In This Week’s Update:
- States of Unwinding
- HHS’ New Website Launch
- Milbank Leadership Programs
- Access to Maternity Providers: Midwives and Birth Centers
- Adults Forgo Healthcare Because of Transportation Barriers
- State updates: CA, CO, GA, MD, MN, MS, NC, NJ, NY, OR, PA & WA
States of Unwinding
Last week, State Health and Value Strategies (SHVS) launched a new webpage to host the States of Unwinding series. The series, which SHVS will continue to update, highlights examples of the work states are engaging in to prepare for and operationalize the unwinding of the continuous coverage requirement to minimize coverage losses. This series aims to showcase strategies that other states may be interested in adopting and highlight how states are leveraging federal flexibilities. As a reminder, SHVS also has a one-stop resource page to support states as they plan for and implement unwinding.
HHS’ New Website Launch
Also last week, the U.S. Department of Health and Human Services (HHS) launched a new user-friendly website, designed for the general public, to help people identify available resources, explore unbiased information about various treatment options, and learn how to reach out to get the support they need for issues related to mental health, drugs, or alcohol. The concept for FindSupport.gov was developed by HHS’s Substance Abuse and Mental Health Services Administration and CMS in response to research showing that people were looking for an unbiased, trustworthy source of information on how to get support for mental health and substance use issues.
Milbank Leadership Programs
The Milbank Memorial Fund is now accepting applications for the 2023-2024 cohorts of two leadership programs for legislative and executive branch state, larger-county, and large-city government officials committed to improving population health. The Milbank Fellows Program is an opportunity for senior leaders and the Emerging Leaders Program is an opportunity for rising leaders. These programs, all costs of which are covered by Milbank, provide a unique opportunity for participants to engage with colleagues from across the country, as well as with Milbank’s broader state leadership network; enhance their leadership skills; learn from experts about pressing health policy topics; and improve their capacity to advance population health reforms in their communities. Milbank is seeking applicants who have diverse backgrounds and lived experience, interest in acquiring new knowledge and sharing of their own subject matter expertise on key areas of population health policy and program administration, commitment to achieving health equity, curiosity and enthusiasm about engaging with others, and interest in self-reflection and development of new insights.
Access to Maternity Providers: Midwives and Birth Centers
Medicaid finances a significant portion of births, particularly for birthing individuals who are more likely to have disparities in maternal health outcomes. A new issue brief from the Medicaid and CHIP Payment Access Commission (MACPAC) highlights evidence that midwives and the midwifery-led model of care provided in birth centers can improve maternal and child health outcomes at a lower overall cost to Medicaid. Certified nurse-midwife services and coverage for care at licensed birth centers are mandatory Medicaid benefits under federal law. However, there are barriers to expanding access. These include variation in payment policies, challenges contracting with managed care organizations, requirements related to licensure, certification, and accreditation, scope of practice for midwives, and the limited supply of these providers, especially in rural communities and communities that have been marginalized.
Adults Forgo Healthcare Because of Transportation Barriers
Highlighting the importance of public transit accessibility in promoting equitable access to care, an analysis from the Urban Institute provides new evidence on transportation barriers to healthcare. Using nationally representative survey data, the analysis finds that transportation barriers to healthcare disproportionately affect Black and Latino/a adults and those with low incomes, disabilities, public health insurance coverage, residence in rural areas, and lack of household access to a vehicle. More than one in five adults without access to a vehicle who reported living in neighborhoods with fair or poor access to public transit forgo healthcare because of difficulty finding transportation. Access to healthcare requires that affordable care is not only available but also reachable. When transportation barriers cause patients to forgo or skip healthcare visits, this can be detrimental to long-term health. More work is needed to understand national patterns in the role of transportation and public transit in access to medical care and, ultimately, the importance of transportation for health equity.
State updates: CA, CO, GA, MD, MN, MS, NC, NJ, NY, OR, PA & WA
- California – California awarded nearly $17 million to 44 community-based and tribal organizations to develop and increase substance use disorder prevention services through civic engagement and culturally competent programs. These awards are part of Elevate Youth California, a statewide Department of Health Care Services program addressing substance use disorder.
- Colorado – The Colorado Division of Insurance issued an order regarding a Medicare Supplement guaranteed issue period for consumers losing Medicaid coverage due to the unwinding. This will allow individuals who became eligible for Medicare during the continuous coverage requirement and missed the open enrollment window to access Medicare Supplement plans during the unwinding.
- Georgia – Governor Brian Kemp signed multiple bills related to maternal health and access to healthcare services. The signed legislation includes SB 65, which authorizes the Department of Insurance to create and administer a state-based health insurance exchange.
- Maryland – Governor Wes Moore signed legislation that solidifies protections for reproductive rights and protects the rights of transgender Marylanders. The legislation includes a bill that establishes the fundamental right to reproductive freedom and a bill that requires Maryland’s Medicaid program to provide gender-affirming treatment in a nondiscriminatory manner.
