May 22 Update

In This Week’s Update:

  • Where we are on Unwinding
  • Serving Justice-Involved Individuals Through 1115 Demonstration Evaluations
  • Should the Federal Government Establish Minimum Standards for Marketplaces?
  • School-Based Services in Medicaid
  • State Updates: CA, CO, DE, IL, IN, KT, MI, MN, NH, NJ, NY, OR, PA, WA, WI

Where We Are on Unwinding

Last week Health Affairs Forefront published an article with Manatt Health, Maintaining Coverage Gains During Medicaid Unwinding. As states have begun reporting on changes in enrollment as a result of unwinding, the article highlights strategies states, the federal government and community partners can employ to limit the loss of coverage among people who are eligible, and connect individuals no longer eligible for Medicaid to other sources of coverage. Also on the topic of unwinding, State Health and Value Strategies published a new States of Unwinding post which features the collaborative approach several states are adopting to disseminate information about unwinding, including co-branding materials across Medicaid and the Marketplace and working with other stakeholders. Lastly, in case you missed it, CCIIO released guidance that provides operational details for unwinding for enrollees in Marketplaces using the federal platform, which are also applicable to State-Based Marketplaces.


Also last week, SHVS published a new State Spotlight: Oklahoma’s Award-Winning Communications Campaign to Promote Medicaid Expansion Enrollment. This new spotlight describes the Oklahoma Health Care Authority’s approach to Medicaid expansion outreach and education and the state’s development and deployment of a data-driven integrated communications plan.


Serving Justice-Involved Individuals Through 1115 Demonstration Evaluations

A new issue brief from the State Health Access Data Assistance Center (SHADAC), funded by the California Health Care Foundation, identifies the unique opportunities states should consider when designing evaluation plans specific to their justice-involved populations. The issue brief provides an overview of justice-involved 1115 demonstration initiatives and summarizes what is known from existing evaluations of these activities. The brief also identifies a set of opportunities to design robust and equity-focused 1115 demonstration evaluation plans specific to justice-involved populations. As a reminder, SHVS has an expert perspective, CMS Issues Guidance on Section 1115 Demonstration Opportunity to Support Reentry for Justice-Involved Populations.


Should the Federal Government Establish Minimum Standards for Marketplaces?

The ACA established health insurance Marketplaces to facilitate enrollment in comprehensive and affordable health insurance. Most states rely on the federal government to run their Marketplaces, but recently, several states have expressed interest in taking over Marketplace operations. A new blog post from the Georgetown Center on Health Insurance Reforms describes how with Marketplace enrollment at an all-time high, and millions more people poised to transition from Medicaid to commercial insurance, the role of Marketplaces as a coverage safety net has never been more pivotal. But federal rules impose few standards for states launching and maintaining a Marketplace. The blog post explores whether it may be time for the federal government to establish a stronger federal floor.


School-Based Services in Medicaid

Last week, CMS released Delivering Service in School-Based Settings: A Comprehensive Guide to Medicaid Services and Administrative Claiming. As part of the Biden-Harris administration’s effort to strengthen and expand Medicaid school-based services, the guide offers new flexibilities and consolidates existing guidance, making it easier for all schools, no matter their size or the resources available to them, to deliver Medicaid-covered services. Additional resources released alongside the guide include: a companion fact sheet; an informational bulletin on policy flexibilities and guidance regarding coverage, billing, reimbursement, documentation and school-based administrative claiming; and example state plan amendments (SPAs). Both New Mexico and Oregon were granted SPAs to provide more Medicaid funding for eligible children receiving Medicaid-covered healthcare services in schools. 

