July 31 Update

In Last Week’s Update:

  • Mental health parity proposed rule
  • Recognizing Medicaid 58 Years Later 
  • How Managed Care Is Supporting Unwinding
  • State updates: CA, CO, CT, DC, GA, IL, NC, NH, NJ, NV, NY, PA & WI


Mental Health Parity Proposed Rules

Last week the departments of Labor, Health and Human Services and the Treasury announced proposed rules to improve and strengthen mental health parity requirements and provide clear guidance to plans and issuers on how to comply with the requirements of the Mental Health Parity and Addiction Act. The Department of Labor, in consultation with the departments of Health and Human Services and the Treasury, also issued a technical release that requests public feedback on proposed new data requirements for limitations related to the composition of a health plan’s or issuer’s network.

Recognizing Medicaid on its 58th Anniversary

58 years ago, President Lyndon B. Johnson signed the Medicare and Medicaid Act into law, establishing Medicaid as the national healthcare safety net. Today, Medicaid covers more than 90 million adults and children and drives innovations in healthcare access, care delivery, and health equity in all 50 states. That’s Medicaid, a project supported by the Robert Wood Johnson Foundation, is recognizing the anniversary with a new Twitter thread that shares stories of individuals who turned to Medicaid at critical moments in their lives. Visit ThatsMedicaid.org to find a story about Medicaid in your state.

How Managed Care Is Supporting Unwinding

The Institute for Medicaid Innovation released findings from their survey of Medicaid health plans. The survey, supported by the Robert Wood Johnson Foundation, asked plans how they are handling the redetermination process in an effort to identify best practices. The national survey captures information that can be used to inform federal and state policymaking and provides insight on the barriers, challenges, and successes health plans are experiencing related to Medicaid redeterminations. This is the first in a four-part series of surveys related to the unwinding of the Medicaid continuous coverage requirement.

State Regulation of Hospital Outpatient Facility Fees

Healthcare consolidation—in conjunction with growing insurance deductibles and other changes to coverage—is increasingly exposing consumers to a new expense when they seek outpatient medical care: hospital facility fees. In a new report, researchers from Georgetown University’s Center on Health Insurance Reforms explore outpatient facility fee billing in the commercial sector, the impact of these fees on consumers and how states are seeking to regulate them and better protect consumers. The companion issue brief, co-authored with West Health, provides a high-level overview of the current state laws on outpatient facility fees.

State updates: CA, CO, CT, DC, GA, IL, NC, NH, NJ, NV, NY, PA & WI

  • California
    • Covered California, the state’s official health insurance Marketplace, announced that its board of directors approved enhanced benefit designs that will ensure over 600,000 Covered California enrollees see reduced out-of-pocket costs in 2024. The state’s fiscal year 2024 budget appropriates $82.5 million of the Health Care Affordability Reserve Fund to Covered California to support a program of financial assistance for coverage year 2024. About 40% of Covered California’s enrollees will be eligible for cost-sharing reduction benefits, deductibles will be eliminated entirely in all silver plans, and other benefits such as reduced generic drug costs, copays and maximum out-of-pocket costs will vary by plan.
    • Covered California announced its health plans and rates for the 2024 coverage year with a preliminary weighted average rate increase of 9.6%.
  • Colorado – The Department of Health Care Policy & Financing (HCPF) is hosting its annual stakeholder webinar during which HCPF leaders will share what the Department has accomplished over the past year, address priorities for this fiscal year and invite stakeholder feedback and comments.  
  • Connecticut – Governor Ned Lamont signed into law legislation that will license free-standing birth centers and allow them to operate in Connecticut, serving as an alternative to traditional hospitals for low-risk pregnancies and deliveries. The goal of the new law is to expand access and increase choices for high-quality maternal health services and will fill geographic and financial gaps that often prevent patients from receiving needed birthing care.
  • District of Columbia – The District of Columbia Department of Health Care Finance announced during a bi-weekly Medicaid renewal community meeting that it is conducting dedicated outreach to special populations, including senior enrollees, enrollees living with disabilities, and enrollees experiencing homelessness. For the latest update on state activities in support of unwinding see our July 21 States of Unwinding post.
  • Georgia – CMS sent a letter conditionally approving Georgia’s Blueprint Application to operate a State-Based Exchange (SBE) for plan year (PY) 2025, and to operate a State-Based Exchange on the Federal Platform (SBE-FP) for plan year 2024. Georgia has until August 4, 2023, to respond as to whether or not it will transition to an SBE-FP for PY 2024.
  • Illinois – Governor JB Pritzker signed into law the “Deceptive Practices of Limited Services Pregnancy Centers Act,” which bars so-called “crisis pregnancy centers” from using misinformation, deceptive practices, or misrepresentation in order to interfere with access to abortion services or emergency contraception. The law also allows the Illinois attorney general to investigate complaints against centers and strengthens the attorney general’s power to prosecute incidences of consumer fraud.
  • New Hampshire – The New Hampshire Department of Health and Human Services, Division of Long Term Services and Supports is seeking responses to a request for proposals from New Hampshire counties to pilot a program that defers and delays institutional care for individuals who are dually eligible for Medicare and Medicaid benefits. The purpose of the pilot is to identify opportunities to develop a comprehensive community-based care system that supports individuals staying in the community longer, as opposed to entering institutional care. 
  • New Jersey – Governor Phil Murphy signed legislation to establish a commission to study the effects of social media usage on youth to further address the mental health needs of New Jersey youth. The commission will issue a final report detailing its findings, including proposed social media usage standards, effective strategies to mitigate the adverse effects of social media usage on student health and academic performance, and other recommendations.
  • New York – The New York State Department of Health released the first issue of the state’s “Public Health Emergency Unwind Dashboard,” a monthly report reflecting data on renewal status, demographics and program transitions for public health insurance enrollees. The report indicates that roughly 72% of New Yorkers enrolled in Medicaid, Child Health Plus or the Essential Plan renewed their coverage before the June deadline to re-enroll. As a reminder, SHVS continues to track states that are publicly reporting unwinding data.
  • Nevada – The Department of Health and Human Services released a request for information for the state’s next Medicaid managed care procurement.
  • North Carolina – The North Carolina Department of Health and Human Services (NCDHHS) announced an anticipated start date for Medicaid expansion of October 1, 2023. This announcement is part of a compromise agreement NCDHHS obtained from CMS that will allow NCDHHS to move forward with the required public notices for enrollees, counties and providers while still awaiting authority from the state general assembly.
  • Pennsylvania – The Department of Human Services announced that Pennsylvania will receive an estimated $42 million in federal funding from CMS through the Money Follows the Person Program to continue existing and support new community-based healthcare services for individuals who are elderly or disabled.
  • Wisconsin – The Wisconsin Department of Health Services launched a new webpage showing statewide Medicaid enrollment data following the end of the continuous coverage requirement. The data on the new webpage show that in June, 99,037 members were due to renew their coverage and 61,057 members took some action to initiate the renewal process.