May 1 Update

In This Week’s Update:

  • The Basic Health Program
  • Medicaid Unwinding Estimated Coverage Losses
  • Strategies for Providing Whole Child Care
  • Regulatory-Palooza Week
  • State updates: CA, CT, DC, ID, IN, KY, MA, MI, MN, NM, NY, OR, PA, VA & WA


The Basic Health Program

The ACA allows states to create a Basic Health Program (BHP), for which states receive federal funding in lieu of ACA subsidies to provide coverage for low-income individuals (with the state covering any remaining costs). While only two states—New York and Minnesota—have implemented a BHP to date, several other states are considering doing so. In a new report, researchers from Georgetown University’s Center on Health Insurance Reforms and the Urban Institute interviewed federal and state officials, insurers, providers, and consumer advocates to examine the BHPs in New York and Minnesota and explore how the program might play out in other states. Both New York and Minnesota’s BHPs have shown success in making coverage affordable and accessible for low-income consumers, but it’s not clear that these experiences are replicable in other states or can be achieved without countervailing costs. Much depends on state-specific factors, including administrative capacity and the difference in provider reimbursement rates between Medicaid and the commercial market. Understanding how these factors may play out in a given state will require careful analysis that considers the state’s specific goals, market conditions, and operational capabilities.


Medicaid Unwinding Estimated Coverage Losses

A new Kaiser Family Foundation (KFF) analysis estimates the number of people who could lose Medicaid during the unwinding period under three possible rates of Medicaid coverage loss, and shows for each illustrative rate, state-by-state coverage reductions among Medicaid children and adults. The KFF analysis uses a combination of enrollment data from the CMS Performance Indicator Project, Medicaid claims data, and some state-specific sources. In practice, rates of Medicaid coverage loss will vary across the states, depending on states’ approaches to the unwinding and the extent to which they engage in outreach and assistance activities to minimize disenrollment among people who are still eligible. SHVS recently launched a new series of expert perspectives, States of Unwinding, highlighting the work states are engaged in to operationalize unwinding and to minimize coverage losses following the expiration of the Medicaid continuous coverage requirement.


Strategies for Providing Whole Child Care

In a new webinar, Manatt Health will review recent developments and promising approaches for financing the health-related social needs (HRSN) of children, including 1115 waivers, “in lieu of services”, and Children’s Health and Wellness Funds. Strong evidence suggests that investing in children’s social needs leads to long-term improvements in health, economic stability and resilience. Despite this growing body of research, stakeholders have historically prioritized addressing the HRSN, also referred to as social drivers of health, of adults with complex health issues due to the short-term return on investment. The webinar, which will convene a panel discussion with state and national leaders who are pioneering new ways to address the HRSN of children, will take place Tuesday, May 2, at 3:30 p.m. ET. Registration information is available here


Regulatory-Palooza Week

Last week was “regulatory-palooza” for State Health and Value Strategies. The following is a round-up of new guidance released last week and new analyses authored by SHVS experts of recently released federal rule-making:  

  • CMS released two notices of proposed rulemaking (NPRMs) that aim to enhance Medicaid enrollees’ access to healthcare services across both the fee-for-service (FFS) and managed care delivery systems: the Managed Care Access, Finance, and Quality proposed rule  (the managed care NPRM) and the Ensuring Access to Medicaid Services proposed rule (the access NPRM). The managed care NPRM proposes to: establish new standards for appointment wait-times and monitoring/enforcement; improve standards for state directed payments; specify the scope of in lieu of services/settings; specify medical loss ratio requirements; and create a quality rating system framework to compare managed care plans. The access NPRM proposes to standardize data and monitoring; promote transparency in FFS payment rates; improve access to home and community-based services; and engage enrollees and stakeholders through Medical Care Advisory Committees. An SHVS analysis of the proposals and related programming is forthcoming.
  • HHS published a proposed rule aimed at expanding health coverage options for certain recipients of Deferred Action for Childhood Arrivals (DACA) status. The proposed rule would add DACA recipients to the list of “lawfully present” immigrants who can receive three types of federally supported health coverage. SHVS posted an expert perspective that reviews the proposed rule. SHVS also published an expert perspective that highlights findings from focus groups with non-citizens that can be used to inform outreach efforts to DACA recipients and other non-citizens eligible for health coverage.
  • Following the release of the final Notice of Benefit & Payment Parameters for plan year 2024, SHVS published an expert perspective focused on the provisions of the final rule most of interest to State-Based Marketplaces and state insurance regulators.


