119, went into effect on July 1, implementing a minimum floor for Vermont hospitals providing charity care to protect consumers from medical debt. Under the new requirements, Vermont residents with incomes up to 250% of the federal poverty level (FPL) will have access to free medical care at Vermont hospitals; residents with incomes up to 400% FPL will receive a discount of at least 40% on hospital bills or out-of-pocket costs if they are insured; and residents with incomes up to 600% FPL can be charged no more than 20% of their household income in medical bills. The law also bars hospitals from selling medical debt.
• Washington – The Washington Health Care Authority announced the launch of the Crisis Response Improvement Strategy (CRIS) Lived Experience Stories Project. This project will elevate stories of people across the state who have accessed behavioral health crisis services for themselves or someone else. The lessons learned from these stories will be integrated into recommendations for improving Washington’s behavioral health crisis system. A $25 gift card will be offered for the first 200 stories received.
• Illinois, Kentucky, Oregon, Utah & Vermont – CMS has approved Medicaid reentry section 1115 demonstration requests in five states to provide Medicaid and CHIP coverage up to 90 days before an eligible person’s expected release from incarceration. This includes coverage of substance-use disorder treatment before an enrollee is released from jail, prison, or a youth correctional facility. Additionally, states will be able to help connect the person to community-based Medicaid and CHIP providers up to 90 days prior to their release to ensure they can continue their treatment after they return to the community. For more information on the opportunity for states to provide certain pre-release healthcare services to justice-involved populations, see the SHVS webinar, Section 1115 Demonstration Opportunity to Support Reentry for Justice-Involved Populations: CMS Guidance.