November 16 Update

In This Week’s Update:

  • Transition COVID-19 Advisory Board
  • CMS Managed Care Rule
  • COVID-19 State Updates: CA, MI, NC & WI
  • Other State Updates: HI, IN, NC, OR, TN & WA
  • 2020 Annual Medicaid Survey Results
  • Family Engagement and Children’s Social and Emotional Development
  • Medicaid Leadership Series Podcast


Transition COVID-19 Advisory Board

Last week, the Biden-Harris Transition team announced the formation of the Transition COVID-19 Advisory Board, a team of leading public health and scientific experts who will advise President-elect Biden, Vice President-elect Harris, and the Transition’s COVID-19 staff. Also last week, the Supreme Court heard oral arguments over the constitutionality of the individual mandate and the fate of the entire ACA. For an overview of the questions asked by the justices and potential outcomes, see this Health Affairs blog post or listen to this week’s Kaiser Health News What the Health? podcast episode (beginning at 27:27).


CMS Managed Care Rule

The Centers for Medicare & Medicaid Services announced the final managed care rule last week. The rule provides some more flexibility for states in terms of setting capitation rate ranges if certain conditions are met, more flexibility in defining network adequacy (not requiring miles and minutes standards), and some changes related to directed payments and risk corridor payments.


COVID-19 State Updates: CA, MI, NC & WI

  • California – Covered California launched open enrollment with a new ad campaign focused on the intersection of the COVID-19 pandemic and insurance coverage. The state kicked off its annual open enrollment period with a statewide effort to encourage Californians to protect themselves, their families, and their friends from the COVID-19 pandemic by wearing a mask and signing up for health care coverage. The campaign includes sending face masks, emblazoned with the message “Get Covered/Stay Covered,” to every Covered California enrollee who is renewing their coverage, as well as all new enrollees.
  • Michigan – As part of the state’s continued efforts to slow the increasing spread of COVID-19, the Michigan Department of Health and Human Services and the Michigan Department of Technology, Management and Budget announced the statewide rollout of the COVID-19 exposure notification app MI COVID Alert. The anonymous, no-cost, and voluntary app lets users know whether they may have recently been exposed to COVID-19. Users can confidentially submit a positive test result into the app and alert others in recent proximity that they may have also been exposed to the virus. 
  • North Carolina – The North Carolina Department of Health and Human Services expanded the demographic data for COVID-19 cases and added new filtering functions to the NC COVID-19 Dashboard. Demographic data for COVID-19 total cases are available by age group, gender, race, and ethnicity and can be filtered by county. The information will be displayed on a new Case Demographics Page on the dashboard.
  • Wisconsin – The Wisconsin Department of Health Services added a “critically high” category to the Disease Activity Dashboard to give Wisconsinites a better picture of the impact of COVID-19 in the state amid a surge in activity. This new category indicates how alarming COVID-19 activity is in counties and regions throughout Wisconsin. The “critically high” category is nearly three times higher than “very high.”


