November 13 Update

In This Week’s Update:

  • State Strategies to Operationalize Unwinding
  • CMS Releases New Guidance on SOGI Questions
  • Preparing to Implement the 12-Month Continuous Enrollment for Children Requirement
  • Strategies for Reducing Clinician Burnout
  • Impacts of Medical Debt: Findings From a National Survey
  • Leveraging Medicaid to Support Children and Youth Living With Complex Behavioral Health Needs
  • State updates: AR, AZ, CA, ID, KS, MD, MI, MO, NC, NE, NM, NY, OR, PA, SD & WY

State Strategies to Operationalize Unwinding
Last week, SHVS published a new States of Unwinding post highlighting the work states are engaged in to operationalize unwinding and preserve coverage. And as states prepare to implement the 12-month continuous enrollment requirement for children as of January 1, 2024, SHVS is hosting a webinar on recent guidance released by CMS. The November 16 webinar will review the provisions in the Consolidated Appropriations Act, 2023 that require states to provide children up to age 19 with 12 months of continuous enrollment in Medicaid and CHIP. Registration is required (see below for more details).

CMS Releases New Guidance on SOGI Questions
Also last week, CMS released an informational bulletin on adding sexual orientation and gender identity (SOGI) questions to state Medicaid and CHIP applications. The guidance follows a recent announcement that starting November 1, individuals applying for coverage through will be asked three new optional SOGI questions. States that elect to include these questions on their Medicaid and CHIP applications exactly as they are worded will not be required to seek CMS approval, while states using alternative language are asked to work with CMS and may need to seek formal approval. Irrespective of which wording states choose, these questions must be optional. State Health and Value Strategies is currently updating our recently published issue brief on SOGI data collection in Medicaid to reflect this new guidance. In the meantime, if you have questions for our experts, please be in touch. Updates follow.

Preparing to Implement the 12-Month Continuous Enrollment for Children RequirementSHVS is hosting a webinar on provisions included in the Consolidated Appropriations Act, 2023 (CAA) that require states to provide children up to age 19 with 12 months of continuous enrollment (CE) in Medicaid and the Children’s Health Insurance Program starting January 1, 2024. During the webinar, experts from Manatt Health will review recent sub-regulatory guidance from the Centers for Medicare & Medicaid Services and considerations for states as they prepare to newly take up CE for children or modify existing CE policies to meet the CAA requirement. Registration (required):

Strategies for Reducing Clinician Burnout
The latest episode of the Princeton Pulse podcast examines clinician burnout, a public health issue propelled into the spotlight by the COVID-19 pandemic. This episode features Dr. Bryant Adibe, Sugarman Practitioner in Residence at Princeton’s School of Public and International Affairs, and Dr. Wayne Jonas, a practicing family physician and president of the Healing Works Foundation. Our conversation addresses widespread dissatisfaction among healthcare workers, absenteeism, staffing shortages, and other repercussions that threaten access to safe, quality healthcare in the United States and beyond. We talk about reducing clinician burnout through a systems approach that leverages actionable data, and highlight a recent summit that united scholars, healthcare providers, and policymakers in the collaborative pursuit of clinical wellbeing.

Impacts of Medical Debt: Findings From a National SurveyResearch firm PerryUndem recently released findings from a national survey prepared for the American Cancer Society Cancer Action Network (ACS CAN), the Leukemia & Lymphoma Society (LLS), and R.I.P Medical Debt to create a national picture of experiences and attitudes on medical debt. The survey, which is summarized in a recent Vox article, found that most (69%) of Americans struggle with high healthcare costs and medical bills they cannot pay. Many are also unsure or confused about costs after they receive healthcare services, with nearly 40% reporting that they are always or frequently unsure about what it will cost. In addition to this confusion about costs, nearly half of respondents were unaware many providers offer financial assistance programs to help with debt. The survey also tested 12 policy ideas to protect people from medical debt—such as giving patients more time to pay back bills and capping interest rates for medical debt—and all received strong majority support.

Leveraging Medicaid to Support Children and Youth Living With Complex Behavioral Health NeedsThe COVID-19 pandemic exacerbated the already-growing mental health and substance-use disorder (behavioral health) crisis gripping children and youth in the United States. In a new report prepared for the Commonwealth Fund, Manatt Health and its coauthors provide an actionable framework and strategies for how state-level policymakers can use Medicaid and CHIP to respond to the behavioral health crisis among children and youth living with complex needs. The framework and strategies are rooted in a family- and community-based approach that recognizes children and youth fare best when treated in the context of their families (broadly defined) and communities, as well as when interventions build on their strengths and maximize their choices and autonomy.

