In This Week’s Update:

• Demonstration Facilitation Toolkit
• Congressional Budget Office Insurance Coverage Projections for 2023 to 2033
• Medicaid Leadership institute, Class of 2024
• State updates: AZ, IA, KY, MA, MN, MO, MS, MT, NC, NE, NH, NJ, NM, OR, PA & RI  

Demonstration Facilitation Toolkit

Last week, SHVS published a new toolkit for states seeking to leverage an 1115 waiver to support reentry for justice-involved populations. This tool can be used by states to compare their demonstration’s proposed features with the reentry requirements outlined in CMS’ State Medicaid Director Letter (SMDL) and California’s section 1115 demonstration approval. 

  

Congressional Budget Office Insurance Coverage Projections for 2023 to 2033

The Congressional Budget Office (CBO) released updated projections of health insurance coverage. CBO estimates that in 2023, 248 million people in the U.S. who are younger than 65 will have health insurance coverage (mostly through employer-based plans) and 23 million people, or 8.3% of that age group will be uninsured—with significant variations in coverage by income and, to a lesser extent, by race and ethnicity. The current unprecedented low uninsurance rate is largely attributable to temporary policies that kept individuals enrolled in Medicaid and enhanced the subsidies available through the health insurance Marketplaces during COVID-19. As the continuous eligibility provisions unwind in 2023 and 2024, an estimated 9.3 million people younger than 65 will transition to other forms of coverage, and 6.2 million will become uninsured. If the enhanced subsidies expire after 2025, 4.9 million fewer people are estimated to enroll in Marketplace coverage, instead enrolling in unsubsidized nongroup or employer-based coverage or becoming uninsured. By 2033, the uninsurance rate is projected to be 10.1% which is still below the 2019 rate of about 12%.

 

Medicaid Leadership Institute, Class of 2024

The Medicaid Leadership Institute (MLI), led by the Center for Health Care Strategies, is uniquely positioned to support Medicaid directors in cultivating the necessary skills to successfully lead their programs and impact key health outcomes. With support from the Robert Wood Johnson Foundation, 71 state Medicaid directors and their senior teams from states across the political spectrum have participated in MLI since 2009. MLI offers an intensive 10-month leadership development program for competitively selected Medicaid directors. Medicaid directors in all states, commonwealths, and territories are eligible to apply. Priority will be given to applicants who have been in their positions at least nine months. Up to six Medicaid directors will be selected. Applications are due June 9, 5 p.m. ET.

 

Medicaid Coverage for Children and Families in Rural Counties

Georgetown University’s Center for Children and Families, using data from the University of North Carolina’s Sheps Rural Health Research Center, has examined the role that Medicaid plays in health insurance coverage in rural areas, including how state Medicaid expansions helped reduce uninsurance. New national and state maps present updated data for 2020-2021. Rural areas are more likely to face barriers to coverage and care such as a lack of access to transportation, poor internet connectivity, hospital closures, and provider shortages, and people living in rural areas tend to experience worse health outcomes as a result. Nationwide, almost half (47%) of children and one in five (18%) of adults rely on Medicaid coverage in small towns and rural areas (compared to about 40% of children and 15% of adults in metro areas).

