November 2 Update

In This Week’s Update:

  • HHS’ COVID-19 Interim Final Rule
  • New SHVS Resources
  • COVID-19 State Updates: MI, NE, NJ, OR & VA
  • Other State Updates: IN, MD, MN, NJ, NC, OR, PA, RI & WI
  • Webinar: Screening for Social Risk Factors Part II
  • Navigator Resource Guide
  • Integrated Care for Dual-Eligibles During COVID-19
  • Two-Part Webinar Series on Medicaid Managed Care


HHS’ COVID-19 Interim Final Rule

Last week, the United States Department of Health and Human Services (HHS) released its fourth COVID-19 interim final rule with comment. The rule sets out new flexibility states have to adjust benefits and cost-sharing without violating the Families First Coronavirus Response Act’s continuous coverage requirement. The Centers for Medicare & Medicaid Services (CMS) explains that the new interpretation is designed to balance enrollee protections with state and provider interests and also notes that the increased flexibility to effectuate enrollment transitions between eligibility groups that receive equivalent benefits could help states decrease backlogs in redeterminations and appeals following the Public Health Emergency. Additionally, the interim rule clarifies the obligations of health plans and insurers with respect to coverage of COVID-19 vaccinations. The newest expert perspective from State Health and Value Strategies (SHVS), Ensuring Access to the COVID-19 Vaccine for Enrollees in Private Health Insurance: A Roadmap for States, and its companion piece, Ensuring Access to the COVID-19 Vaccine for Adult Medicaid Enrollees: A Roadmap for States, have been updated to include these clarifications.


New SHVS Resources

  • SHVS published an expert perspective, Stable Rates Reflect Strength of ACA Marketplaces, which provides a brief overview of how the rate review process has developed since the first Affordable Care Act (ACA) OEP in 2013 and how those developments came together this year to enable regulators and insurers to manage uncertainty and achieve more stable rates for the 2021 plan year.
  • A new expert perspective, COVID-19 and MLR Guidance on Risk Corridor Recoveries: State Options for Restoring Funds to Policyholders and the Public, considers ways states could potentially redirect insurers’ extra cash to benefit policyholders and the public following recent Center for Consumer Information and Insurance Oversight guidance on how to allocate risk corridor payments under the ACA’s medical loss ratio formula.
  • SHVS held a webinar for states on October 26 that drew from the recently published issue brief Social Risk Factor Screening in Medicaid Managed Care and reviewed key terms, screening tools, and design decisions for states interested in screening Medicaid managed care members for social risk factors. A slide deck and recording are now available on the SHVS website. Part II of the webinar series will take place on November 16.


COVID-19 State Updates: MI, NE, NJ, OR & VA

  • Michigan – The Michigan Department of Health and Human Services announced a $3.9 million project funded through the CARES Act that offers retention payments to newly hired direct care workers. The goal is to hire and retain at least 2,000 new workers by December 30, 2020. Newly hired direct care workers are defined as individuals who have not worked as a direct care worker in home- and community-based services for at least 60 days before the date of hire. Workers could receive up to $1,600 if they complete training and 300 hours of work by December 30.
  • Nebraska – As part of the Nebraska Department of Health and Human Services (DHHS) pandemic response, DHHS has worked with the Department of Administrative Services and the Department of Economic Development to purchase five walk-up and five drive-through freestanding COVID-19 testing sites from Pacific Engineering, Inc. The pods, called Rapid On Demand-Portable Medical Platforms, will expand the state’s ability to provide rapid testing during the cold weather season.
  • New Jersey – Governor Phil Murphy and New Jersey Health Commissioner Judith Persichilli announced the state’s COVID-19 vaccination plan, designed to provide equitable access to approved vaccine(s), achieve maximum community protection, and build public trust in advance of an approved vaccine(s).
  • Oregon – The Oregon Health Authority (OHA) is now publishing data related to its statewide COVID-19 wastewater monitoring project. The project documents where the virus is detected in small- to medium-sized communities around the state. Currently there are 29 communities participating in the project. The map indicates whether COVID-19 is “detected” or “not detected” in a community. The monitoring serves as an early warning system for OHA to flag whether COVID-19 is spreading silently in communities and is intended to help public officials try to prevent potential outbreaks or move resources to a community.
  • Virginia – The Virginia Department of Health announced that its COVID-19 data website now includes an outbreaks in educational settings dashboard which shows a list of outbreaks in kindergarten through 12th-grade schools by school name with associated case numbers and deaths. The dashboard shows current and previous outbreaks of COVID-19 in specific schools in Virginia and will help schools measure the extent to which the COVID-19 virus is spreading in their localities and guide possible responses to mitigate the spread.


