July 26 Update

In This Week’s Update:

  • CMS Repeals 2019 Public Charge Determination
  • HHS Renews Public Health Emergency
  • State Updates: CA, LA, ME, MD, MO, NC, OR & WI
  • Leveraging Community Expertise to Advance Health Equity
  • The Case for the Accountable Health Communities Model
  • Medicaid Policy Options for CYSHCN Post-COVID-19


CMS Repeals 2019 Public Charge Determination

CMS released an Informational Bulletin reminding states that the Department of Homeland Security (DHS) 2019 Public Charge Final Rule has been vacated and is no longer in effect. DHS will not consider an individual’s receipt of Medicaid benefits as part of the public charge determination, with one exception for individuals who are institutionalized on a long-term basis (such as nursing facility residents) and are receiving Medicaid coverage for their institutional services.


HHS Renews Public Health Emergency

HHS Secretary Xavier Becerra renewed the federal public health emergency (PHE). The PHE is in effect through October 17, 2021. 


Related resource: Federal Declarations and Flexibilities Supporting Medicaid and CHIP COVID-19 Response Efforts Effective and End Dates 


State Updates 

  • California – The Department of Health Care Services notified county agencies that it received approval from the federal government to extend time-limited Refugee Medicaid Assistance Medi-Cal benefits to eligible refugees, asylees, federally certified victims of human trafficking, and other entrants who are not eligible to receive Title XIX Medi-Cal benefits. Medi-Cal coverage in the Refugee Medical Assistance program is extended until September 30, 2021.
  • Louisiana – The Louisiana Department of Health is developing competitive procurements for qualified companies to serve as single benefit managers for its Medicaid non-emergency medical transportation (NEMT) and pharmacy benefit (PBM) programs. LDH is seeking input from the public on the NEMT and PBM programs to inform the procurements.
  • Maine – In response to the COVID-19 pandemic’s impact on the provision of behavioral health services, the Maine Department of Health and Human Services is issuing one-time supplemental payments to help offset lost revenue for certain behavioral health services. Payments are proportional to revenue loss experienced during the pandemic and are calculated by comparing provider revenue for behavioral health services from a baseline period six months prior to the pandemic to revenue for the same six months during the pandemic. 
  • Maryland – The Maryland Department of Health submitted a renewal application to CMS to extend the HealthChoice Section 1115 demonstration through December 31, 2026. The proposed renewal application aims to modify three demonstration programs: (1) Assistance in Community Integration Services Pilot Program; (2) Home Visiting Services Pilot Program; and (3) the Residential Treatment for Substance Use Disorder program. In addition, the renewal will add three new programs: (1) Emergency Triage, Treatment, and Transport Model; (2) Expansion of IMD for SMI population; and (3) the Material Opioid Model program.
  • Missouri – The Missouri Supreme Court overturned a lower court ruling that found a voter-approved constitutional amendment to expand Medicaid was invalid. The judges unanimously ruled that a ballot measure voters approved last August only requires that Medicaid be expanded under the Affordable Care Act and does not force the state legislature make a new appropriation, which would have been unconstitutional. The decision returns the case to the lower court to determine next steps.
  • North Carolina
    • The North Carolina Department of Health and Human Services (NCDHHS) is partnering with Piedmont Triad Regional Council Area Agency on Aging (PTRC AAA) to provide free COVID-19 vaccinations to people with limited mobility who cannot leave their home. The new initiative expands PTRC AAA’s local at-home vaccination program to communities across the state. The At-Home Vaccination Hotline at 1-866-303-0026 allows caregivers, providers and individuals across North Carolina to schedule an at-home vaccination. An online registration form is also available. A PTRC Vaccination Specialist then follows up to schedule an at-home vaccination.
    • NCDHHS announced that the state’s five Medicaid prepaid health plans have joined NCCARE360, the statewide coordinated care network connecting individuals to local services and resources. The plans will use the platform to coordinate whole-person care, promote health equity and address the social drivers that influence their members’ health.
  • Oregon
    • The state submitted a five year demonstration extension request to CMS seeking authority to provide Medicaid family planning services to eligible men and women of childbearing age who are not otherwise eligible for Medicaid, have a household income at or below 250 percent of the federal poverty level, may not have insurance, and/or are not able to use their available insurance to meet their reproductive health care needs. The federal public comment period is open through August 22, 2021.
    • The Oregon Health Authority released its annual Oregon Hospital Payment report as an online dashboard, which has been updated with 2019 data. The report details the median amounts paid by commercial insurers for the most common inpatient and outpatient procedures performed in Oregon hospitals in 2019 and the median prices on 115 procedures that account for over $1.2 billion in payments to hospitals. Among these procedures, 79 of the 115 saw increases in median prices, while 32 procedures saw prices fall and four stayed the same.
  • Wisconsin – The Department of Health Services is co-hosting visits to home lead abatement projects to raise awareness of childhood lead poisoning and what can be done to prevent it. The DHS Lead Policy Advisor is visiting homes with active lead abatement projects to highlight the work of local public health departments, community partners, and contractors who work together to prevent childhood lead poisoning. 


