March 16 Update

In This Week’s Update:

  • SHVS Expert Perspective on COVID-19
  • CMS FAQ on COVID-19
  • Future COVID-19 Updates
  • COVID-19 State Updates: AZ, CA, CO, FL, MA, MI, NJ, NM, OR, WA
  • Other State Updates: CO, OK, OR
  • Webinar: Responding to COVID-19
  • Webinar: Healthy Adult Opportunity Medicaid Demonstration
  • Waiving Cost-sharing Requirements for COVID-19 Testing and Care
  • SHVS Resources on Medicaid’s Role in Addressing Maternal Health


SHVS Expert Perspective on COVID-19

As concerns regarding widespread COVID-19 infection increase, State Health and Value Strategies (SHVS) stands ready to assist state Medicaid and insurance agencies in preparing for and responding to COVID-19. Last week, SHVS posted an Expert Perspective that highlights strategies state Medicaid and CHIP agencies can take as part of their emergency preparedness and response plans. If your state is in need of technical assistance related to COVID-19, please be in touch with SHVS.



CMS released a new FAQ for state Medicaid and CHIP agencies that provides guidance on emergency preparedness and response and flexibilities related to eligibility and enrollment, benefits, cost-sharing, and financing. CMS also announced an FAQ this morning on Essential Health Benefit (EHB) coverage, which details existing federal rules governing health coverage provided through the individual and small group insurance markets that applies to the diagnosis and treatment of COVID-19.


Future COVID-19 Updates

This week, and for the near future, SHVS will be sharing COVID-19-specific updates from states, in addition to its regular state updates. Georgetown’s Center on Health Insurance Reforms has produced a state-by-state compendium of actions related to COVID-19 coverage. If you have COVID-19 updates from your state to share, please be in touch with SHVS.


COVID-19 State Updates

  • California – The Business, Consumer Services and Housing Agency released guidance for homeless assistance providers on how to protect individuals experiencing homelessness, as well as their volunteers and employees who serve this vulnerable population, from the spread of COVID-19.
  • Colorado – The Department of Labor and Employment (CDLE) published emergency rules which temporarily require employers in certain industries to provide a small amount of paid sick leave to employees with flu-like symptoms while awaiting COVID-19 testing.
  • Massachusetts – The Massachusetts Health Connector announced that uninsured residents can apply and enroll in coverage through a 45-day special enrollment period through April 25. The announcement of the special enrollment period follows the Division of Insurance announcement that Massachusetts health insurers are required to cover the cost of testing and treatment for members who may be affected by COVID-19. 
  • Michigan – Governor Gretchen Whitmer is sent a letter to the President requesting a special open enrollment period on to allow people to sign up for health insurance.
  • New Jersey – Governor Phil Murphy in a press release announced administrative actions from the Department of Banking and Insurance, Department of Human Services, Department of Health, and Department of the Treasury to support consumer access to COVID-19 testing and testingrelated services.
  • New Mexico – The Department of Insurance issued three orders related to COVID-19: an order adopting an emergency amendment prohibiting any cost sharing requirement for the provision of health care services for COVID-19; a notice and order to insurance plans that they provide information regarding the benefits covered for COVID-19; and a notice and order that every health insurance or carrier confirm they are in compliance with orders and submit data regarding COVID-19 claims.
  • Tracking COVID-19
    • Arizona – The Department of Health Services is publishing data on COVID-19 cases by county via a map and is providing information about the number of individuals tested and confirmed cases.
    • Florida – The Department of Health is tracking COVID-19 cases to date by county with details of age and sex of individual and whether a case is travel related.
    • New Jersey – The Department of Health created a dashboard for tracking COVID-19 cases by county which includes data on the number of calls to the state’s hotline.
    • Oregon – The Oregon Health Authority is tracking cases by age, county, and the number of COVID-19-related hospitalizations.
    • Washington – The Department of Health is reporting data on cases by county as well as cases by age and sex.


