In This Week’s Update:
- New SHVS Unwinding Toolkit
- Medicaid Leadership Institute Applications Open
- Medicaid Managed Care Innovation In Response to Pandemic
- FAQ’s on Agent Compensation and Availability of Coverage
- Implementing Social Risk Factor Screening Measures
- Standards for Provider Network Adequacy in Medicaid
- State Updates: CO, DE, GA, MI, NH, NC, TX, VA & WV
Last week, State Health and Value Strategies published a new resource for unwinding the continuous coverage requirement, Improving Ex Parte Renewal Rates: State Diagnostic Assessment Tool. Improving ex parte rates as part of the Medicaid renewal process is one of the most effective tools available to states to mitigate coverage loss for eligible individuals when the public health emergency (PHE) ends. This toolkit contains a table that can be used by a state to examine current ex parte processes and identify and deploy additional strategies that could increase their ex parte rates.
FAQ’s on Agent/Broker Compensation and Guaranteed Availability of Coverage
CMS posted an FAQ that says issuers that reduce or eliminate agent and broker commissions for enrollments through special enrollment periods (SEPs) are violating the guaranteed issue provisions of the ACA and doing so would constitute a discriminatory marketing practice. This follows announcements earlier this year from some marketplace insurers that they were eliminating commissions for SEPs. As a reminder, SHVS published an expert perspective on the negative effects of reduced or eliminated SEP commissions on the role of agents and brokers in helping consumers make a smooth transition from Medicaid to the marketplace during the PHE unwinding.
Medicaid Managed Care’s Pandemic Pivot
The Institute for Medicaid Innovation (IMI) will host a webinar examining the innovation that Medicaid health plans led in response to the pandemic to address social determinants of health and improve health equity. With support from the Robert Wood Johnson Foundation, IMI conducted a national environmental scan, culminating in the creation of a comprehensive compendium of 33 innovative initiatives and emerging best practices focused on meeting the health and social needs to address inequities that were exacerbated by COVID-19. Three initiatives in the national compendium will be featured at the upcoming webinar, which will take place on June 27, 3 p.m. ET. Registration can be accessed here.
Call for Applications: Medicaid Leadership Institute, Class of 2023
The Medicaid Leadership Institute, led by the Center for Health Care Strategies, is uniquely positioned to support Medicaid directors in cultivating the necessary skills to successfully lead their Medicaid programs, improve key health outcomes, and advance health equity. Made possible by the Robert Wood Johnson Foundation, it offers an intensive 10-month leadership development program for up to six competitively selected Medicaid directors. Since 2009, 65 state Medicaid directors and their senior leadership teams from states across the political spectrum have participated in the program. Medicaid directors in all states, commonwealths, and territories are eligible to apply. Applications are due July 11, 5 p.m. ET.
Standards for Provider Network Adequacy in Medicaid and the Marketplaces
Under the final Notice of Benefit & Payment Parameters, CMS will require Qualified Health Plan provider networks for plans sold on the federal marketplace to meet minimum time-and-distance standards beginning in 2023 and, beginning in 2024, minimum standards for appointment wait times. A new Center on Health Insurance Reforms blog post examines the new marketplace network adequacy standards and how they compare to Medicaid’s standards. As a reminder, SHVS published an expert perspective, The Final 2023 Notice of Benefit & Payment Parameters: Implications for States.
- Pregnant undocumented immigrants and their children will be eligible for Medicaid starting in 2025 under a bill signed by Governor Jared Polis. Under the law, pregnant undocumented people who would otherwise qualify for Medicaid and the Children’s Basic Health Plan, or CHIP, would be provided full health insurance coverage for up to a year following a child’s birth. Undocumented children will be eligible until they turn 18.
- Governor Polis held a signing of Senate Bill 22-081, which directs Connect for Health Colorado, the state’s official health insurance marketplace, to conduct a consumer outreach and education campaign to help Coloradans attain and retain healthcare coverage based on their healthcare needs and financial circumstances.
