November 22 Update

In This Week’s Update:

  • CMCS Strategic Vision
  • Increasing Cancer Screenings via Medicaid Managed Care 
  • State Updates: AZ, CA, MT, NC, OR, RI, UT, VA & WY
  • Using Federal Funds to Address Drivers of Health
  • Rethinking Telehealth for Addiction Treatment
  • Policies to Reduce Maternal Morbidity and Mortality


CMCS Strategic Vision 

Center for Medicaid and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure and the Center for Medicaid and CHIP Services (CMCS) Director Dan Tsai published a blog post in Health Affairs laying out the strategic vision for Medicaid and the Children’s Health Insurance Program (CHIP). The policy agenda for CMCS focuses on three key areas: coverage and access, equity, and innovation and whole-person care. These three key areas also align with the larger vision for CMS as a whole and the agency’s six strategic pillars. An important priority will be the collection of data on race, ethnicity, language (REL), disability status and other factors, and using those data to identify disparities in access, health outcomes and quality of care. As a reminder, State Health and Value Strategies (SHVS) has an issue brief that provides an overview of REL data collection standards and examines state Medicaid application’s question structure, answer options, and instructional language.


Increasing Cancer Screenings in Medicaid Managed Care 

SHVS published a new expert perspective, Medicaid Managed Care Strategies for Increasing Cancer Screening Rates. The impact of missed cancer screenings due to COVID-19 creates an even greater urgency for state Medicaid programs to advance strategies to encourage cancer screenings and early treatment. This expert perspective offers state agencies some promising practices to work with their contracted Medicaid health plans, providers, and enrollees to increase rates of colorectal and lung cancer screening. 


State Updates


  • Arizona – The Arizona Health Care Cost Containment System (AHCCCS) announced the award of expanded contracts to three AHCCCS Complete Care health plans to provide integrated physical and behavioral health services to Medicaid members who have a serious mental illness designation.
  • California – Covered California, the state-based marketplace, announced that three of its health insurance carriers will increase their compensation, by an estimated $22 million annually, for agents who help people sign up for coverage in the individual market. The increased compensation will come at no additional cost to consumers, as Covered California’s Licensed Insurance Agents are paid through the monthly premiums that the carriers receive.
  • Montana – The state updated its COVID-19 vaccine dashboard to reflect the addition of the newly added 5 to 11-year-old age group now eligible to be vaccinated. The eligible population percentage of Montanans fully vaccinated against COVID-19 has been updated to 50 percent and the county percentages on the map have been adjusted accordingly as well.
  • North Carolina – The North Carolina Department of Health and Human Services announced that Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plans will launch December 1, 2022, instead of July 1, 2022. The updated implementation schedule recognizes community concerns that the COVID-19 pandemic has contributed to an increased need for behavioral health and intellectual/developmental disabilities services. These additional five months will provide the Department and the Local Management Entities/Managed Care Organizations with the necessary time to ensure this transition addresses the complexities of a high-quality behavioral health and I/DD system.
  • Oregon
    • The state submitted an application to CMS requesting a new five-year Section 1115 demonstration to provide limited services to older adults and individuals with disabilities who are currently ineligible for Medicaid. The federal comment period will be open from November 16, 2021 through December 16, 2021.
    • The Measure 110 Drug Treatment and Recovery Act Oversight and Accountability Council (OAC), appointed by the Oregon Health Authority, is charged with developing rules and eligibility requirements for establishing Behavioral Health Resource Networks (BHRNs) throughout the state. The OAC announced that it will distribute $270 million in grants to organizations that will serve Oregonians who need treatment and support services for substance use, including housing, harm reduction, peer support, supported employment, and substance use disorder treatment. The BHRNs will also help people who request substance use support and other services in lieu of paying a fine for a Class E violation for possession of a small quantity of drugs.
  • Rhode Island – The Executive Office of Health and Human Services released a Medicaid managed care request for qualifications. The contracts to be awarded are worth approximately $1.4 billion annually and will cover over 300,000 individuals.
  • Utah – Governor Spencer Cox announced the formation of a new health initiative, the Utah Sustainable Health Collaborative, focused on reducing health care costs and improving health outcomes for Utahns. The patient-centric collaboration will convene a broad group of partners—including providers, payers, patients, community-based organizations, nonprofits, legislators, employers, and others—to pilot different models of health service delivery, access, and payment.
  • Virginia – CMS approved the state’s request to extend Medicaid and Children’s Health Insurance Program (CHIP) postpartum coverage to 12 months. This approval makes Virginia the third state in the nation, following Illinois and New Jersey, to expand Medicaid to birthing people for 365 days after childbirth. The extended coverage will be available to Medicaid members in 2022, pending state confirmation and the Medicaid agency estimates the new policy will extend coverage for more than 6,000 members per year.
  • Wyoming – The Wyoming Department of Health (WDH) is inviting state residents to participate in a series of upcoming forums that will inform the selection of strategies for the state health improvement plan. WDH, together with the State Health Improvement Plan Steering Committee organized by the department, chose behavioral health, access to healthcare, and unintentional injury as priorities following an earlier effort to evaluate health-related issues in the state.


