July 6 Update

In This Week’s Update:

  • New CMCS Director  
  • ACA Parameters for 2022
  • Rule Limiting Surprise Billing
  • State Updates: IL, LA, MA, MO, NC, NJ, NY, OK, OR, RI, & VA   
  • Building Health Equity Into Medicaid Budgeting
  • Understanding Racial Health Disparities in NY
  • Learning Collaborative on Midwifery-Led Care Models  


New CMCS Director

The Centers for Medicare and Medicaid (CMS)  announced Daniel Tsai as Deputy Administrator and Director of Center for Medicaid and CHIP Services (CMCS). Tsai will lead the Center’s efforts to address disparities in health and serve the needs of children, pregnant people, parents, seniors, and individuals with disabilities who rely on federal programs. He previously served as Medicaid Director for the Commonwealth of Massachusetts.


ACA Parameters for 2022

The Department of Health and Human Services (HHS) and the Department of Treasury released a proposed 2022 Notice of Benefit & Payment Parameters rule, which governs the Affordable Care Act health insurance marketplaces and insurance standards for plan year 2022. The rule reverses several provisions finalized in January 2021 by the previous administration. 


Related resource: Round III of the 2022 Notice of Benefit & Payment Parameters: Implications for States


Rule Limiting Surprise Billing

The Departments of Health and Human Services, Labor, and Treasury, and the Office of Personnel Management issued an interim final rule implementing the “No Surprises Act”, restricting excessive out-of-pocket costs to consumers from surprise billing and balance billing. This rule extends protections to Americans insured through employer-sponsored and commercial health plans. 

 State Updates

  • Illinois
    • The Pritzker administration announced increased rates of pay for eligible in-home care providers. Made possible by funding from the administration’s FY 21 and 22 budgets, the Illinois Department on Aging and Department of Human Services will issue $54 million in bonus payments for services rendered by eligible providers between January 1 and March 31, 2021, to make up for the rate increase that was frozen until April 1.
    • The administration also announced $94.3 million will be awarded in the state’s inaugural round of Healthcare Transformation Collaboratives funding. The Department of Healthcare and Family Services will administer the awards to eight innovative partnerships across the state in order to reorient health care in Illinois to reduce inequities, improve health outcomes, address social determinants of health, and remedy persistent difficulties for underserved communities to access quality healthcare.
  • Louisiana – Louisiana marked five years since expanding Medicaid coverage to its low-income residents. As of July 1, 2021, more than 638,000 Louisiana residents are enrolled in Medicaid expansion. Governor Edwards noted positive health benefits Louisiana residents have had over the past five years, including: an average of 72 percent of adults enrolled have visited a doctor’s office during each year of Medicaid expansion, more than 105,000 women have been screened for breast cancer, over 63,000 adults have received colon cancer screenings, and about 100,000 adults have been diagnosed and provided an opportunity for treatment for either diabetes or hypertension.
  • Massachusetts – Massachusetts announced additional vaccination opportunities for residents via the Vax Bus, a rolling mobile vaccination unit that will increase access to the vaccines across the state. Two buses will provide local community-based vaccination clinics as they travel across the state from June 26 through July 15.
  • Missouri – The Missouri Department of Health and Senior Services published the Missouri Pregnancy-Associated Mortality Review: 2018 Annual Report on behalf of the state’s Pregnancy-Associated Mortality Review board. The annual report contains data including the timing of maternal deaths and factors that contributed to these deaths, such as substance use disorder and mental health conditions. The report also reflects the disparities that exist in the state and among certain populations, including Black and publicly-insured communities.
  • New Jersey – Governor Phil Murphy signed legislation allowing hospitals to construct housing and provide wrap-around services for individuals experiencing homelessness or housing insecurity.
  • New York – NY State of Health, the state-based marketplace, and the New York State Department of Agriculture and Markets announced that certified enrollment assisters will be on site at select farmers’ markets statewide to educate New Yorkers about new and enhanced federal financial assistance now available to current enrollees and new enrollees.
  • North Carolina  
    • Beginning July 1, nearly 1.6 million Medicaid beneficiaries in North Carolina began receiving their Medicaid services via the NC Medicaid Managed Care health plans. Features of the state’s program include establishing a payment structure that rewards better health outcomes, integrating physical and behavioral health, and investing in non-medical interventions aimed at reducing costs and improving the health of Medicaid beneficiaries.
    • Healthier Together, a public-private partnership between the North Carolina Department of Health and Human Services and NC Counts Coalition, awarded $500,000 in grants to support community groups that will help North Carolina deliver equitable access to COVID-19 vaccines. The Healthier Together grants fund activities such as conducting vaccine outreach and education efforts, helping people schedule appointments, arranging transportation, coordinating local vaccine events at trusted and accessible locations, and ensuring that people get to second-dose appointments.
  • Oklahoma – Medicaid expansion benefits began on July 1, 2021, following a ballot initiative passed last year. The Oklahoma Health Authority is tracking enrollment on a dashboard, reporting that 126,014 individuals have been approved for expansion benefits to date.
  • Oregon – The Division of Financial Regulation announced that Oregonians can see and comment on the state’s preliminary rate decisions for 2022 individual and small employer health insurance plans. For the individual market, six companies were issued preliminary decisions with average rate changes ranging from a 1.0 percent decrease to a 4.9 percent increase. The preliminary decisions will go through continued review and discussion during a series of virtual public hearings on July 6 and 7.
  • Rhode Island – The Rhode Island Department of Health announced an expansion to support and funding to establish four new Health Equity Zones (HEZs). Like the 11 existing HEZs, the four new HEZs will annually receive $150,000 in core funding and support to ensure these communities ground their work in public health principles and best practices, certifying that measurable outcomes are reached and evaluated.
  • Virginia – Governor Ralph Northam announced that more than 750,000 adult Medicaid members will have access to comprehensive dental services under a benefit that began on July 1, 2021. Adult members currently eligible for full Medicaid benefits will have more services and provider choices under the initiative approved in the new state budget. The new benefit covers up to three regular cleanings annually as well as preventive care, X-rays, fillings, dentures, oral surgeries and other oral health services.



