March 25 Update

In This Week’s Update:

  • Recognizing the ACA’s 14th Anniversary
  • New Resources for Cyberattack Prevention
  • CMS Resources: Permissibility of Certain Practices During Medicaid and CHIP Renewals
  • Early Data From Community Health Centers During the Unwinding
  • Automatic Enrollment: A Pathway to Increased Coverage


Recognizing the ACA’s 14th Anniversary
In recognition of the 14th anniversary of the Affordable Care Act (ACA), HHS and CMS released four new enrollment reports highlighting the impacts of the ACA on coverage. Two reports highlight the historic open enrollment figures, including Marketplace enrollment numbers and overall coverage levels. HHS also released a report on Marketplace coverage trends by race and ethnicity as well as a review of Marketplaces after 10 plan years of operation.


New Resources for Cyberattack Prevention
The Center for Medicaid and CHIP Services (CMCS) published an informational bulletin (CIB) on Friday, March 15 which provides the flexibilities requested by state Medicaid programs in response to the Change Healthcare cyberattack. The National Association of Medicaid Directors highlighted the key flexibilities provided by the CIB in a recent blog post and also outlines three recommendations for steps states, the federal government, and the private sector can take to protect against future cyberattacks. Updates follow.


CMS Resources: Permissibility of Certain Practices During Medicaid and CHIP Renewals
On March 15, CMS released an informational bulletin clarifying certain federal renewal requirements and providing illustrative examples of policy and operational practices that are not permitted under federal Medicaid and CHIP redetermination regulations during the unwinding period and beyond. To ensure compliance, state Medicaid and CHIP eligibility and IT systems leaders should jointly verify that the correct policies are in place and that such policies are being operationalized in a manner consistent with federal regulations and guidance. In instances where states do identify issues, CMS directs them to “change their practices as quickly as possible” and “reach out to CMS for technical assistance.”


Early Data From Community Health Centers During the Unwinding
The Medicaid redetermination process is largely complete, but we are only beginning to understand the impact on enrollees and providers. A new brief for the Robert Wood Johnson Foundation’s Marketplace Pulse series examines data on pediatric encounters from a large network of community health centers to provide an early perspective on how coverage and payer mix is changing. Findings show a decline in the overall volume of Medicaid-insured visits and an increase in the share of visits from uninsured patients, with little variation among states.


Automatic Enrollment: A Pathway to Increased Coverage
Despite gains under the Affordable Care Act, the number of uninsured Americans remains stubbornly high, and many Americans do not obtain the coverage for which they are eligible, even when insurance is free. In a new report from the Commonwealth Fund, researchers from the Urban Institute outline a system for automatically enrolling people with low incomes in health coverage and model the impact on coverage and spending at the federal and state levels. The analysis shows that if all states adopted an auto-enrollment policy for those with incomes at or below 150% of the federal poverty level, 4.3 million uninsured people would be enrolled, an additional 1.8 million would be auto-enrolled through provider contact or contingently covered and thus protected from large medical bills, and spending on uncompensated care would fall by 32%.


State updates: AL, CA, CO, IA, IL, MI, NJ, NY, PA & VT

  • Alabama – Alabama Medicaid is inviting providers, recipients, advocates and other interested individuals to a Community Waiver Program (CWP) public forum. The CWP was approved by CMS in 2021 and the waiver targets persons with intellectual disabilities not currently receiving services through current home and community-based services waivers. The program provides supports to enable individuals with developmental disabilities to continue to live with family or in their own homes.
  • California
    • Governor Gavin Newsom announced the appointment of Tyler Sadwith as state Medicaid Director, effective March 25. Tyler previously served as Deputy Director for Behavioral Health. Congratulations Tyler!
    • Voters approved a ballot initiative that will allow the state to issue up to $6.4 billion in bonds to build 11,150 new behavioral health treatment beds and supportive housing and increase the state’s behavioral health outpatient capacity.
  • Colorado – The Colorado Department of Health Care Policy & Financing (HCPF) announced a stakeholder engagement kickoff meeting for advocates, providers, members and case managers to collaborate with and advise HCPF on long-term home health (LTHH). HCPF will also host LTHH policy team office hours for interested stakeholders to receive training and technical assistance and share information with HCPF staff.
  • Illinois – Governor JB Pritzker signed an executive order that tasks the Illinois Department of Healthcare and Family Services (HFS) with leading the state’s effort to establish payment models and financial structures that support access to new sickle cell disease treatments and other new high-cost drug treatment within the Illinois Medicaid program. The executive order also creates an advisory council to provide HFS with input as the Department develops innovative and sustainable financing models.
  • Iowa – The Iowa Department of Health and Human Services is seeking input from individuals and providers who have had experiences with crisis services to gather insights and improve the provision of crisis services.
  • Michigan
    • The Michigan Department of Insurance and Financial Services issued a bulletin to urge state-regulated health plans to take steps to support families impacted by the ongoing national shortage of medications used to treat attention-deficit/hyperactivity disorder. The bulletin urges insurers to exercise flexibility by, for example, covering alternative drugs when covered drugs are unavailable.
    • The Michigan Department of Health & Human Services (MDHHS) is seeking additional participants to inform MDHHS’ social determinants of health community influencer program. The program fosters community engagement, addresses barriers such as food insecurity and affordable housing and advances health equity. MDHHS is seeking to recruit community health workers, including family advocates, Navigators and outreach workers, but anyone is welcome to apply.
  • New Jersey – The state was awarded $25 million from the U.S. Department of Treasury to support the construction of the Maternal and Infant Health Innovation Center (MIHIC) in Trenton. The MIHIC, which is being developed by the New Jersey Economic Development Authority, is a critical component of First Lady Murphy’s Nurture NJ Maternal and Infant Health Strategic Plan.
  • New York
    • The New York State Department of Health issued a standing order to authorize pharmacists to dispense hormonal contraception medication without a prescription, including the oral pill, vaginal ring and contraceptive patch. Pharmacists who choose to participate can dispense up to 12 months of a self-administered hormonal contraception of the individual’s preference that is covered under their insurance.
    • Governor Kathy Hochul launched a $102 million effort to broaden wraparound care for individuals with serious mental illness. More than $92 million will be deployed to develop 26 Critical Time Intervention teams, which provide continued support and care coordination for individuals living with mental illness. In addition, $10 million will be deployed to develop additional Safe Options Support teams that focus on youth and young adults to help individuals experiencing homelessness move to stable housing.
  • Pennsylvania – The Pennsylvania Department of Human Services released the latest issue of the “Positive Approaches Journal,” which aims to provide the most recent research for people with mental health, substance-use disorder and behavioral challenges, intellectual disabilities, autism, and other developmental disabilities. This edition focuses on the aging process in those with intellectual disabilities and autism and offers resources and solutions.
  • Vermont – The Department of Vermont Health Access (DVHA) announced that pharmacy claims began processing again, starting March 18, after the cybersecurity incident with Change Healthcare. Vermont Medicaid removed copay requirements for all members during the duration of the outage (from February 21 through March 18, 2024) and if a pharmacy collected copays on any prescriptions dispensed during the outage, DVHA is asking those to be refunded to members as applicable.