State updates: AR, AZ, CA, ID, KS, MD, MI, MO, NC, NE, NM, NY, OR, PA, SD & WY

  • Arizona – The Arizona Health Care Cost Containment System is investing $47.5 million in funds from the American Rescue Plan Act (ARP) into a second round of the ARP Program Awards to strengthen home and community-based services (HCBS) in the state. Starting on December 4, 2023, providers can apply for up to $1,000,000 for programmatic or infrastructure projects to improve the health, safety, and member experience of individuals who receive HCBS. As a reminder, SHVS published an issue brief on the enhanced payment available through the ARP for HCBS.
  • Arkansas – The Arkansas Department of Health released an anti-vaping campaign animated video for children ages five through seven. The campaign is designed to reach children with anti-vaping and anti-nicotine messages before they start getting messages from peers and the vaping industry.
  • California – On November 6, the Department of Health Care Services will host the next PATH Justice-Involved Program virtual office hour session for Round 3 eligible agencies. Office hours will be held every other Monday at 12 p.m. through December 18 to assist Round 3 agencies, including supporting implementation plan submission. For more information, visit the Justice-Involved Program website.
  • Idaho – The state requested to amend its Behavioral Health Transformation demonstration to allow spouses and parents of minor children to be reimbursed for providing personal care services to eligible individuals. Idaho currently has this authority through temporary COVID-19 authorities. The federal public comment period will be open from November 8, 2023 through December 8, 2023.
  • Kansas
    • Governor Laura Kelly announced the launch of the Council of State Government’s Justice Center’s Stepping Up Initiative in Kansas’ juvenile justice system to reduce the over-incarceration of Kansans with mental illness and substance-use disorders. The initiative provides Department of Corrections staff at juvenile justice system facilities with training and other technical assistance to identify youth who could benefit from behavioral health supports and services to avoid reincarceration.
    • Governor Laura Kelly held a roundtable focused on how Medicaid expansion would benefit the Kansas agriculture industry. Farmers, ranchers and legislators joined to share healthcare issues facing the agriculture industry and discussed how expansion could address these challenges.
  • Maryland – The state submitted a request to amend its section 1115 demonstration, entitled “Maryland Health Choice,” to establish an Express Lane Eligibility program to utilize data from the Supplemental Nutrition Assistance Program for Medicaid redeterminations, as well as to continue Maryland’s waiver of the Four Walls Requirement to allow clinics to bill telehealth services at the standard rates. The federal public comment period will be open from November 9, 2023 through December 9, 2023.
  • Michigan – The Michigan Department of Health and Human Services (MDHHS) launched a competitive procurement for the Comprehensive Health Care Program contract for Michigan’s Medicaid health plans. The rebid is part of MIHealthyLife, an initiative launched in 2022 to strengthen Medicaid services through new Medicaid health plan contracts. Input from nearly 10,000 enrollees and family members, healthcare providers, health plans and other community partners informed the creation of five MIHealthyLife strategic pillars to guide MDHHS’ planning and decision-making in the rebid process.
  • Missouri – The Missouri HealthNet Division (MHD) announced upcoming listening sessions, called MO Mom Chat, to provide Medicaid-enrolled mothers an opportunity to share their thoughts about their healthcare. MHD also launched an online survey seeking feedback from Medicaid enrollees who are pregnant or recently gave birth.
  • Nebraska – Governor Jim Pillen announced the appointment of Matt Ahern to serve as interim Medicaid director beginning December 1, upon resignation of the current director Kevin Bagley.
  • New Mexico – BewellNM, the state’s official health insurance Marketplace, has launched a dashboard monitoring the open enrollment period for plan year 2024. The dashboard includes enrollment data, summary statistics on level of coverage, average subsidy amounts, enrollment by federal poverty level, and customer engagement center statistics.
  • New York – Governor Kathy Hochul announced New York’s latest efforts to combat maternal and infant mortality rates, including legislation that directs the New York State Department of Health to create a directory of doulas. The governor also announced doula services will be covered for all Medicaid enrollees starting January 1, 2024 and $4.5 million in annual funding has been allocated for regional perinatal centers.
  • North Carolina – The North Carolina Department of Health and Human Services began contacting up to 300,000 people who are enrolled in Medicaid’s limited Family Planning program and who are eligible for full Medicaid benefits starting December 1. Text messages, phone calls and emails will be sent by the department letting those eligible know to look out for a letter from their local Department of Social Services.
  • Oregon – Governor Tina Kotek announced that she has appointed Dr. Sejal Hathi as the director of the Oregon Health Authority. Incoming Director Hathi previously served as New Jersey’s deputy health commissioner for public health services and as the White House’s senior policy advisor for public health. Congratulations Dr. Hathi!
  • Pennsylvania – Governor Josh Shapiro and Pennsylvania Insurance Department (PID) Commissioner Michael Humphreys have directed health insurers to provide coverage for autism benefits starting on January 1, 2024 in compliance with mental health parity laws. Some commercial insurers have historically categorized autism services as a physical health benefit, but PID published a notice directing insurers to treat autism as a mental health condition subject to parity requirements.
  • South Dakota – The Department of Social Services recently launched the South Dakota Opioid Settlement Fund Community Grant Program, offering South Dakota-based organizations the opportunity to apply for funding assistance to provide direct services and support to populations affected by opioid overdose within South Dakota communities.
  • Wyoming – Wyoming submitted a new demonstration request to provide home and community-based services to individuals over the age of 65 who are currently ineligible for Medicaid. The goal of the demonstration is to prevent or delay future institutional level of care. The federal public comment period will be open from November 8, 2023 through December 8, 2023.