November 7 Update

In This Week’s Update:

  • OEP Kicks Off
  • CMS Final Rule
  • State-Based Strategies for Boosting Health Plan Enrollment 
  • The Institute for Medicaid Innovation 2022 Medicaid Managed Care Organization Survey
  • Social Determinants of Health for Infants and Toddlers
  • State updates: AL, AR, AZ, CA, IL, MI, MS, NJ, OR & SD

OEP Kicks Off

Last week marks the first week of the 2023 open enrollment period (OEP), which will run from November 1, 2022, to January 15, 2023. To help navigators, assisters, and consumers answer questions about marketplace eligibility and enrollment, the Georgetown University Center on Health Insurance Reforms released an updated and expanded Navigator Resource Guide. The guide is a practical resource with over 300 FAQs on topics such as marketplace eligibility, premium and cost-sharing assistance and special enrollment opportunities. It also provides answers to commonly-asked questions for small businesses and individuals with employer-based coverage.


CMS Final Rule

Two weeks ago, CMS released the Medicare Program: Implementing Certain Provisions of the Consolidated Appropriations Act, 2021 and other Revisions to Medicare Enrollment and Eligibility final rule. The rule creates a new Medicare special enrollment period (SEP) for individuals no longer eligible for Medicaid when the continuous coverage requirement ends, but who did not enroll in Medicare on time. As a reminder, SHVS has created a single-stop resource page to support states as they plan for unwinding the PHE and consolidated all our template communication materials for states in one place where they can be easily downloaded to customize. Updates follow.


State-Based Strategies for Boosting Health Plan Enrollment 

In a new issue brief for the Commonwealth Fund, experts from the Georgetown Center on Health Insurance Reforms detail innovative outreach strategies employed by state-based marketplaces (SBMs) during the open enrollment period for plan year 2022—tactics that can be applied during the forthcoming enrollment season for plan year 2023. A survey of SBMs underscored the importance of adequately funding enrollment assistance and marketing campaigns, providing enough time to enroll in coverage, and using targeted communications as well as broader messaging to reach the uninsured. Successful enrollment strategies included culturally and linguistically appropriate outreach and highlighting more affordable plan options due to expanded premium subsidies.


The Institute for Medicaid Innovation 2022 Medicaid Managed Care Organization Survey

The COVID-19 pandemic has caused unprecedented change and disruption to the health care sector. This turbulence led to policies that supported increased flexibilities in the Medicaid program and fueled interest in revisiting other opportunities for transformation. The Institute for Medicaid Innovation’s (IMI) 2022 Medicaid MCO survey findings offer insights that can help inform efforts led by Medicaid health plans and state Medicaid agencies to meet enrollees’ needs post-pandemic. This year’s annual Medicaid MCO survey findings highlight the long-standing systemic issues with data collection and communication that affect enrollee care and how strengthened partnerships between Medicaid health plans and community-based organizations helped to address many of the front-line social drivers of health. Medicaid stakeholders can use the 2022 Medicaid MCO survey results to share and generate ideas, gauge performance, and improve services to enrollees.

Social Determinants of Health for Infants and Toddlers

A recently published ZERO TO THREE report uses State of Babies Yearbook data to cast light on the specific conditions that influence the lives of babies and their families. The resulting robust picture of economic and social resources available to the nation’s babies shows that while many young children are thriving, Black, Latino/a, and American Indian/Alaska Native babies and those in families with low-incomes experience disparities in resources and outcomes that raise significant concerns about the near-term development and long-term health of young children. The report highlights policy solutions to help families sort through the interrelated influences in their lives, as well as achieve broad changes that address racial equity issues underlying the many disparities evident in social determinant of health indicators.

