Nov. 20 Update

In This Week’s Update:

  • New Unwinding Resources 
  • CMS Resources to Navigate Health Insurance Programs 
  • CMS Guidance on Health-Related Social Needs
  • Innovations to Improve Outpatient Billing Practices 
  • Toolkit: New CMS Tribal Protections in Medicaid and CHIP 
  • State updates: AL, CA, IA, KS, MA, MI, MN, MO, NC, NY, OR, WV & WY

New Unwinding Resources

Last week, State Health and Value Strategies (SHVS) published three new resources related to unwinding the continuous coverage requirement:


CMS Resources to Navigate Health Insurance Programs 

Also last week, in case you missed it, CMS issued the Proposed Notice of Benefits and Payment Parameters for 2025 and fact sheet. The proposed rule includes several proposals impacting the Medicaid program, CHIP, the Basic Health Program, and a proposal for section 1332 waivers. Our experts are reviewing the proposed rule and SHVS is planning to publish an analysis that highlights considerations for State-Based Marketplaces. 


CMS Guidance on Health-Related Social Needs

SHVS also published an
expert perspective summarizing CMS’ new Informational Bulletin and accompanying framework which together detail Medicaid coverage options for services that address the health-related social needs (HRSN) of Medicaid enrollees. The new guidance reiterates the importance of addressing HRSNs to improve access to care and health outcomes, and summarizes (and in some cases updates) multiple previous sources of CMS guidance on how HRSN services may be covered in Medicaid, including guidance on in lieu of services authority and on HRSN coverage in section 1115 waivers.


Strategies to Improve Outpatient Billing Practices 

As hospitals acquire or otherwise affiliate with physician practices, they can charge facility feesa second fee in addition to a healthcare professional’s billfor outpatient care. This practice results in higher spending for office-based services, which increases premiums and out-of-pocket costs for consumers without improving quality. In a new cheat sheet for policymakers, researchers from Georgetown University’s Center on Health Insurance Reforms share several strategies for reforming hospital outpatient billing practices and evaluate how effectively each of these strategies can better protect consumers from out-of-pocket costs, reduce healthcare system costs, and increase transparency and oversight.


New CMS Tribal Protections in Medicaid and CHIP Toolkit

CMS recently released the Tribal Protections in Medicaid and CHIP Managed Care Oversight toolkit. The toolkit provides resources for states, managed care plans, and Indian Health Care Providers (IHCPs) to maximize the benefits of Medicaid and CHIP managed care for American Indian and Alaska Native (AI/AN) enrollees and the IHCPs consistent with the statutory and regulatory Indian managed care protections. The toolkit highlights promising practices and strategies that state Medicaid agencies and managed care plans can use to: (1) improve state-Tribal relationships including Tribal consultation; (2) establish a Tribal liaison position to improve access to care for AI/AN enrollees and improve claim processing; (3) improve contracting between managed care plans and IHCPs; (4) develop internal processes to improve understanding of the managed care delivery system for AI/ANs and IHCPs; and (5) partner with Tribes or Tribal organizations to develop an Indian Managed Care Entity.


The State Health Update will be taking next week off to celebrate Thanksgiving and will be back on December 1. Updates follow.


State updates: AL, CA, IA, KS, MA, MI, MN, MO, NC, NY, OR, WV & WY

  • Alabama – The Alabama Department of Public Health announced the 2022 Alabama infant mortality rate was 6.7 deaths per 1,000 live births, a decrease from the 7.6 rate in 2021. Black mothers continue to have the highest infant mortality rate in the state. In 2022, the infant mortality rate for Black mothers increased to 12.4 from the 2021 rate of 12.1, while the rate for White mothers was 4.3, a decrease from 5.8 in 2021.
  • California – The California Department of Health Care Services (DHCS) announced that starting January 1, 2024, Medi-Cal managed care plans (MCPs) will have new requirements to advance quality, equity, access, accountability, and transparency. As part of these improvements, approximately 1.2 million Medi-Cal members in 21 counties will transition to a new MCP. DHCS is working to ease member transitions to new MCPs and ensure continuity of care and coverage. 
  • Iowa – The Iowa Department of Health and Human Services announced the intent to award contracts to Delta Dental of Iowa and DentaQuest USA Inc. to provide dental care to Iowa Medicaid members, beginning July 1, 2024.
  • Kansas – Governor Laura Kelly hosted a roundtable focused on how Medicaid expansion would address the statewide child care shortage by making it easier for providers to recruit and retain employees. Providers and community leaders shared how extending health insurance to child care workers would make it more likely that those workers join and stay in the workforce.
  • Massachusetts – As part of a new medical respite pilot program to provide individuals experiencing homelessness a safe space to recover after a hospital visit, the Healey-Driscoll Administration awarded $5.2 million in grants for partnerships between healthcare agencies and community-based organizations that provide services to people experiencing homelessness. Respite locations will offer 40 beds of temporary housing with clinical support while program participants receive assistance in finding suitable long-term housing. 
  • Michigan – The Michigan Department of Health and Human Services (MDHHS) will launch five Social Determinants of Health (SDOH) Hub pilots in January 2024 and is seeking participants across the state to serve on the SDOH Hub Advisory Council. The pilot is part of the 2022-2024 MDHHS SDOH Strategy, Michigan’s Roadmap to Healthy Communities, and brings together resources at the state and local level for a greater impact in communities. 
  • Minnesota – The Minnesota Department of Health invites community members to apply to serve on the new African American Health State Advisory Council. The council will work closely with the new Office of African American Health and engage in activities to identify health disparities, recommend policies or practices, and submit a report to the commissioner of health to address health disparities experienced by African American communities.
  • Missouri – CMS announced Missouri’s extension of comprehensive coverage after pregnancy through Medicaid and CHIP for postpartum individuals for a full 12 months. Missouri’s approval marks 40 states, D.C., and the U.S. Virgin Islands that have extended postpartum Medicaid coverage for an entire year. As a reminder, SHVS published an issue brief on the American Rescue Plan option to extend postpartum coverage.
  • New York – New York has submitted to CMS an addendum to the state’s section 1332 waiver application, which would expand the state’s Basic Health Program to individuals up to 250% of the federal poverty level. The public comment period will be open through December 2, 2023.
  • North Carolina – The North Carolina Department of Health and Human Services announced that Medicaid behavioral health reimbursement rate increases will soon be implemented for the first time in more than a decade. The rate increases will include most mental health, substance-use, intellectual and developmental disabilities and traumatic brain injury services in North Carolina. 
  • Oregon – The Oregon Health Authority (OHA) is seeking members to inform policy and program decisions on a new Behavioral Health Crisis System Advisory Committee, which will begin meeting this winter. Created through House Bill 2757, the committee will advise OHA on implementation and operation of the statewide coordinated crisis system, and provide feedback and recommendations on the 988 Suicide & Crisis Lifeline in Oregon. 
  • West Virginia – The ​​​West Virginia University Health Affairs Institute and the West Virginia Department of Health and Human Resources are seeking participants for an Extended Telehealth Pilot initiative. The Extended Telehealth Pilot will provide eligible West Virginians receiving long-term services and supports with six months of free telehealth services, in addition to their current care. The goal of the pilot is to provide individuals with a greater choice in where they live and receive long-term healthcare services and support. 
  • Wyoming – The Wyoming Department of Health (WDH) is working to help expecting parents learn how paying attention to their baby’s movements can sometimes help prevent stillbirths. WDH is encouraging Wyoming families with a baby on the way to use the evidence-based stillbirth prevention program, Count the Kicks.