- Delaware – The Delaware Division of Medicaid and Medical Assistance released a draft of an 1115 waiver amendment to add five services to the state’s Medicaid managed care program. The amendment would incorporate into managed care home visits for pregnant women and children under the age of two, home-delivered meals, a pediatric respite benefit, a nursing home transition program (formerly Money Follows the Person Demonstration), and a self-directed state plan personal care option.
- Georgia – The Georgia Department of Community Health (DCH) released a request for information soliciting insights from Georgia providers, care management organizations, advocates, and others about Georgia’s Medicaid managed care program. DCH is seeking to gather stakeholder knowledge that will contribute to the agency’s learnings on what Georgia may need for increasing care access, improving quality, and managing costs to assist the agency in planning for a competitive managed care procurement. The request for proposals is expected to be released in late 2022 or early 2023.
- Michigan – The Michigan Department of Health and Human Services announced the awardees of the Sickle Cell Clinic Expansion and Enhancement Program grants. The purpose of the program is to offer new resources to providers that help increase patient access to quality multidisciplinary healthcare and improve care coordination, as well as establish preferred provider networks that focus on sickle cell disease. The three awardees, each receiving $100,000, are Henry Ford Health, Michigan State University, and the University of Michigan.
- New Hampshire
- The New Hampshire Department of Health and Human Services (DHHS) hosted a healthcare coverage renewal event on June 9 for Medicaid enrollees to provide updated information and receive assistance completing their applications. Individuals attending the event received a free bag of groceries and representatives were on hand to assist with applying for other public benefit programs.
- DHHS announced that it received approval from CMS to amend the state’s Substance Use Disorder Treatment and Recovery Access Section 1115(a) research and demonstration waiver. The approved amendment will increase access to treatment for Medicaid enrollees with a serious mental illness and help reduce the number of people waiting in hospital emergency departments for a mental health bed.
- North Carolina
- The North Carolina Department of Health and Human Services (NCDHHS) released two funding opportunities to award a total of $6,755,000 to community-based mental health providers. These programs will help individuals with serious mental illness involved with the criminal justice system.
- NCDHHS also released two funding opportunities to award a total of $6,000,000 for tuition scholarships to improve behavioral health outcomes and substance use disorder treatment across the state. These include the Addiction Education Minority Fellowship Program, which focuses on growing the minority provider workforce to address disparities and increase equity in access to care for all with substance use disorders, and the Expansion of Practitioner Education, which aims to expand the integration of substance use disorder education into the standard curriculum of relevant healthcare and health services education programs.
- The state submitted an amendment to the Texas Healthcare Transformation and Quality Improvement Program (THTQIP) Section 1115(a) demonstration. The state is proposing to provide an additional four months of Medicaid eligibility to women receiving Medicaid at the time they deliver or experience an involuntary miscarriage, for a total of six months of postpartum coverage.
- The Texas Health and Human Services Commission (HHSC) announced draft policy changes concerning covered services using telemedicine, telehealth, and audio-only delivery if clinically appropriate and cost effective. HHSC has also drafted behavioral health service policy changes to allow non-local mental health authorities to deliver mental health targeted case management and mental health rehabilitation services to persons in fee-for-service Medicaid. The policy changes, which are in line with newly passed state laws, are open for public comment.
- Virginia – There is now a Spanish website for CoverVA (the state’s Medicaid program) known asCubre Virginia. The new site provides a place for Spanish-speaking individuals to check their eligibility, review health plan options, and learn more about other programs, such as the Family Access to Medical Insurance Security Plan (Virginia’s health insurance program for children).
- West Virginia – The state submitted a request to extend its Creating a Continuum of Care for Medicaid enrollees with Substance Use Disorders 1115 demonstration for a five-year period. The extension request includes improving health outcomes by increasing access to and utilization of appropriate health treatment services, improving care coordination and care transitions, and addressing social determinants of health influencing outcomes.