State Updates

• Arizona
  • The Arizona Health Care Cost Containment System (AHCCCS) issued a notice that AHCCCS members who have recently lost Medicaid coverage and are now enrolled with another health insurance company may be able to continue seeing a previous healthcare provider to continue a course of treatment. The notice includes details on eligibility requirements for continuity of care with a previous provider and instructs the new member to send a written request to the new health plan in order to continue care with a previous provider.
  • AHCCCS announced that Medicaid or CHIP members, ages 3 to 19, who are enrolled in an AHCCCS managed care health plan and complete their first well-care visit of 2023 between June 5 and September 5 are eligible to receive a $25 gift card from their health plan.
• Iowa – The Iowa Department of Health and Human Services released a request for proposals for the delivery of high-quality dental healthcare services for the Iowa Dental Wellness Plan and Healthy and Well Kids in Iowa programs. The agency seeks to improve the quality of care and health outcomes for Medicaid and CHIP populations. The agency expects to award three-year contracts to two or more pre-paid ambulatory health plans, with two optional two-year extensions.
• Kentucky – Kentucky is hosting monthly stakeholder meetings throughout the unwinding of the Medicaid continuous coverage requirement. During the May stakeholder meeting, the Cabinet for Health and Family Services presented on the state’s renewal caseload planning, priorities, renewal updates, outreach, reporting to CMS, and how providers can support patients through renewals.
• Massachusetts – The board of directors of the Massachusetts Health Connector, the state’s official health insurance Marketplace, voted to propose regulation amendments guaranteeing that health insurance plans meeting state Minimum Creditable Coverage (MCC) standards will continue to cover preventive services without cost-sharing. The Health Connector, which is the independent state authority that governs MCC, will commence a regulatory amendment process with a public hearing on the proposed amendment.
• Minnesota – Governor Tim Walz signed the state’s new budget, which will allow for the expansion of MinnesotaCare, the state’s Basic Health Program, to undocumented residents using state funding. This will expand access to more than 40,000 people who are undocumented. The budget also provides continuous Medicaid coverage for children up to age six; the creation of an easy enrollment health insurance outreach program; an actuarial analysis for a public option; an analysis of a Universal Health Financing System; and an implementation plan for a direct payment system for Medicaid and MinnesotaCare.
• Mississippi – The Mississippi Division of Medicaid submitted a state plan amendment to extend postpartum coverage for pregnant women from 60 days to 12 months, effective April 1, 2023.
• Missouri –The Missouri Department of Social Services announced a webinar to discuss case management for pregnant women enrolled in Medicaid. The webinar will review resources, policy and billing information for providers.
• Nebraska – Nebraska Governor Jim Pillen signed into law the Certified Community Behavioral Health Clinic Act (CCBHC) to increase access to outpatient mental health and substance use treatment through service delivery coordination with community partners. The CCBHC program requires the state Department of Health and Human Services (DHHS) to develop a prospective payment system through which providers will be reimbursed based on the anticipated cost of providing required services to Medicaid recipients on either a daily or monthly basis—rather than on a fee-for-service basis. Under the legislation, DHHS is required to apply for a Medicaid state plan amendment through CMS to implement the bill’s provisions by January 1, 2026.
• New Hampshire – The New Hampshire Department of Health and Human Services announced “Mission Zero,” a plan to eliminate hospital emergency department (ED) psychiatric boarding by 2025. ED boarding refers people in acute behavioral health crisis waiting in medical emergency departments for care in another setting. The work to address ED boarding reduction is also outlined in the state’s 10-Year Mental Health Plan.
• New Jersey – Governor Phil Murphy and Secretary of Higher Education Dr. Brian Bridges announced a partnership with Uwill—a mental health and wellness platform that will support students at 44 institutions of higher education throughout New Jersey. The partnership will provide 24/7 access to free virtual mental health services throughout the entire year for students enrolled in an eligible institution.
• New Mexico – New Mexico is incentivizing enrollees to complete their Medicaid renewal during the unwinding and become a “Renew NM SuperStar.” Eligible individuals who update their contact information will earn $5 in rewards, with the ability to earn another $15 by posting about Renew NM on social media, sending a thumbs up photo in support of Renew NM, or by sharing a short story about how Medicaid has made a difference in their life or the life of someone they love. The state is also encouraging individuals to submit a Renew NM video and will select a winner every two weeks to earn a $100 visa gift card.
• Oregon – The Oregon Department of Consumer and Business Services announced that consumers can get a first look at the requested rates for 2024 individual and small group health insurance plans. Rate changes in the individual market have a weighted average increase of 6.2%, slightly lower than last year at 6.7%. Rate changes in the small group market have a weighted average increase of 8.1%, which is higher than last year’s 6.9% average increase. The state’s reinsurance program lowered rates by at least 6% for the sixth straight year.
• Pennsylvania – Pennsylvania Acting Insurance Commissioner Michael Humphreys announced the Pennsylvania Insurance Department (PID) has strengthened its review of mental health and substance use disorder coverage in 2024 health plans. For 2024 filings, PID is enhancing its compliance review of mental health and substance use disorder parity requirements to prevent potential violations.
• Rhode Island – Governor Dan McKee signed into law the Equality in Abortion Coverage Act which requires the coverage of abortion procedures for individuals enrolled in state employee health plans and Medicaid.

Kentucky, Montana, Nebraska & North Carolina – SHVS updated our expert perspective that is tracking state unwinding dashboards to include these four states. The EP includes an interactive map with links to all of the dashboards and states publishing CMS unwinding reports. SHVS will continue to update the EP and map as more states publish their unwinding data.