Building Health Equity into Medicaid Budgeting

The COVID-19 pandemic, the ensuing recession, and amplification of issues related to health equity have forced state Medicaid agencies to evaluate their budgets and investments to better serve Medicaid enrollees. In the latest episode of the Medicaid Leadership Exchange podcast, Tracy Johnson, Medicaid director at the Colorado Department of Health Care Policy and Financing, and Caprice Knapp, director of the medical services division at the North Dakota Department of Human Services, share strategies on discussing investments in infrastructure that supports long-term health equity goals with budget staff and legislators. They also explore how Medicaid services and budgets are affected by factors impacting equitable care, including criminal justice, childcare, broadband access, and more.


Differential Impacts of COVID-19: Understanding and Eliminating Minority Health Disparities in New York

The University at Albany published a new report analyzing why communities of color in New York have been disproportionately impacted by COVID-19. The research, carried out in partnership with the New York State Department of Health and other organizations, adds to the existing well of knowledge about health disparities in New York by identifying the environmental, socioeconomic and occupational factors that explain why COVID-19 has disproportionately harmed Black and Hispanic New Yorkers and proposes practical intervention strategies to eliminate these disparities and save lives. Additionally, the work suggests important differences exist in the way different minority groups experience the progression of the disease. 


Maternal Health Learning Collaborative on Midwifery-Led Care Models

Offering midwifery-led care options to birthing people is a powerful tool to reduce maternal mortality, morbidity, and disparate outcomes for those covered by Medicaid. However, few resources exist to support Medicaid stakeholders including state Medicaid agencies, Medicaid health plans, provider groups, and consumer/community organizations to implement this high-value, evidence-based model of care. The Institute for Medicaid Innovation, with funding from the W.K. Kellogg Foundation, is launching a national learning collaborative for Medicaid stakeholders. The midwifery learning collaborative is an intensive three-year program providing support, resources, and guidance for state-based teams to develop sustainable initiatives to advance midwifery-led models of care for the Medicaid population in their communities. Up to five state-based teams will be selected. Applications are due Friday, July 9.