Other State Updates: IN, MD, MN, NJ, NC, OR, PA, RI & WI

  • Indiana – CMS notified the state that it was approving Indiana’s request to extend its section 1115 demonstration project entitled “Healthy Indiana Plan” (HIP) for ten years. CMS is only conditionally approving the state’s request to extend the community engagement and exclusions from eligibility components of its HIP demonstration, contingent upon the Supreme Court issuing a decision in Azar v. Gresham, that legally authorize these elements of the proposed extension to the demonstration.
  • Maryland – The state’s official health insurance marketplace,, announced the launch of the OEP with a reminder for consumers that the marketplace provides a one-stop shop for Marylanders to compare and select private health plans through December 15 for coverage that starts January 1, 2021. Health plan rates have dropped by an average of 31 percent since 2018. Also, in addition to CareFirst and Kaiser Permanente, a third health insurer, UnitedHealthcare, has returned to the marketplace, with plans in 14 counties.
  • Minnesota – Minnesotans can enroll in comprehensive health insurance coverage through, the state’s official marketplace, from Sunday, November 1, at 8 a.m. through December 22, 2020. MNsure-certified brokers and navigators are providing free enrollment help through virtual meetings, phone appointments, or in-person meetings that follow the Minnesota Department of Health’s COVID-19 safety guidelines. The marketplace has also extended the hours of MNsure’s contact center for open enrollment.
  • New Jersey – Governor Phil Murphy kicked off the OEP for Get Covered New Jersey, the state’s official health insurance marketplace. The OEP began November 1, 2020 and runs through January 31, 2021, six weeks longer than last year. New Jersey residents will no longer use to enroll in Marketplace health insurance plans. New state subsidies are available this year under a law signed by Governor Murphy, resulting in more financial help to lower the cost of health insurance for those who qualify under the ACA income thresholds. Nearly eight in ten people purchasing coverage on Get Covered New Jersey will qualify for state subsidies.
  • North Carolina – The North Carolina Department of Health and Human Services and the Cherokee Indian Hospital Authority have entered into a contract to support the Eastern Band of Cherokee Indians (EBCI) in addressing the health needs of American Indian/Alaskan Native Medicaid enrollees. This managed care entity is the first of its kind in the nation and will establish a new delivery system called the EBCI Tribal Option. The EBCI Tribal Option is a managed care option for federally recognized tribal members and other individuals eligible to receive Indian Health Services.
  • Oregon
    • Analysts in the Injury and Violence Prevention Section at the Oregon Health Authority Public Health Division found that Oregon saw a nearly 70 percent increase in the number of overdose deaths during April and May 2020 compared to the same time in 2019. There was also a nearly 8 percent increase in the number of overdose deaths during the first quarter of 2020 compared to the same period in 2019.The preliminary data come from the State Unintentional Drug Overdose Reporting System, which includes combined and abstracted data from medical examiners and death certificates.
    • The Oregon Health Authority has finalized the 2021 capitation rates for coordinated care organizations (CCOs). These rates are the per-member-per-month amounts the state pays CCOs to coordinate health care for Oregonians who are members of the Oregon Health Plan. The rate increase represents a 3.4 percent rate of growth for 2021.
  • Pennsylvania – Governor Wolf signed into law legislation that requires health insurers that want to offer comprehensive health insurance coverage in Pennsylvania to verify that they have completed and fully documented analyses of their efforts to provide mental health and substance-use disorder coverage that is comparable to physical health services with respect to cost-sharing, in- and out-of-network coverage, and other treatment limits. In addition to the verified analyses, insurers must make that documentation available to the Insurance Department, upon request, to demonstrate compliance with the Mental Health Parity and Addiction Equity Act of 2008. Documentation must also be available to policyholders and providers upon request.
  • Rhode Island – HealthSource RI, the state’s official health insurance marketplace, will offer an extended OEP from November 1, 2020 through January 23, 2021. HealthSource RI will be hosting a series of virtual events so that residents can learn about HealthSource RI’s offerings, connect with navigators, or schedule enrollment support. Enrollment support will also be available at locations throughout the state through HealthSource RI’s navigator network of community organizations. Additionally, HealthSource RI will be offering live web chat services in English and Spanish. 
  • Wisconsin – Grants totaling more than $3.1 million to increase access and enhance quality care in rural Wisconsin were announced by the Wisconsin Department of Health Services. The grants support education and training to assist rural hospitals and clinics in filling “high need, high demand” positions.