State updates: AL, AR, AZ, CA, IL, MI, MS, NJ, OR & SD

  • Alabama – The Alabama Medicaid Agency released a request for proposals for a system integration contractor to provide data integration, identity management, and centralized incident and change management services for the Alabama Medicaid Modernization Program. The contract, which will run for eight years, will be implemented on December 1, 2023. Proposals are due by March 17, 2023.
  • Arizona – The Arizona Health Care Cost Containment System recently launched “Talk Heals,” a public awareness campaign aimed to reduce substance misuse among youth by encouraging them to talk to trusted people in their lives. The “Talk Heals,” campaign includes TV, outdoor, and online ads which encourage youth that it is better to talk to a trusted person than to turn to substances to cope with life’s stressors and mental health challenges.
  • Arkansas – CMS approved an amendment to Arkansas’ Medicaid section 1115 demonstration that will test interventions to address housing and food insecurity, as well as other health-related social needs. The amendment will provide coverage of intensive care coordination and other person-centered supports for young people at high-risk for long-term poverty or homelessness, pregnant and postpartum women, and those dealing with mental illness and substance use diagnoses.
  • California – A Health Affairs Forefront article by Alice Chen, chief medical officer at Covered California (the state’s official health insurance marketplace), and Peter Lee, founding executive director, describes the marketplace’s approach to improve health plan accountability for quality and equity. The efforts consist of two strategies: 1) establishing a minimum level of quality performance for existing carriers to participate in the marketplace, and 2) incentivizing high levels of performance for a set of measures selected in concert with other public purchasers.
  • Illinois – The administration of Governor JB Pritzker announced it is launching a new state program designed to help pediatricians and other providers meet children’s mental health needs by strengthening mental health services in emergency departments and schools. The new program will focus on increasing the volume of consultation services provided across the state, providing a multitude of mental health education and training opportunities to physicians and healthcare professionals, and strengthening the network of mental health resources and referrals accessible to providers and their patients.
  • Michigan – The Michigan Department of Health and Human Services proposed an increase in Medicaid payment rates to $2,300 for dental services provided at outpatient hospitals and $1,495 for dental services provided in an ambulatory surgical center. Under the proposal, the services would move from the current outpatient prospective payment system to a Medicaid fee schedule. If approved by CMS, the new rates would be effective October 1, 2022. Comments on the proposed policy are due by November 23.
  • Mississippi – The state of Mississippi submitted a five-year extension request for their current section 1115 demonstration entitled “Heathier Mississippi,” to be effective October 1, 2023, through September 30, 2028. The demonstration has operated since 2006 and the state is requesting no programmatic changes to the demonstration with this extension request. The federal comment period will be open from October 31, 2022, through November 30, 2022.
  • New Jersey – The Department of Health’s New Jersey Maternal Mortality Review Committee released a report this week which finds that more than 90% of pregnancy-related deaths in New Jersey between 2016 and 2018 were preventable. Nearly 60 percent of pregnancy-related deaths occurred during the postpartum period within one year of the end of pregnancy. The report includes recommendations to ensure high-quality care, build patient knowledge, address barriers to care, implement a holistic approach to care, and share patient records and information about care provided.
  • Oregon
    • The Oregon Health Authority (OHA) announced the launch of the Veteran Dental Program for veterans who do not qualify for the Oregon Health Plan (OHP). Administered by the OHA, this state-funded program is separate and distinct from the dental benefit offered by the U.S. Department of Veterans Affairs, and offers the same dental care as OHP Plus, such as teeth cleanings, fillings and extractions, and emergency dental care at no cost to enrollees. Beginning November 1, 2022, veterans with incomes up to 400% of the federal poverty level can apply for the program using the OHP application
    • OHA is seeking applications from behavioral healthcare workers who qualify under the Oregon Behavioral Health Loan Repayment program. The program provides tax-free grants to supplement the behavioral health workforce in underrepresented and underserved areas of Oregon who provide behavioral health services to their communities.
  • South Dakota – South Dakota requested to extend the Former Foster Care Youth section 1115 demonstration for a five-year period. The demonstration provides full Medicaid state plan benefits to former foster care youth who are under age 26, with income up to 182% of the federal poverty level, and who were in foster care under the responsibility of another state or tribe on the date of attaining 18 years of age.