- The Minnesota Department of Human Services (DHS) has cancelled unpaid MinnesotaCare (the state’s Basic Health Program) premiums and will waive premiums for May 2023 through June 2024 coverage for all enrollees. The state passed legislation in 2021 that prevents DHS from collecting unpaid MinnesotaCare premiums that accrued during the public health emergency. Additionally, the 2023 Minnesota legislature passed a law that temporarily waives MinnesotaCare premiums for all enrollees for coverage from May 2023 through June 2024.
- MNsure, the state’s official health insurance Marketplace, has announced the appointment of Libby Caulum as chief executive officer (CEO) after serving as acting CEO since Nate Clark retired in March. Congrats Libby!
- Mississippi – The Mississippi Division of Medicaid (DOM) announced it is eliminating all Medicaid copayments for pharmacy and healthcare services, effective May 1, 2023. DOM plans to submit a state plan amendment to allow the agency to remove copays from Medicaid services. While DOM will continue to pay providers for their services, providers will no longer be able to collect copays from enrollees beginning May 1, 2023.
- New Jersey – GetCoveredNJ, the state’s official health insurance Marketplace, created a list of frequently asked questions (FAQs) on the loss of NJ FamilyCare (Medicaid/CHIP) during the unwinding. The FAQ informs enrollees of a 120 day special enrollment period to enroll in coverage through GetCoveredNJ after Medicaid or CHIP coverage ends. Consumers who are determined ineligible for Medicaid based on income will automatically be transferred to GetCoveredNJ and will receive a welcome notice by mail or email with a unique access code that allows them to access their account, complete a pre-filled application to determine eligibility for financial assistance, and shop for coverage. The state has created a consumer guide for individuals enrolling in coverage if their account was transferred to the Marketplace and a consumer guide for individuals enrolling in coverage if their information was not transferred to the Marketplace.
- New York – Governor Kathy Hochul announced actions as part of the 2024 budget to strengthen abortion protections and access. The budget increases Medicaid reimbursement rates to boost New York abortion access, enacts data protections for patients seeking reproductive healthcare, requires private insurers to cover medication abortion when prescribed off-label for abortion, and allocates $100.7 million in new funding to support abortion providers and reproductive healthcare. Governor Hochul also signed legislation to allow pharmacists to dispense hormonal contraception over the counter and legislation to ensure that every student enrolled within the State University of New York and the City University of New York public university systems has access to medication abortion on campus.
- North Carolina – The North Carolina Department of Health and Human Services (NCDHHS) released the NCDHHS State Action Plan for Nutrition Security. This plan is part of the department’s larger strategic goal to support child and family wellbeing. The action plan outlines an innovative, multi-pronged strategy to decrease the number of North Carolinians currently experiencing food insecurity. Actions include: increasing the reach of NCDHHS’ nutrition programs; building connections between healthcare and nutrition supports; and increasing breastfeeding support and rates.
- Oregon – The Oregon Health Care Authority (OHA) published Oregon’s 2022 Annual Cost Growth Trends Report, which presents data on healthcare spending and healthcare cost growth in the state between 2018 and 2020. Data confirm healthcare costs grew between 2018 and 2019 before dropping between 2019 and 2020 due to COVID-related changes in the use of healthcare. Medicaid experienced the lowest rate of cost growth compared to Medicare and the commercial market.
- Pennsylvania – Governor Josh Shapiro signed a law that will require insurers to cover preventive breast and ovarian screenings for high-risk women at no cost. The law removes out-of-pocket costs associated with genetic testing for hereditary breast, ovarian, prostate and other cancer syndromes—as well as supplemental breast screenings for women with a high lifetime risk of breast cancer.
- Washington – The Washington State Health Care Authority published a plan for removing barriers to access health and human services, including Medicaid, the Supplemental Nutrition Assistance Program, Temporary Assistance for Needy Families, and child care programs. The plan outlines two goals: 1) to remove barriers to accessing benefits, so that individuals can seamlessly apply for multiple programs in less than 20 minutes and immediately know their eligibility status; and 2) to share information across organizations to proactively offer other benefits for which the individual may qualify. The plan was developed by the Washington State Health and Human Services Enterprise Coalition, which consists of Washington state health and social service agencies.
- AK, DE, GA, HI, ID, MD, ME, MN, MT, ND, NH, NJ, OR, PA, VA & WI – CMS notified these 16 states with Section 1332 waivers of the final amounts of federal pass-through funding for the 2023 plan year. Section 1332 waivers permit states to pursue innovative strategies for providing residents with high-quality, affordable health insurance, while retaining the basic protections of the Affordable Care Act. Overall the 16 states will receive $2,593,746,722 for the plan year 2023.