Other State Updates: HI, IN, NC, OR, TN & WA

  • Hawaii – The state released a request for proposals for a qualified behavioral health plan to manage the state’s Community Care Services program, which provides behavioral health services to over 4,500 Medicaid-eligible adults with serious mental illness or serious and persistent mental illness. Proposals are due Jan. 8, 2021. Awards are expected on Feb. 8, 2021, with implementation slated to begin July 1, 2021.
  • Indiana
    • The state submitted an application requesting a new five-year Section 1115 demonstration entitled “Maternal Opioid Misuse Indiana Initiative.” The state is requesting authority to extend postpartum Medicaid coverage for women that meet certain criteria and have an opioid use disorder from the current 60 days to 365 days. The state also wants to provide continuous eligibility for the mother and baby during the entire postpartum period. The federal public comment period will be open from Nov. 9, 2020 through Dec. 9, 2020.
    • The Indiana Family and Social Services Administration’s Division of Mental Health and Addiction (DMHA) announced a series of pilot programs designed to increase access to mental health care for inmates in Indiana county jails. The pilot programs will focus on individuals found incompetent to stand trial who are awaiting placement in the state psychiatric hospital network. Currently, these individuals are forced to await the availability of a bed in a state psychiatric hospital before they can receive the competency restoration services required by law. DMHA’s pilot programs will work with a variety of partners to provide these services in three new and different settings: jails, the community, and private inpatient psychiatric settings.
  • North Carolina – The North Carolina Department of Health and Human Services announced the launch of NC Medicaid’s managed care enrollment website,, in preparation for the launch of Medicaid Managed Care scheduled for July 1, 2021. The purpose of the enrollment website is to help Medicaid enrollees learn more about Medicaid managed care. Medicaid Managed Care open enrollment will begin March 15, 2021, and will continue through May 14, 2021. 
  • Oregon – The Oregon Health Authority announced the data from the Oregon Health Insurance Survey is now available via interactive dashboards, allowing people to explore 2011 to 2019 survey data, complete with demographic and geographic breakdowns. Every two years, the Oregon Health Insurance Survey asks people in 8,000 Oregon households about insurance coverage, access to care, and health care use. The interactive data set allows users to examine trends within and among groups of Oregonians across time.
  • Tennessee – The state received approval for a Katie Beckett program, which covers home-based medical services for children with disabilities who are not eligible for Medicaid. The program provides full Medicaid benefits for children with significant disabilities or complex medical needs or up to $10,000 in annual financial support without enrolling in Medicaid. The program is set to begin Nov. 23.
  • Washington – CMS approved the state’s amendment to its Section 1115 demonstration “Medicaid Transformation Project,” which will enable the state to receive federal financial participation for inpatient, residential, and other services provided to otherwise eligible Medicaid beneficiaries while residing in institutions for mental diseases primarily to receive treatment for diagnoses of serious mental illness.


Institute for Medicaid Innovation’s 2020 Annual Medicaid MCO Survey Report Release

Registration is now open for the Institute for Medicaid Innovation’s upcoming webinar on Dec. 8 to accompany the release of the 2020 annual Medicaid MCO survey report, “Medicaid Access and Coverage in 2019.” The webinar will provide an overview of the results, including trend analysis, in eight key categories: high-risk care coordination, value-based payment, pharmacy, behavioral health, women’s health, child and adolescent health, managed long-term services and supports, and social determinants of health. The release of key findings will be followed by a panel discussion with Medicaid stakeholders. The panel discussion will share their reaction and shed light on how the report can be utilized by Medicaid health plans and state Medicaid agencies.


Moving Beyond the Family Engagement Check Box: An Innovative Partnership to Promote Authentic Family Engagement in Systems Change

This case study examines the partnership that the Center for the Study of Social Policy and Family Voices undertook to create and implement a process for engaging families in the Pediatrics Supporting Parents national initiative to promote the social and emotional development of young children. While many individuals and organizations, including funders, see the value of family engagement, they often struggle with the logistics of how to engage families. This case study provides valuable insights about best practices for engaging families, describes a framework for implementing family engagement in systems-level initiatives and why it is important, and highlights the significance of providing adequate funding for family-led organizations and for individual family leader participants.


Medicaid Leadership Series: Driving and Delivering Results

The COVID-19 pandemic presents an opportunity for public sector leaders to innovate their programming in response to the public health emergency and continue to find new ways to deliver high-quality care for their members, both related to COVID-19 and as part of their “normal” work. With support from the Robert Wood Johnson Foundation, the newest episode of the Center for Health Care Strategies’ Leadership Forward podcast series focuses on how the framework’s “Driving and Delivering Results” domain applies in practice. Cindy Beane, commissioner for the West Virginia Bureau for Medical Services, and Sue Birch, director of the Washington State Health Care Authority, discuss leadership strategies they have implemented in response to the COVID-19 pandemic. The conversation is moderated by Gretchen Hammer, senior strategic advisor at the National Association of Medicaid Directors.