May 3 Update

In This Week’s Update:

  • American Families Plan
  • Public Option Proposals
  • Final 2022 NBPP Rule
  • American Rescue Plan Analysis
  • COVID-19 State Updates: CA, KS, PA, WV
  • Other State Updates: AK, AZ, ME, NM, NV, NY, VA
  • New Medicaid Leadership Training Opportunity
  • Principles for Antiracist, Equitable Response to COVID-19
  • Case Study: Washington’s Individual Market


American Families Plan

Last week, President Biden gave his first joint address to Congress and highlighted the priorities in the proposed American Families Plan. The White House released a fact sheet on the American Families Plan which includes specific mention of making the American Rescue Plan’s premium tax credit enhancements permanent. For an overview of President Biden’s first 100 days with an emphasis on the Affordable Care Act (ACA) and the American Families Plan, see this Health Affairs blog post.


Public Option Proposals

Sabrina Corlette from the Georgetown University’s Center on Health Insurance Reforms and Heather Howard from State Health and Value Strategies (SHVS) spoke on the latest Tradeoffs podcast episode about state and federal public option proposals and what the future may hold. SHVS has an expert perspective that provides a brief overview of selected state efforts to implement a public option and highlights what to expect in a federal policy environment.


Final 2022 NBPP Rule

The Biden administration released the final 2022 Notice of Benefit & Payment Parameters (NBPP) rule, the annual rule governing ACA insurance reforms and marketplace operations. Of note, the rule creates a special enrollment opportunity for individuals enrolled in COBRA whose employer or government subsidies are discontinued, adjusts the methodology for calculating marketplace enrollees’ premium contributions and out-of-pocket maximums to improve affordability, and updates requirements for direct enrollment websites. The administration will revisit other sections of the NBPP rule finalized in January 2021, including changes to marketplace user fees and Section 1332 regulations, as well as the authorization of “Direct Enrollment’ marketplaces later this spring. The administration also declined to finalize several changes to the risk adjustment program as well as proposed program integrity requirements. A fact sheet on the rule is available here.


American Rescue Plan Analysis

SHVS published a new expert perspective, American Rescue Plan Provides a New Opportunity for States to Invest in Equitable, Comprehensive and Integrated Crisis Services, which provides an overview and state considerations on the state option to provide community mobile crisis interventions services included in the American Rescue Plan. SHVS has also updated its expert perspective which reviews the data states are currently publicly reporting related to vaccine administration and provides an interactive map that highlights how states are reporting vaccine administration data breakdowns by age, gender, race, ethnicity, provider type, and level of geography.


COVID-19 State Updates: CA, KS, PA, WV

  • California – Covered California (the California state-based marketplace), the Department of Health Care Services, and CalPERS announced complementary efforts to ensure that everyone covered by their programs gets COVID-19 vaccines as they become available while addressing preventive care gaps caused by patients not getting needed services. The agencies will pay specific attention to racial and ethnic disparities that have been exacerbated by the COVID-19 pandemic. In addition, Covered California will require its 11 health insurance companies to reach pre-pandemic levels of childhood immunizations and colorectal cancer screenings by the end of 2021 and to exceed those numbers by the end of 2022.
  • Kansas – Gov. Laura Kelly encouraged Kansas medical and behavioral health providers to apply for the Federal Communications Commission’s COVID-19 Telehealth Program. Qualifying providers have the opportunity to apply for federal funding between April 29 and May 6. The program is designed to help providers cover costs associated with delivering connected care services to patients.
  • Pennsylvania  
    • Pennie (the Pennsylvania state-based marketplace) and the YMCA held their Health Equity Tour event on May 1. This kickoff event will include COVID-19 vaccines available by appointment. The free, in-person event will also be an opportunity to learn about Pennie, the YMCA’s evidence-based chronic disease management programs, and other educational services about COVID-19, dental health, senior health, lung health, and more.
    • The Wolf Administration outlined the impacts of COVID-19 on people living with substance use disorders and highlighted projects and collaborations made possible through the Opioid Disaster Declaration’s creation of the Opioid Command Center.
    • Gov. Wolf talked about how the state and its partners are using various means to reach people not able to leave home to be vaccinated against COVID-19. Acting Secretary of Health Alison Beam amended an order to ensure vaccine providers are working with local Area Agencies on Aging and other groups to reach those who are not able to leave their homes.
  • West Virginia – Gov. Jim Justice announced West Virginia plans to use a portion of the state’s first allocation of CARES Act dollars to offer a $100 savings bond to each person from 16 to 35 years old who decides to get their vaccine. The incentive will be retroactive, meaning all West Virginians ages 16 to 35 who have already been vaccinated will also receive a $100 savings bond.