State Updates: CA, CO, DE, IL, IN, KT, MI, MN, NH, NJ, NY, OR, PA, WA, WI

  • California
    • Beginning June 2023, Covered California, the state’s official health insurance Marketplace, will automatically select consumers losing Medicaid coverage into the lowest cost silver plan available to maximize premium tax credit and cost-sharing support. The program will ensure that consumers will not experience a gap in coverage if they effectuate their coverage within a month. Covered California will send customized notices to consumers to explain their plan enrollment and financial assistance and educational materials related to coverage, plan benefits, and key insurance terms. A dedicated website will be made available for consumers to direct them to their pre-selected plan and effectuation options, as well as a specialized phone support system with an interactive voice response menu and live assistance.
    • The California Department of Health Care Services (DHCS) launched a new tool and resources for substance use disorder (SUD) prevention, treatment and recovery. The new resources include Shatterproof Treatment Atlas, an SUD treatment locator, assessment, and standards platform that will connect individuals to appropriate evidenced-based treatment. To empower individuals and change attitudes about SUDs, DHCS launched Unshame California, a science-driven and content-based campaign that promotes anti-stigma messaging through stories of Californians impacted by SUDs.
  • Colorado – The Colorado Division of Insurance has issued its first annual report on healthcare sharing plans and arrangements (HCSAs) in Colorado. HCSAs are arrangements that do not offer the same protections and benefits as ACA plans. The report is the result of legislation which requires HCSAs to report data annually to the Division to better understand these entities. Colorado is only the second state to require such information on HCSAs to be collected.
  • Delaware – The state received approval from CMS to expand Medicaid and CHIP postpartum coverage to one year through the American Rescue Plan (ARP). With the addition of Delaware a total of 33 states and the District of Columbia have extended postpartum Medicaid/CHIP coverage to a full year. As a reminder, SHVS published an issue brief on the ARP option to extend postpartum coverage.
  • Illinois
    • The Illinois Department of Healthcare and Family Services is seeking a five-year extension of its Behavioral Health Transformation section 1115 demonstration. The proposed extension focuses on social determinants of health to address structural inequities including housing insecurity; food insecurity; employment assistance; non-medical transportation; justice-involved community reintegration; and violence prevention and intervention. If approved, the extension will incorporate non-traditional providers into the Medicaid enterprise and managed care service delivery system.
    • Governor JB Pritzker, the Illinois Department of Public Health (IDPH) and the Illinois Department of Financial and Professional Regulation announced a new process to expand access to self-administered hormonal contraceptives, making them more available to Illinois residents. The IDPH standing order authorizes Illinois pharmacists to dispense hormonal contraception following training.
  • Indiana – Governor Eric Holcomb signed legislation to reform long-term care by improving oversight of facility staffing and workforce. The legislation will require the state to conduct individual eligibility assessments to determine proper levels of care under the Medicaid aged and disabled waiver and allow facilities to increase the number of comprehensive care and Medicaid-certified beds.
  • Kentucky – The Kentucky Cabinet for Health and Family Services released a Medicaid renewals snapshot which includes data on the number of passive and active renewals, the number of mailed notices and emails the state has sent, and phone calls made to Medicaid members, and the anticipated renewal case counts for each month through April 2024.
  • Michigan – The Michigan Department of Health and Human Services announced Meghan Groen has been selected to serve as the state’s Medicaid director. Groen previously served as deputy policy director and health policy advisor for Governor Gretchen Whitmer. Congratulations Meghan!
  • Minnesota – MNsure, the state’s official health insurance Marketplace, created a webpage to assist individuals who need help replacing Medicaid or MinnesotaCare (the state’s Basic Health Program) coverage during the unwinding. The webpage directs consumers who are unsure about their eligibility renewal status to the Minnesota Department of Human Services’ webpage on renewals. For individuals who receive a notice that they are no longer eligible for Medicaid or MinnesotaCare, MNsure has created a guide on how to get new coverage through the Marketplace with information about the available special enrollment period, free enrollment help through a MNsure-certified assister, and available financial assistance through the Marketplace.
  • New Hampshire – The New Hampshire Department of Health and Human Services released a report on Medicaid enrollment which shows that total enrollment declined 10.8% from March to April. The total number of disenrollments for this period was 27,217.
  • New Jersey – Governor Phil Murphy signed a bill to permit mental and behavioral healthcare providers to operate within emergency shelters that serve people experiencing homelessness. Greater access to mental and behavioral healthcare programs for residents with disabilities, mental health concerns, or substance use disorders will help to address underlying issues that contribute to homelessness.
  • New York – The New York State Department of Health announced it has submitted a proposal to the federal government to expand the Essential Plan (the state’s Basic Health Program). The section 1332 State Innovation Waiver, which was submitted to the U.S. Departments of Health and Human Services and Treasury, requests that eligibility for the Essential Plan be extended to New Yorkers with incomes up to 250% of the federal poverty level. If the waiver is approved, nearly 100,000 additional New Yorkers are expected to gain access to the Essential Plan.
  • Oregon – Oregon has created several resources aimed at employers to help keep people covered during the unwinding. The resources include a flyer for employers on coverage available through the Marketplace, a flyer for employees losing Medicaid benefits to inform them of both employer-sponsored coverage and the Marketplace and suggested newsletter text for employer or association newsletters. SHVS has created a template flyer and sample messaging available for states to download and customize to share with employers during the unwinding.
  • Pennsylvania – Pennsylvania Acting Insurance Commissioner Michael Humphreys announced the Pennsylvania Insurance Department is launching a new round of examinations targeting insurer compliance with mental health and substance use disorder parity laws.
  • Washington
    • The Washington Health Care Authority is seeking feedback on the draft amendment request for its section 1115 Medicaid demonstration waiver. The amendment would authorize 1) Medicaid coverage for former foster care youth from other states who turn (or turned) 18 prior to January 1, 2023 and 2) continuous CHIP enrollment for children during the first six years of their lives.
    • Governor Jay Inslee signed the new 2023-2025 operating and capital budgets which includes more than $1 billion for housing and homelessness and funding for behavioral health services. Funding is included for strengthening the behavioral health workforce and community behavioral health providers; supports and services for children and youth experiencing a behavioral health crisis; increased access to opioid treatment and prevention services; and a statewide 988 system behavioral health crisis response system that will include new mobile crisis response teams and seven crisis stabilization facilities.
  • Wisconsin
    • The Wisconsin Department of Health Services (DHS) released two new reports on birth outcomes that continue to shed light on how to reduce and address significant disparities in infant deaths across Wisconsin. The Wisconsin Perinatal Periods of Risk reports analyze the factors that contribute to inequalities in fetal and infant mortality. Data from the DHS Maternal and Infant Mortality Prevention Unit show Wisconsin’s overall infant mortality rate, which represents the number of infant deaths per 1,000 live births, was 5.7 for 2019-2021. However, the data continue to show troubling disparities, with Black infants three times more likely to die before their first birthdays than White infants. During those same years, the infant mortality rate for American Indian or Alaska Native infants was 1.5 times the rate for White infants.
    • The state received approval from CMS for its Mobile Crisis State Plan Amendment. As a reminder, SHVS published an expert perspective on the enhanced payment available through the ARP for community-based mobile crisis services.
  • Arizona, District of Columbia, Idaho, Pennsylvania & Virginia – SHVS updated our expert perspective that is tracking state unwinding dashboards to include these five states. The EP now also includes an interactive map with links to all the dashboards and states publishing CMS unwinding reports. SHVS will continue to update the EP and map as more states publish their unwinding data.