Webinar: Screening for Social Risk Factors Part II

Monday, November 16, 2020, 3:00 to 4:00 p.m. EST

This webinar is the second in a two-part series highlighting two issue briefs recently published by SHVS for state officials on screening for social risk factors. This second webinar will share findings from Developing a Social Risk Factor Screening MeasureStates are increasingly requiring their Medicaid managed cared organizations (MCOs) and accountable care organizations (ACOs) to screen for and address social risk factors in their populations. As they do so, some are seeking to hold their contracted plans and ACOs accountable through performance measurement. This webinar will examine the steps to create and implement such a measure, drawing on the experiences of Massachusetts, North Carolina, and Rhode Island, profiled in the recently published issue brief.

Registration (required) at the following link:


Navigator Resource Guide

With support from the Robert Wood Johnson Foundation, Georgetown University’s Center on Health Insurance Reforms (CHIR) released an updated Navigator Guide to reflect recent federal policy changes, many of which are summarized under “What’s New for 2021.” The updated guide also offers two new resources for navigators and assisters: State-specific Policies, which highlights how state policies might affect consumers’ eligibility for, and enrollment in, coverage in their state and Ask an Expert,” a new portal for navigators and assistors to submit questions to experts at CHIR and the Center for Children & Families (CCF). This guide is focused on the private insurance reforms of the ACA, including the health insurance marketplaces, benefit and cost structures, and premium tax credits. It is organized into four sections that address how individuals may present themselves to navigators based on their insurance status and coverage options. The questions and answers have been developed in collaboration with the staff at the CCF, the Center on Budget and Policy Priorities, and the Kaiser Family Foundation. This guide is intended to supplement the Navigator training available from HHS.


Integrated Care Programs for Dually Eligible Individuals in the Era of COVID-19

As the COVID-19 pandemic has unfolded, it has become evident that people who are dually eligible for Medicare and Medicaid are among the nation’s most at-risk for, and vulnerable to, the virus. With this group of individuals largely receiving care in uncoordinated, fragmented systems, it is critical to identify opportunities to strengthen programs and policies to best support this population during the pandemic and in the future. While there has been significant progress over the last decade to integrate services for this population, today only 10 percent of the 10 million full-benefit dually eligible individuals are currently served in an integrated program. A new report, published by the Center for Health Care Strategies, distills insights about COVID-19 response efforts from states and health plans that offer integrated programs. It outlines recommendations to support integration, including suggestions to: (1) increase alignment between Medicare and Medicaid; (2) increase health plan flexibilities to meet member needs; (3) pay family caregivers and support other efforts to expand the workforce; (4) expand supplemental benefit offerings; (5) improve communication and data-sharing; and (6) ensure fiduciary oversight.


Medicaid Managed Care Organization (MCO) Learning Hub – Two-Part Webinar Series on Medicaid Managed Care

Funded by the Robert Wood Johnson Foundation, the NORC Medicaid MCO Learning Hub is committed to providing information on ways to address health equity and transform health care to key MCO leadership, consumer groups, state Medicaid leaders, and other stakeholders. Through early discussions with various organizations, the Learning Hub has learned that, among some stakeholders, there is an interest in learning more about the basics of the Medicaid program and Medicaid managed care. In order to disseminate this type of information to the field, the Learning Hub is conducting two national webinars, both of which will include ample time for Q&A:

  • November 19 from 1:00-2:00 p.m. EST:  This first webinar will provide an overview of Medicaid managed care, including the use of Medicaid managed care across states and state contracting strategies, as well as cost growth, rate-setting, and the use of managed care reserves. Register here.
  • December 3 from 3:00-4:00 p.m. EST: This second webinar will cover Medicaid managed care federal authorities and how these authorities are both defined and used by managed care plans, as well as promising approaches and strategies for community-based organizations to partner with Medicaid managed care plans. Register here.