May 17 Update

In This Week’s Update:

  • New CDC Guidance on Masks
  • CMS Enhances Home and Community-Based Care
  • HHS Interprets Section 1557 to Include LGBTQ Americans
  • State Updates: CA, MI, MO, NC, NJ, OH, OR, VA & WI
  • Implementing Primary Care VBP Through Medicaid Managed Care
  • COVID-19 Vaccines Experiences Among Hispanic Adults  
  • Analyzing COVID-19’s Effect on Youth Mental Health


Last Thursday, the CDC updated COVID-19 guidance permitting fully vaccinated people can participate in indoor and outdoor activities without wearing a mask or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local businesses and workplace guidance. CDC will continue evaluating and updating public health recommendations for fully vaccinated people as more information, including developments on new variants, becomes available.


Also last week, CMS released guidance on implementing the provision of the American Rescue Plan (ARP) that provides states with a one-year, 10 percent increase in their Medicaid matching rate for home and community based services (HCBS) expenditures provided between April 1, 2021 and March 31, 2022. The legislation requires states to use the additional federal funds received through the enhanced matching rate to supplement, not supplant, the state funds expended for HCBS as of April 1, 2021. The CMS guidance gives states broad flexibility for HCBS reinvestments, a process for moving ahead and, notably, the opportunity to spend the investment funds through March 2024. The guidance also identifies specific types of HCBS that are eligible to receive the enhanced federal medical assistance percentages (FMAP), as well as activities that states may undertake to “enhance, expand, or strengthen” Medicaid HCBS systems. This guidance addresses many of the outstanding questions outlined in SHVS’ issue brief describing ARP’s HCBS FMAP increase provision. Stay tuned for more programming as SHVS dives deeper into what this new guidance means for states.


Finally, HHS announced that the Office for Civil Rights will interpret and enforce Section 1557 and Title IX’s prohibitions on discrimination based on sex to include: (1) discrimination on the basis of sexual orientation; and (2) discrimination on the basis of gender identity. Section 1557 prohibits discrimination based on race, color, national origin, sex, age, or disability in covered health programs or activities. The update was made after the U.S. Supreme Court’s decision in Bostock v. Clayton County and subsequent court decisions. For more information on this interpretation and Section 1557, see this Health Affairs blog post.


COVID-19 Updates

  • Michigan – The Michigan Department of Health and Human Services launched the Vacc to Normal Milestone Tracker to complement the Michigan COVID-19 Vaccine Dashboard. The Tracker includes vaccinations Michiganders received both in-state and out-of-state, allowing the state to provide more comprehensive data as they reach vaccination milestones.
  • New Jersey – The New Jersey Department of Health launched a new data dashboard that includes the percentage of adults in each municipality who have received their first doses and the percentage of adults in each municipality who are now fully vaccinated. SHVS updated its map on state COVID-19 vaccine dashboards to reflect this latest development.
  • North Carolina
    • The North Carolina Department of Health and Human Services announced that its COVID-19 Support Services Program helped more than 41,800 households isolate or quarantine during COVID-19. Launched in August 2020 in COVID-19 “hot spots” throughout the state, the Support Services Program focuses on communities hit hardest by COVID-19 and offered food assistance, financial relief payments, COVID-19-related supplies, transportation to medical or vaccine appointments, and medication delivery to individuals who needed support to be able to quarantine or isolate due to COVID-19. The Support Services Program started in 20 counties and later expanded to 29 counties.
    • The Consolidated Appropriations Act, signed into law December 27, 2020, continues to provide emergency relief to young people in or transitioning from foster care who are struggling because of the pandemic. The North Carolina Department of Health and Human Services is encouraging young adults (ages 18-21) eligible for the state’s extended foster care program who aged out of the program during the COVID-19 pandemic to apply for re-entry to receive available services and support.
  • Ohio – Governor Mike DeWine announced a series of statewide drawings to provide incentives to Ohioans to get a COVID-19 vaccination. Ohioans younger than 18 who are eligible to receive a COVID-19 vaccine will be entered into a drawing for a four-year full scholarship to any of Ohio’s state colleges and universities, including full tuition, room, and board. Additionally, Ohioans aged 18 and older will be entered into a weekly drawing with a prize of up to $1 million.