Leveraging Community Expertise to Advance Health Equity

The COVID-19 pandemic’s disproportionate effects on people of color and increased attention to racial justice have given rise to new or expanded efforts to address health inequities. In a new issue brief by the Urban Institute, the authors examined how governments and organizations adopt community engagement approaches to collaborate and share power with communities that experience health inequities. Drawing on interviews with representatives from national organizations and stakeholders in four states, the authors identified principles and strategies that help build trust with and engage community members, including ensuring sufficient and flexible funding and cross-sector support, dedicating time and patience and forging continuity, and fighting structural racism more broadly. The urgency of the pandemic is not only a challenge but an opportunity to elevate and operationalize community voices to better understand drivers of inequities and develop solutions with community buy-in, ultimately leading to inclusive and sustainable progress toward health equity.


Advancing Value and Equity in the Health System: The Case for Accountable Communities for Health

A new report released by the Funders Forum on Accountable Health and the California Accountable Communities for Health Initiative (CACHI) reveals how the Accountable Communities for Health (ACH) model is emerging as an important vehicle for improving population health and health equity. ACHs recognize that health is the result of interdependent factors at work in a community and that no single entity controls all the levers. This model brings together health care providers, public health departments, schools, social service agencies, and others, along with residents in a collective effort to make a community healthier, more equitable and resilient. The report and a companion executive summary provides an alternative framework for defining and assessing value that moves beyond the traditional “Return on Investment (ROI)” and captures the transformational nature of the ACH. It identifies three key roles that ACHs play in the community and provides in-depth case studies to demonstrate each role. This new framework will be discussed during a webinar on “Lessons Learned from the Accountable Community for Health Model.” The webinar will take place on August 24, and is part of a new webinar series that seeks to identify key lessons for scaling this model as policy makers across the country increasingly endorse multisector collaboratives focusing on equity as a way to better address social determinants of health. 


Medicaid Options for States During COVID-19: Considerations for Children and Youth with Special Health Care Needs

A new fact sheet by Georgia Health Policy Center and the Association of Maternal and Child Health Programs summarizes the implications for children and youth with special health care needs (CYSHCN) of critical Medicaid policy modifications that states implemented rapidly in response to the COVID-19 crisis. The COVID-19 pandemic has required state Medicaid programs to quickly adapt to a new health care delivery landscape for millions of children, including CYSHCN. With the economic downturn, growth in the program has soared. Over 2.7 million children nationally enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) during the eight-month period from March 2020 to November 2020. To respond to the crisis, CMS created multiple policy options that states have used to institute critical modifications to their Medicaid programs during the PHE. This fact sheet explores Medicaid policy options for states to meet the needs of CYSHCN during the PHE and discusses how future rollbacks of PHE modifications may affect CYSHCN populations. The document may help inform state decisions regarding which adaptations should become permanent.