May 2 Update

In This Week’s Update:

  • Final 2023 NBPP
  •  New Medicare Special Enrollment Period
  • New SHVS toolkit: Medicaid Estate Recovery
  • County Health Rankings
  • Prioritizing Childhood Mental Health
  • State updates: AZ, CO, CT, FL, NM, OH, OR, PA, TN & WI

 Final 2023 Notice of Benefit & Payment Parameters

The Biden administration released the final 2023 Notice of Benefit & Payment Parameters, the annual rule governing Affordable Care Act marketplaces and insurance reforms. The rule includes new standardized plans for, new network adequacy requirements for plans in the federally facilitated marketplace, and other provisions addressing the accessibility and value of marketplace coverage options. While our experts work on a detailed analysis of the rule’s implications for states, check out the Fact Sheet on the final rule.

New Medicare Special Enrollment Period

Also this week, CMS released a proposed rule that would create a Medicare special enrollment period (SEP) to be timed with the end of the Medicaid continuous coverage requirement. CMS is proposing the SEP for individuals enrolled in Medicaid when they initially qualify for Medicare who do not enroll in Medicare coverage when they turn 65, resulting in a coverage gap if they are then determined ineligible for Medicaid coverage following the end of the continuous coverage requirement. The proposed SEP would allow individuals to enroll after termination of Medicaid coverage following the end of the federal public health emergency (PHE) without being subject to a late enrollment penalty. 

New SHVS Toolkit: Making Medicaid Estate Recovery Policies More Equitable

Medicaid estate recovery has important health equity implications. While estate recovery is intended to recoup funds to support the Medicaid program and ensure that enrollees and their families who are able to pay for long-term services and supports do so, the burden falls disproportionately on families of color and exacerbates existing inequities in the distribution of wealth tied to the historical and contemporary realities of structural discrimination and racism. A new resource published by SHVS, Making Medicaid Estate Recovery Policies More Equitable: State Toolkit, is intended to assist state officials in evaluating their current estate recovery policies and understanding where they may have flexibility to make the policies less burdensome for affected low-income families.

2022 County Health Rankings National Findings Report

County Health Rankings & Roadmaps (CHR&R), a program of the University of Wisconsin Population Health Institute, recently released a national findings report on 2022 county health rankings. The report features actionable measures related to income, education, family and social support, and health outcomes. The report focuses on the importance of pursuing economic security for all communities as they recover from the COVID-19 pandemic and the layered crises of racism and economic exclusion. CHR&R also highlights in the report the importance of closing the gender pay gap, which impacts the health of women, families, and communities. The authors feature a curated list of evidence-informed strategies that can improve health. The 2022 state reports show detailed information on county health rankings by state.

Prioritizing Childhood Mental Health

The Connecting Kids to Coverage National Campaign is hosting a webinar on May 4, 2022 at 3:00 p.m. ET, titled “Prioritizing Childhood Mental Health: Encouraging Use of Mental and Behavioral Health Benefits Covered Under Medicaid and CHIP.” The webinar will feature new data on the impact of the PHE on youth mental health, strategies for improving access to and use of mental and behavioral health services, resources for suicide prevention, practices to support youth mental health, and resources available on for organizations to use in their outreach. Registration for the webinar is available here.  

 State Updates

  • Arizona – The Arizona Health Care Cost Containment System awarded a new contract to two collaborative vendors that will provide housing and healthcare services in a new transitional housing facility for individuals experiencing homelessness and living with a Serious Mental Illness designation. The facility will include transitional housing for up to 70 residents, as well as an on-site healthcare clinic open to the public. Initial capital funding for the project was approved by the Arizona State Legislature and supplemented with funds from the American Rescue Plan Act (ARP).
  • Colorado – The Department of Health Care Policy and Financing (DHCPF) announced the first meeting of the Community First Choice (CFC) Council. The CFC Council collaborates with and advises the DHCPF on the design and implementation of a CFC option in Colorado. The CFC Council consists primarily of individuals with disabilities, those 65 years or older, and their representatives to help ensure CFC is implemented in a way that best meets the needs of Coloradans with disabilities.
  • Connecticut – Access Health CT, the state’s official health insurance marketplace, announced a new SEP for Connecticut residents with lower incomes beginning April 25. This new SEP will provide access to no- or very low-cost health insurance plans made possible by ARP. To be eligible for the SEP, Connecticut residents must have a household income at or below 150 percent of the federal poverty level and cannot currently be enrolled in a health insurance plan through Access Health CT.
  • Florida – The Agency for Health Care Administration and Agency for Persons with Disabilities announced the approval of up to $502.7 million in federal funding under the ARP FMAP increase for HCBS services to be distributed to eligible home and community-based services providers.
  • New Mexico – The state’s Office of Superintendent of Insurance recently notified its carriers that a broker compensation structure that pays differing commissions for open and special enrollments violates state nondiscrimination provisions and constitutes an unfair or deceptive practice under the state’s unfair trade practices statute.
  • Oregon
    • The Oregon Health Authority (OHA) Health Care Cost Growth Target Program released a report showing the impacts of rising healthcare costs on Oregon families and individuals in 2019, as average costs total more than 23 percent of family expenditures. Oregon’s personal spending for health care rose by 34 percent from 2013 to 2019, outpacing national averages. The Health Care Cost Growth Target Program was established by the Oregon legislature in 2019 and sets a statewide target for the annual per person growth rate of total healthcare spending in the state, monitoring and publishing reports on healthcare cost increases and factors driving these trends.
    • OHA announced the launch of a new program to fund community-based organizations to support their focus on local priorities while meeting their health equity goals. This grant opportunity supports community-based organizations working toward equity in: communities of color; federally recognized tribes and tribal communities; people with disabilities; immigrant and refugee communities; undocumented communities; migrant and seasonal farmworkers; LGBTQIA+ communities; faith communities; older adults; houseless communities; and others. OHA is awarding 147 community-based organizations a total of about $31 million.
  • Wisconsin – The Wisconsin Department of Health Services announced that 18 healthcare providers from around the state have received the annual Wisconsin “Big Shot” award for their efforts to vaccinate children against diseases. This recognition is given to healthcare providers who have vaccinated 90 percent or more of their patients who are two years-old and younger, based on 2021 immunization data collected by the Wisconsin Immunization Registry.
  • Ohio, Pennsylvania and Tennessee – These three states announced the expansion of Medicaid coverage for pregnant enrollees, and will extend the period during which enrollees are eligible for postpartum care services from 60 days to 12 months as of April 1. For more information on the ARP state option to extend postpartum coverage, see this SHVS issue brief.