Other State Updates

  • California – The California Department of Health Care Services released a list of counties that submitted a full letter of intent to transition to a local Medi-Cal managed care plan model by January 2024. DHCS is beginning a statewide procurement of commercial Medi-Cal managed care plans. Some counties have expressed interest in transitioning to a model that includes a local plan. If a county transitions to a model that includes a local plan, DHCS may remove that county from the commercial plan procurement (for a single local plan model) or reduce the number of commercial plans procured in the county (for a Two-Plan Model).
  • Missouri – The Missouri Department of Social Services submitted a letter to CMS withdrawing the state plan amendments (SPAs) submitted by Missouri to expand Medicaid. The letter cites the lack of appropriation of funding for Medicaid expansion by the legislature as the reason for withdrawing the SPAs.
  • New Jersey 
    • The Health Benefits Quality and Value Task Force released their final report on recommended longer-term strategies to improve health outcomes for members and better manage the costs of employee and retiree health benefits. The Task Force recommends nine strategies for long-term improvement in quality and value, organized into three thematic areas: primary care and care coordination; behavioral health; and specialty care.
    • Governor Phil Murphy signed S703/A1079, requiring all health care professionals who provide perinatal treatment and care to pregnant persons at a hospital or birthing center undergo explicit and implicit bias training. 
  • Oregon – The Oregon Health Authority released data showing hospitals ended 2020 with a surplus for the year of $483 million, representing a 3.3 percent statewide operating margin including CARES Act funding. Hospitals statewide ended the year with positive margins and net patient revenue returning to trend in Q3 and Q4 after falling sharply in the second quarter of 2020.
  • Virginia – The Virginia Department of Medical Assistance Services announced the launch of updated agency and outreach websites to better support Medicaid members, providers and individuals seeking information about Medicaid programs and services. The new outreach website—the English-language and Spanish-language—includes consumer-friendly features to help visitors learn who is eligible for Medicaid, what services are covered, and how they can apply for coverage. A new live chat feature allows website visitors to communicate directly with a Virginia Medicaid representative, creating a new option that supports the Cover Virginia Call Center.
  • Wisconsin – The Office of Children’s Mental Health announced the publication of a new fact sheet, Strengthening Social Connections and Relationships, that details what communities, schools, parents, and policymakers can do to strengthen children’s social connections and relationships.


Implementing Primary Care Value-Based Payment through Medicaid Managed Care

The Center for Health Care Strategies (CHCS) is hosting a webinar, made possible by The Commonwealth Fund, that will explore how state and health plan payers can develop primary care value-based payment (VBP) models that promote health equity and support the capabilities of advanced primary care. The 60-minute event will include perspectives on: (1) creating a VBP program focused on reducing health disparities in a primary care setting; and (2) implementing a global payment model at the provider level to support enhanced primary care. This webinar is part of a learning series, Strengthening Primary Care through Medicaid Managed Care, which is examining the tools and levers that states can use to advance comprehensive primary care strategies and equitably improve the health of Medicaid enrollees. This latest webinar will take place May 20 and those interested can register here.


KFF COVID-19 Vaccine Monitor: COVID-19 Vaccine Access, Information, and Experiences Among Hispanic Adults in the U.S.

A new Kaiser Family Foundation COVID-19 Vaccine Monitor report focused on the vaccine views and experiences of Hispanic adults finds that 33 percent of unvaccinated Hispanic adults say they want to get a COVID-19 vaccine as soon as possible – twice the share as among unvaccinated white (16 percent) or Black (17 percent) adults, presenting an opportunity for targeted outreach to boost overall vaccination rates. The higher share of Hispanic adults who want to get vaccinated quickly but have not yet reflects some significant access barriers and information gaps identified by the Monitor, including concerns about potential costs, lost wages, and immigration-related issues. The latest report also highlights the disproportionate toll the pandemic has taken on Hispanic adults in the United States.


Social Distancing to Virtual Learning: Breaking Down COVID-19’s Impact on Mental Health Across Youth Developmental Stages

While children have largely been spared from severe COVID-19 symptoms, the effects of the pandemic on children’s development and behavioral health have raised concerns among mental health professionals. At the same time, related stressors such as parental job loss and financial challenges, food insecurity, civil unrest, and racial injustice have amplified the potentially traumatic impact of the pandemic on children’s sense of safety and security. A new blog post by the PolicyLab at the Children’s Hospital of Philadelphia breaks down what these challenges have looked like across four distinct developmental stages, reviews how providers can support children and their caregivers, and discusses where more research will be needed beyond the pandemic. As more data comes to light, researchers are just beginning to understand not only the immediate repercussions of the pandemic for the mental health of children, but also the full extent of what the many challenges families encountered over the last year might mean for children’s long-term well-being. Understanding nuances across developmental stages will be an important component in helping children and families through pandemic recovery.