Other State Updates: AK, AZ, ME, NM, NV, NY, VA

  • Alaska – The Department of Health and Social Services’ Division of Public Assistance launched a new Virtual Call Center (VCC) earlier this month. The VCC streamlines the application and eligibility process and makes access easier for Alaskans statewide who need assistance with Medicaid, the Supplemental Nutrition Assistance Program, Temporary Assistance for Needy Families, Heating Assistance, Senior Benefits, General Relief Assistance, and other assistance programs.
  • Arizona – The Arizona Health Care Cost Containment System is asking members, their families, and registered providers to submit questions about various evidence-based practices that support health outcomes. The agency is seeking questions related to assertive community treatment, permanent supportive housing, supported employment, and consumer operated services and will host a series of hour-long sessions hosted by subject matter experts to hear answers to the questions.
  • Maine – The Maine Department of Health and Human Services announced that it will establish the Office of Population Health Equity (OPHE) within the Maine Center for Disease Control and Prevention in order to identify and address health disparities in communities throughout Maine. The OPHE will focus on data-driven interventions to advance health equity for a number of populations, including but not limited to racial and ethnic populations, women, LGBTQ+ individuals, people with disabilities, and other groups for which disparate health outcomes are present in Maine.
  • Nevada – Gov. Steve Sisolak introduced legislation to establish a Public Health Resource Office in the Department of Health and Human Services under the Division of Public and Behavioral Health. The office will be charged with identifying opportunities for improved coordination, state infrastructure needs, federal funding opportunities, and improve public health delivery systems throughout the state.
  • New Mexico – The Human Services Department is accepting nominations for the Primary Care Council until May 14. The Council will develop a five-year strategic plan to determine how primary care investment could increase access to primary care, improve the quality of primary care services, lower the cost of primary care delivery, address the shortage of primary care providers, and reduce overall health care costs.
  • New York – NY State of Health, the New York state-based marketplace, announced its 2021 Spring Training materials for assisters. The materials cover information on the American Rescue Plan and changes to the state’s Essential Plan.
  • Virginia
    • Gov. Ralph Northam’s administration, in partnership with the Virginia Council on Women, unveiled a statewide Maternal Health Strategic Plan to guide the commonwealth in its ongoing work to eliminate the racial disparities in Virginia’s maternal mortality rate by 2025. The statewide Maternal Health Strategic Plan outlines six specific strategies and 21 recommendations to achieve the governor’s goal and address the racial disparities in maternal health outcomes. The strategies focus on improvements in six areas, including insurance coverage, health care setting, criminal justice and child welfare response, community-based services, contraception, and data collection.
    • The State Corporation Commission is reminding Virginians they can enroll in 2021 health insurance coverage through Aug. 15 and that they may now qualify for financial help available through the American Rescue Plan. The state highlighted provisions under the American Rescue Plan, including tax reconciliation relief. SHVS also published template language for state-based marketplaces to adapt and use in consumer-facing communications.


New Medicaid Leadership Training Opportunity

With support from the Robert Wood Johnson Foundation, the Center for Health Care Strategies (CHCS) is launching the Medicaid Pathways Program, an initiative designed to bolster the leadership capacity of senior Medicaid leaders. This nine-month leadership training program is designed for individuals who are new to Medicaid leadership roles and/or are interested in advancing to a more senior role in the future. This program aims to support a diverse cohort of senior leaders within Medicaid, particularly individuals with lived experience with Medicaid. The objective is to strengthen participants’ knowledge and skills and facilitate the development of senior Medicaid leaders to effectively serve in leadership roles in Medicaid agencies. Applications are due May 28 and CHCS will select up to 20 participants through a competitive selection process.


Three Principles for an Antiracist, Equitable State Response to COVID-19—and a Stronger Recovery

The effects of the COVID-19 pandemic have underscored the ways the nation’s history of racism, bias, and discrimination are embedded in health, social, and economic systems. A new report by the Center for Budget and Policy Priorities highlights three principles state policymakers can consider to enact antiracist, equitable, and inclusive policies that build an economic recovery that extends to all people. Adhering to these three equity principles would help states take advantage of this moment. States can make transformative policy changes to drastically reduce the severe hardships that millions of people will otherwise experience in the months and years ahead, sharply reduce long-standing inequities rooted in historical racism and other forms of oppression, and build revenue systems capable of sustaining a future in which people no longer go hungry and get the housing, health care, and other supports they require.


Case Study on the State of Washington’s Individual Market

Wakely Consulting, with support from the Robert Wood Johnson Foundation, published a white paper analyzing the impact of the American Rescue Plan on Washington state’s individual market. With permission from the Washington Health Benefit Exchange (WAHBE), Wakely used member level enrollment, premium, and plan selection data to estimate how subsidy changes would affect affordability for those currently enrolled as well as how the individual market might change as a result of new subsidies in 2021 and 2022. Overall, Wakely found that the American Rescue Plan, when implemented for a full year in 2022, will increase enrollment in the individual market by 13 percent and decrease net premiums by nearly 25 percent. Overall subsidized enrollment is expected to account for nearly 75 percent of Washington’s individual market on-Exchange, compared to 60.7 percent in 2020. The paper outlines Washington’s individual market without the American Rescue Plan (baseline), what the potential effects of the law will have on the state’s individual market in 2021 and 2022, and concludes with additional considerations.