Using Federal Funds to Address Drivers of Health For COVID-19 Recovery and Beyond

Federal funds arriving to state agencies, including more than $92 billion in the American Rescue Plan Act of 2021, present a critical opportunity to both accelerate the recovery of groups most affected by the COVID-19 pandemic and to redefine approaches in addressing physical and mental health, inclusive of substance use disorders and emotional well-being. Additionally, funds now available as part of the Infrastructure Investment and Jobs Act have potential for innovative and significant public health impact. A recent Health Affairs blog post by the Health Evolution Forum Community Health and Advancing Health Equity Roundtable provides recommendations on how states can maximize the impact of these federal funds, including highlighting how these funds present a unique opportunity for public- and private-sector leadership to engage in partnerships that focus on investment addressing near- and long-term drivers of health. Effectively using these funds requires extending their reach beyond the traditional health care system to strengthen services that address drivers of health, such as affordable housing, access to healthy food, reliable transportation, job training, and child care. The timing, magnitude, and flexibility of incoming federal funds present an unprecedented opportunity to reframe state health and human services strategy with a focus on investing in health and dismantling silos across social, economic, and environmental drivers that impact health.


Rethinking Telehealth’s Role in Treating Addiction

Before the COVID-19 pandemic, treating substance use disorder using telehealth was rare, due in part to federal and state restrictions and limited reimbursement. But when the pandemic hit, policymakers and payers rolled back those restrictions, and telehealth use skyrocketed. A year and a half later, states and the federal government are grappling with if and how they should permanently change their policies around telehealth and addiction treatment. A new Tradeoffs podcast episode, the first in the series made possible through a partnership with the Better Care Playbook, explores how this debate is playing out in Ohio, one of the epicenters of the opioid epidemic. The episode explores how states and the federal government are grappling with whether and how they should permanently change policies around telehealth and addiction treatment post-pandemic. The episode features a new mom who says telehealth kept her sober through her pregnancy, a provider worried about seeing these flexibilities go away, and a researcher who lays out what the field has learned so far about what works and what does not when it comes to telehealth and addiction treatment.


Policies for Reducing Maternal Morbidity and Mortality and Enhancing Equity in Maternal Health: A Review of the Evidence

As bipartisan legislation in the U.S. House of Representatives and the Senate seeks to address the maternal health crisis and narrow racial disparities in outcomes, a new Commonwealth Fund report highlights policies aimed at lowering rates of maternal morbidity and mortality and eliminating inequities. The authors highlight both the evidence underpinning various approaches and the importance of employing an equity framework in designing and implementing these policies. The evidence compiled suggests that solving the U.S. maternal health crisis will require investment in maternal mental health, expanded telehealth services, extended maternal health coverage, and action to address structural racism. In case you missed it, SHVS published an issue brief last week on how states can leverage their managed care organization contracts to reduce disparities in birth-related outcomes.