State updates: CA, CT, DC, ID, IN, KY, MA, MI, MN, NM, NY, OR, PA, VA & WA

  • California – California, through the Department of Health Care Services (DHCS), awarded more than $17 million to 39 nonprofit providers and tribal organizations in underserved areas to expand their in-house behavioral health workforce. Through the DHCS’ Mentored Internship Programs, each entity will receive up to $500,000 to enhance and build their behavioral health substance use disorder workforce, focusing on resources to expand prevention, treatment, and recovery skills for those working with individuals with or at risk of developing an opioid use disorder.
  • Connecticut – Access Health CT (AHCT), the state’s official health insurance Marketplace, announced a request for proposals from health insurance brokers to mentor incoming professionals to the field. The Broker Academy creates a pathway to license health insurance brokers by recruiting from, and building the skillsets of those who live and work in historically underserved communities throughout Connecticut. The program was created as part of AHCT’s mission to increase the rate of the insured and reduce health disparities in the state.
  • District of Columbia – The Department of Health Care Finance (DHCF) hosted a community meeting on restarting Medicaid renewals to educate stakeholders about the renewal process. The meeting included several updates, including the dates for upcoming renewal meetings and trainings and an announcement that automated calls and texts will start next month. DHCF also launched an eligibility monitoring dashboard, which is hosted on their Medicaid renewal information webpage. As a reminder, SHVS is tracking which states have created unwinding dashboards and will be updating the expert perspective as additional states launch dashboards.
  • Idaho – Your Health Idaho, the state’s official health insurance Marketplace, is celebrating 10 years of operation. Since Your Health Idaho was created in 2013, the Marketplace has saved Idahoans $43 million in assessment fees, provided affordable health insurance to almost 375,000 Idahoans with over 826,000 enrollments, and delivered almost $3 billion in advance premium tax credits.
  • Indiana – The Indiana Family and Social Services Administration released projections estimating that net Medicaid enrollment will decline by 400,000 through May 2024. Costs are expected to rise due to the phasing out of the enhanced federal Medicaid matching funds.
  • Kentucky – The Kentucky Cabinet for Health and Family Services created a resource for Medicaid enrollees which demonstrates how to access the enrollee’s renewal date during the unwinding.
  • Massachusetts – The Massachusetts Health Connector, the state’s official health insurance Marketplace, created a webpage featuring resources for employers and employees during the unwinding. The resources include a letter from the Massachusetts Executive Office of Health and Human Services directed to the employer community, a list of frequently asked questions for employers on Medicaid redeterminations and employer coverage, a newsletter with suggested text and graphics for employer associations to share information with the employer community, and an employee flier available in multiple languages for employers to distribute within the workplace. MassHealth and the Massachusetts Health Connector also held a briefing for employer and broker leaders in Massachusetts on the upcoming transition to help ensure state residents continue to have access to health coverage.
  • Michigan – The Michigan Department of Health and Human Services announced a pilot program for community health worker (CHW) services at select COVID-19 neighborhood testing sites to address community health needs. CHWs will offer on-demand referral services to essential health and wellbeing resources including behavioral health and social services. Visitors to participating sites can meet with an on-site CHW to connect with community resources that include food access, housing supports, utilities assistance and healthcare enrollment.
  • Minnesota – The Minnesota Department of Human Services released new renewal forms for Minnesota Healthcare Programs for families, children, and adults. The new renewal form was designed to streamline the renewal process by gathering only the information needed to redetermine eligibility.
  • New Mexico – beWellNM, the state’s official health insurance Marketplace, created a “Medicaid Unwinding Campaign Stakeholder Toolkit” which includes information on how to engage with beWellnm, communications goals, key messages, unwinding talking points for community partners, unwinding frequently asked questions (FAQs), New Mexico’s Medicaid Transition Premium Relief Program FAQs, communications plans, and communications assets.
  • New York – New York State of Health, the state’s official health insurance Marketplace, is teaming up with retail pharmacies across the state to educate New Yorkers enrolled in public health insurance programs about the upcoming changes in their coverage. Certified enrollment assisters will be available on-site at pharmacies to answer current enrollees’ questions about renewals, as well as provide information to uninsured New Yorkers about enrolling in health insurance through NY State of Health.
  • Oregon
    • Governor Kotek announced that the state of Oregon has partnered with Oregon Health and Science University to secure a three-year supply of Mifepristone to ensure that reproductive health providers across the state can maintain access and continue to provide patients with safe and effective miscarriage management and abortion care.
    • The Oregon Health Insurance Marketplace released a 2022 annual report which examines how the Marketplace serves its consumers and partners and works to connect Oregonians to coverage. Nearly 142,000 Oregonians enrolled for the 2023 plan year and more than 79% of enrollees received financial assistance.
  • Pennsylvania – The Pennsylvania Insurance Department announced it will be protecting consumers who had Medicaid continuous coverage through the COVID-19 public health emergency and missed their Medicare Supplemental open enrollment period. As Medicaid once again redetermines eligibility, individuals who lose Medicaid coverage and transition to Medicare coverage will have a guaranteed issue enrollment period for Medicare Supplemental plans.
  • Virginia – Cover Virginia launched a dedicated call center for assisters and Navigators to answer questions about Medicaid renewals and applications, including questions assisters and Navigators may have about a consumer’s application status, existing coverage or other renewal related questions. The Virginia Department of Medical Assistance Services also created a renewal calendar that outlines whose renewals will begin each month over the next year.
  • Washington – Governor Jay Inslee signed five bills that will protect access to abortion medication, enhance data privacy for people who share their health information with third party apps, protect Washington patients and providers who may face legal threats from other states, protect providers’ licenses, and eliminate out-of-pocket costs to make abortion access more equitable.