In This Week’s Update:

• Millions to Lose Coverage if Premium Tax Credits Expire
• State Efforts to Advance Health Equity
• Guidance on Long-Term Use of Unwinding-Related Waivers
• CMS’ Health Equity Advisory Committee
• State updates: CA, CO, FL, HI, IL, MI, MN, NJ, NM, NY & PA

 

Millions to Lose Coverage if Premium Tax Credits Expire
Last week the Urban Institute published a new interactive map of projected coverage losses by state if the enhanced premium tax credits (PTCs) are allowed to expire at the end of 2025. As a reminder, State Health and Value Strategies (SHVS) recently hosted a webinar featuring researchers from Urban Institute on the state-specific impacts of the expiration of the PTC enhancements. Urban’s analysis estimates that an additional 4 million people will become uninsured if the enhanced PTCs are allowed to expire, with coverage losses most acute among people with low incomes and Black and Hispanic people.

 

State Efforts to Advance Health Equity
Also last week, SHVS published a new post in its on-going series, States of Innovation. The series highlights what states are working on to achieve better, more affordable and more equitable health for all. This States of Innovation profiles state activity in October, which included states taking action on coverage for justice-involved populations, Marketplace innovations, and maternal health. Updates follow.

 

Guidance on Long-Term Use of Unwinding-Related Waivers
On November 14, 2024, CMS released its second installment in its series of Medicaid and CHIP guidance intended to support state efforts to verify eligibility and conduct renewals in compliance with federal Medicaid and CHIP requirements. A new expert perspective summarizes the latest CMCS Informational Bulletin and accompanying slide deck which address the continued use of unwinding-related section 1902(e)(14) waivers beyond the previously established expiration date of June 30, 2025. CMS points to existing federal authority for states to continue permanently at state option in a materially similar way over half of the unwinding-related section 1902(e)(14) waivers. As a result of this guidance, the flexibilities that had the biggest impact on increasing ex parte rates and maintaining coverage for eligible individuals are now permanent for states.

 

CMS’ Health Equity Advisory Committee
CMS is seeking nominations for members to serve on the Health Equity Advisory Committee (HEAC). The HEAC is established to advise and make recommendations to the CMS on the identification and resolution of systemic barriers to accessing CMS programs that hinder quality of care for enrollees and consumers. The Committee will focus on health disparities in communities that have been marginalized such as, but not limited to, Black, Latino/a, and Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality as defined in Executive Order 13985, Advancing Racial Equity and Support for Underserved Communities Through the Federal Government. The HEAC will be composed of 20 to 30 members that will serve at least two years and nominations must be submitted by email to HEAC@cms.hhs.gov and are due December 12, 2024.

 

State updates: CA, CO, FL, HI, IL, MI, MN, NJ, NM, NY & PA

• California – The California Department of Veteran Affairs has awarded $33.4 million in grants to community organizations in seven counties through the California Veterans Health Initiative, Mental Health Support Grant Program. The funding will enable community-based organizations to expand access to outpatient mental health treatment options for California’s veterans and their families.
• Florida – Florida submitted an amendment request for the Florida Managed Medical Assistance (MMA) section 1115(a) demonstration. The amendment proposes to expand the Behavioral Health and Supportive Housing Assistance Pilot to two additional regions; provide voluntary populations who enroll into the MMA program a choice of managed care plans and auto-assignment if no choice is made; transfer coverage of behavior analysis services from fee-for-service to managed care; and transfer coverage of non-emergency dental services provided in an ambulatory surgical center or hospital from MMA plans to dental managed care plans.
• Illinois – Governor JB Pritzker announced the state’s medical debt relief pilot program has relieved more than $72 million worth of medical debt for 52,745 residents. This debt abolishment is the first effort as part of the state’s commitment to erase approximately $1 billion in medical debt. SHVS has updated our expert perspective tracking state efforts to cancel medical debt and prohibit medical debt reporting.
• Michigan – Governor Gretchen Whitmer announced more than 300 locations across the state now have free contraception resources available through the Take Control of Your Birth Control program. The resources include over-the-counter oral birth control pills, emergency contraception, condoms and family planning educational resources.
• Minnesota
  • The Minnesota Department of Human Services announced the expansion of MinnesotaCare eligibility to include undocumented individuals, with coverage beginning in January 2025. MinnesotaCare is the state’s Basic Health Program for residents up to 200% of the federal poverty level. SHVS has updated our expert perspective tracking state-funded coverage programs for non-citizens.
  • Governor Tim Walz announced over six million in state grants to keep Minnesotans in their homes as they age. The Live Well at Home grants will support more than 30 organizations and fund services such as retrofitting residences to make them age-friendly and provide support for caregivers.
• New Jersey – Justin Zimmerman was sworn in as Commissioner of the New Jersey Department of Banking and Insurance. Commissioner Zimmerman had been serving as Acting Commissioner since June 2023 and the state senate unanimously confirmed his nomination on October 28, 2024. Congrats Justin!
• New Mexico – The New Mexico Health Care Authority published the Health Care Affordability Fund (HCAF) annual report to the state legislature. The report includes updates on the state’s Marketplace Affordability Program, the small business health insurance premium relief initiative, the uninsured program, and HCAF finances and administration.
• New York – Governor Kathy Hochul announced 24 community-based home care providers will join the statewide partnership to strengthen New York’s Consumer Directed Personal Assistance Program, which provides vital home care services to New Yorkers.
• Colorado, Hawai’i, Minnesota, New York and Pennsylvania – CMS approved section 1115 demonstration amendments authorizing these five states to provide additional years of continuous enrollment for children beyond the minimum 12 months required by law, and will newly provide continuous enrollment to individuals leaving incarceration in Colorado and Pennsylvania. As a reminder, SHVS published a toolkit to support states as they pursue section 1115 demonstrations to provide CE to Medicaid and CHIP populations, with a focus on multi-year CE for young children.