May 18 Update

In This Week’s Update:

  • SHVS Webinar on Coverage Churn
  • New CMS Guidance
  • State Updates: AZ, CO, LA, MD, ME, MN, NJ, NY, PA, VA, WA & WV
  • New SHVS Webinar on Medicaid IT & COVID-19
  • Overlap Plans as Low-cost Option
  • Estimate of Loss of Employer-Sponsored Health Insurance Coverage
  • Supports for Managed Care and Provider Networks


SHVS Webinar on Coverage Churn

Last week, State Health and Value Strategies hosted a webinar for states to help address the rapidly-evolving changes to the coverage environment as a result of rising unemployment due to the COVID-19 crisis. During the webinar, speakers discussed models that have been published of where individuals are expected to gain coverage over the next 18 months, the effect on the Medicaid, individual, and employer-sponsored insurance markets, the role of special enrollment periods, and coordination with unemployment agencies. If you missed the webinar, SHVS has posted the slides and a recording on its website. As a companion to the webinar, SHVS also published a new expert perspective authored by Manatt Health, Medicaid/CHIP and Marketplace Interactions in COVID-19.


New CMS Guidance

CMS has released two new pieces of federal guidance. A new CMCS Informational Bulletin provides states with guidance on how to temporarily modify provider payment methodologies and capitation rates under their Medicaid managed care contracts to address the effects of the public health emergency. SHVS published a related toolkit, Targeted Options for Increasing Medicaid Payments to Providers During COVID-19 CrisisCMS also released the final 2021 Notice of Benefit and Payment Parameters, and Georgetown University’s Center on Health Insurance Reforms penned for SHVS an expert perspective on the final Notice. The expert perspective focuses on several policies that have implications for state insurance regulation and the operation of SBMs.


State Updates: AZ, CO, LA, MD, ME, MN, NJ, NY, PA, VA, WA & WV

  • COVID-19 Testing
    • New Jersey – Governor Phil Murphy announced departmental actions from the Department of Banking and Insurance, Department of Health, Department of Human Services, and Department of Treasury to increase insurance coverage to cover expanded testing access and related services for COVID-19 and improve affordability and alleviate financial burdens for residents affected by COVID-19.
    • New York – Governor Andrew Cuomo launched a new initiative to expand access to testing in low-income communities and communities of color. The state is partnering with Northwell Health to establish an initial 24 temporary testing sites at churches in predominately minority communities in downstate New York.
    • West Virginia – Governor Jim Justice and the West Virginia Department of Health and Human Resources announced a plan to increase COVID-19 testing opportunities for minorities and other vulnerable populations in medically-underserved counties. The plan targets residents who have struggled to be seen by a physician or do not have insurance to pay for testing.
  • Health Equity
    • Pennsylvania – Based on recommendations of the Health Disparity Task Force, Governor Tom Wolf announced the state is now collecting sexual orientation and gender identity data as part of the state’s COVID-19 data collection effort.
    • Virginia – Governor Ralph Northam announced a pilot program with the city of Richmond to support the Commonwealth’s ongoing focus on health equity. The partnership aims to increase equitable access to personal protective equipment in underserved communities that may be most adversely affected by the virus.
  • Promoting Health Insurance Coverage and Access
    • Colorado – Insurance Commissioner Michael Conway sent a letter to Colorado’s Congressional delegation asking for support in the establishment of a federal reinsurance program and to provide additional federal support for people receiving financial assistance in the individual health insurance market. 
    • Maine
      • The Maine Department of Health and Human Services (DHSS) launched a statewide campaign to promote awareness of affordable health insurance options, particularly for people whose employment or income has been affected by the COVID-19 pandemic. DHHS is also collaborating with the Maine Department of Labor to inform those applying for unemployment insurance that they may be eligible for affordable health insurance options.
      • CMS approved the state’s Appendix K waiver amendment to temporarily increase support to HCBS providers serving adults with physical or intellectual disabilities, brain injuries and other related conditions, and older Mainers. Approval of this waiver gives MaineCare the flexibility to increase reimbursement rates by 10 percent for the most highly utilized direct care services for these populations, with the expectation that providers will use most of this financial relief to retain and support their direct care staff.
    • New Jersey – The Department of Human Services hosted an informational Zoom session to promote and discuss the available social services for families affected by COVID-19, including information on health insurance coverage and food assistance.
  • Special Enrollment Periods
    • Colorado – Connect for Health Colorado announced a total of 14,263 Coloradans gained health insurance coverage during Connect for Health Colorado’s emergency SEP, which ran from March 20 to April 30.
    • Washington – During the SEP held between March 10 and May 8, the Washington Health Benefit Exchange saw 22,000 customers sign up for coverage, including 7,000 uninsured residents who came in through the COVID-19 SEP. The Exchange is continuing outreach efforts to ensure that individuals who experience a qualifying life event sign up for coverage.
  • Other
    • Arizona – Governor Doug Ducey announced several grants and funding to expand child care for grocery store employees and food bank workerssupport kids with special health care needs, and provide additional support to food banks.
    • New Jersey – Governor Phil Murphy announced the formation of a statewide council of leaders to advise on New Jersey’s restart and recovery from the COVID-19 pandemic. SHVS Program Director Heather Howard was appointed to join the health care subcommittee and will help advise state leadership on the microeconomic health-related issues that must be taken into account when considering re-opening the state.
    • New York – The Department of Health held a webinar for health care professionals to discuss the symptoms, testing, and care of reported inflammatory disease in children related to COVID-19. Previously, DOH issued an advisory about this disease to inform health care providers of the condition and provide guidance for testing and reporting. DOH also released criteria to health care professionals to establish an interim case definition for COVID-related inflammatory illness in children.