Other State Updates

  • Colorado – The Colorado Department of Health Care Policy and Financing submitted formal comments to the U.S Department of Health and Human Services on its proposed state drug importation program. The Department’s comments were provided in two forms—a formal comment letter as well as within a draft application of its proposed drug importation program. The Department will hold a stakeholder meeting to review the draft application and the formal comments on March 19.
  • Oklahoma – The Oklahoma Health Care Authority submitted a state plan amendment to CMS to add individuals ages 19-64 with incomes at or below 133 percent of the federal poverty level to the state’s Medicaid program. This submission is an initial step in implementing the state’s SoonerCare 2.0 plan proposal, which seeks to extend health coverage to qualifying adults through CMS’ Healthy Adult Opportunity demonstration waiver.
  • Oregon – The state’s System of Care Advisory Council met for the first time this week. The legislatively-created council is charged with improving the efficacy and effectiveness of the state and local continuum of care that provides services to children, youth, and young adults. The 25-member council is appointed by the Governor and incorporates a cross-section of child-serving agencies, programs, professionals, family members, and young people to create a centralized and impartial forum for statewide planning and policy development.


Responding to COVID-19: State Strategies for Medicaid and Commercial Health Insurance Oversight

Wednesday, March 18, 1:00 to 2:00 p.m. EST

As concerns regarding widespread COVID-19 (coronavirus) infection in the United States increase, and in light of the World Health Organization declaring COVID-19 a pandemic, states are evaluating the tools available to them to respond to this new public health crisis. The webinar will explore both the strategies available to Medicaid programs and the opportunities for state regulators to reduce gaps in coverage and lower barriers to accessing care. Technical assistance experts from Manatt Health and Georgetown’s Center on Health Insurance Reforms will discuss the steps states have taken so far as well as strategies and opportunities for states to consider as they ramp up their response to COVID-19. The webinar will include a question and answer session during which states can pose their questions to the experts on the line.

Registration (required) at the following link:


The Fiscal Impact of the Healthy Adult Opportunity Medicaid Demonstration

Thursday, March 19, 3:30 to 4:30 p.m. EST

CMS recently released guidance inviting states to apply for the Healthy Adult Opportunity Medicaid demonstration initiative, which allows states to opt into a block grant funding model. The webinar will discuss findings from a new publication by the Commonwealth Fund and Manatt Health. The issue brief finds that the initiative would result in substantially less federal funding for state Medicaid programs—including a 10.5 percent reduction in the median state between fiscal years 2021 and 2025—as well as greater financial risks for states that elect to pursue the demonstration. The estimates show even greater losses if costs or enrollment rise above current national projections. States opting to participate will likely have to make significant cuts in enrollees’ coverage, reduce benefits, impose higher cost sharing, and lower payment rates for providers who treat Medicaid patients. During the webinar, experts from Manatt Health will share their findings from the new publication, with an opportunity for states to ask questions of the report authors.

Registration (required) at the following link:


Too Much Skin in the Game: Out-of-Pocket Costs May Limit Testing and Treatment of COVID-19

A new blog post by the Robert Wood Johnson Foundation uses data from HIX Compare to highlight the financial aspects of testing and accessing care for COVID-19. The post discusses the challenges and risks associated with implementing cost-sharing requirements for COVID-19 testing and treatment and the implications that these requirements may have in individuals delaying or avoiding care altogether. The post also includes considerations for states and industry stakeholders to help mitigate this public health crisis, including examples of waiving cost-sharing requirements.


Medicaid’s Crucial Role in Combating the Maternal Mortality and Morbidity Crisis

Last week SHVS published an issue brief on Medicaid’s Crucial Role in Combating the Maternal Mortality and Morbidity Crisis. The issue brief, developed by Manatt Health, describes policy and strategy levers that Medicaid agencies can employ to improve maternal health outcomes and address outcome disparities in five areas: coverage, enrollment, benefits, models of care, and quality improvement. In some cases, the Medicaid agency will be responsible for implementing these policies; in other cases, the Medicaid agency can lead collaboration with other state agencies such as the public health department or the state marketplace. Last week, SHVS hosted a companion webinar that discussed select strategies from the brief. A slide deck and a recording of the webinar can be found on the SHVS website.