Other State Updates

  • Louisiana – The Louisiana Department of Health released an interim report on its Reducing Maternal Morbidity Initiative focused on reducing preventable maternal mortality and morbidity related to hemorrhage and hypertension, while also focusing on reducing racial disparities in these maternal outcomes.
  • Maryland – Governor Larry Hogan announced that UnitedHealthcare has filed to offer individual health plans through Maryland Health Connection, the state-based marketplace, in 2021, joining two other insurers already offering on the marketplace.
  • Minnesota – Governor Tim Walz signed the Prescription Drug Price Transparency Act into law requiring drug makers to provide a detailed rationale to the state for any large price increases on drugs that cost $100 or more for a 30-day supply.


Overlap Plans: Option to Promote Continuity of Care and Contain Health Care Costs During a Recession

Kathy Hempstead at the Robert Wood Johnson Foundation authored a blog post for Health Affairs on “Overlap” health plans, which offer Marketplace and Medicaid managed care coverage (other than managed long-term services and supports) in the same county, and their potential role in efforts to provide continuity of care for low-income individuals who churn between Medicaid and ACA Marketplace plans as their eligibility changes. The blog post details how the authors’ research found that most counties have carriers offering Marketplace and Medicaid plans and that the average premiums in overlap counties are considerably lower than in non-overlap counties.


SHADAC Estimate of Loss of Employer-Sponsored Health Insurance Coverage

State Health Access Data Assistance Center (SHADAC) developed the University of Minnesota COVID-19 Health Insurance Model (MN-HIM) with faculty in the Division of Health Policy and Management at the University of Minnesota’s School of Public Health. The model uses information on ESI coverage rates from the Current Population Survey Annual Social and Economic Supplement (CPS ASEC), Bureau of Labor Statistics measures of employment levels by state and industry, and state agency reports of initial unemployment claims overall and by industry. The companion issue brief presents new national and state estimates of potential disruptions to ESI coverage resulting from the COVID-19 pandemic job losses through April 11, 2020, including estimates for policyholders and their covered dependents produced by the MN-HIM model.


Supports for Managed Care and Provider Networks During the COVID-19 Emergency Response

Many health systems across the nation are working at or above capacity to provide care for those afflicted with the virus, while others are experiencing significant declines in revenue. As the rollout of guidance prioritizes ways to support acute care needs, managed care organizations (MCOs) are quickly translating these opportunities to address the strain on their health care delivery systems for specific Medicaid populations. MCOs are identifying a range of important issues requiring immediate attention from state Medicaid agencies to support their plans and providers. The Center for Health Care Strategies published a Q&A based on their recent conversation with Jennifer McGuigan Babcock, senior vice president of Medicaid policy, and Enrique Martinez-Vidal, vice president of quality and operations at the Association for Community Affiliated Plans (ACAP), during which they discussed key considerations for state Medicaid agencies in meeting the needs of beneficiaries in the current pandemic environment.