Oct 10 Update

In Last Week’s Update:

  • New CMS Unwinding Data
  • State Guidance on Continuous Eligibility for Children
  • Leveraging Multi-Payer Aligned Measure sets
  • Webinar on AHEAD model
  • State updates: CA, CT, HI, IA, IL, MA, MD, MI, NC, NV, OK, WA & WV


New CMS Unwinding Data

On September 29, CMS published a new release of state-reported Medicaid unwinding data. This data release covers June and preliminary data for July and, like previous releases, includes national and state-specific metrics pertaining to Medicaid and CHIP eligibility renewal outcomes and total enrollment. As planned, CMS also released more comprehensive data on Marketplace enrollment and transitions—including cumulative enrollment data between April and June for HealthCare.gov, State-Based Marketplaces, and the Basic Health Programs—and separate CHIP enrollment in April 2023. To support states as they analyze this data release, SHVS just published an expert perspective summarizing key findings.

Also last week, SHVS published an expert perspective summarizing the recently released State Health Official (SHO) letter that provides guidance on continuous eligibility (CE) for children. The SHO provides guidance on the requirement in the Consolidated Appropriations Act, 2023 (CAA) that all states must adopt 12-months of CE for children effective January 1, 2024. Key topics addressed in the guidance include the specific eligibility groups subject to CE under the CAA, the impact of CE on children in carceral settings and implementation requirements for states. Updates follow.

New SHVS Expert Perspective: How Medicaid Agencies Can Leverage Multi-Payer Aligned Measure Sets

Quality incentives are a common feature of health plan provider contracts. Plans provide financial incentives to providers for meeting targets or demonstrating improvement on a set of quality measures as a way of encouraging high quality healthcare. A new SHVS expert perspective reviews how Medicaid programs in Connecticut, Massachusetts and Rhode Island have engaged with commercial payers, providers, patients, advocates and other parties to create and adhere to multi-payer aligned measure sets. The expert perspective describes the benefits for Medicaid agencies participating in aligned measure set efforts, as well as tips and resources for Medicaid agencies interested in measure alignment—such as SHVS’ Buying Value websitemeasure selection tool and benchmark repository.


Lessons from States with Healthcare Cost Growth and Primary Care Investment Targets

Last month, CMS announced a new state total cost of care model called the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model. On October 17, the Peterson-Milbank Program on Sustainable Health Care Costs will host a webinar for interested states and healthcare stakeholders. Participants will learn about the AHEAD Model’s approach to healthcare cost growth targets and primary care investment targets, as well as hear from officials in Connecticut and Rhode Island that have implemented these targets as part of an affordability strategy.


Advancing Rural Health Equity

Various factors make meeting rural health needs difficult, from a lack of access to health facilities, services, and professionals to challenging financing systems and payment models. Despite persistent barriers, rural health innovators are building cross-sector partnerships, leveraging data to set priorities and track outcomes, and shifting funding models to ensure rural residents have the opportunity to be as healthy as possible. The Urban Institute and Partners for Rural Transformation are hosting a discussion about challenges and solutions for advancing rural health equity. Speakers will describe the state of rural health in America and highlight community-driven solutions, showcasing promising service and partnership models and financing practices. Practitioners from across the country will share how they leverage partnerships, data, and funding to meet the health needs of diverse rural populations.

State updates: CA, CT, HI, IA, IL, MA, MD, MI, NC, NV, OK, WA & WV

  • California – The California Department of Health Care Services launched the Empowering Faith Leaders in California project to help address the opioid epidemic at the local level through a collaborative learning opportunity that will empower participating religious leaders from diverse faith traditions to respond to substance-use disorder in their communities, using evidence-informed and compassionate approaches.
  • Connecticut – Governor Ned Lamont announced the launch of the state’s new health and human services portal, health.ct.gov. Some of the resources available through the portal include a health benefits eligibility screener; healthy living tools; emergency health service information; insurance and financial resources; and heating and utilities assistance.
  • Hawaii – State Attorney General Anne Lopez filed a lawsuit against pharmacy benefit managers (PBMs) in the state. The complaint alleges that the PBMs’ business practices have driven skyrocketing prices for brand-name prescription medications over the past decade.
  • Illinois – Director Theresa Eagleson, who has led the Illinois Department of Healthcare and Family Services for the past five years, announced that she will be leaving the Department at the end of 2023. Governor Pritzker has appointed Lizzy Whitehorn, who currently serves as First Assistant Deputy Governor for Health and Human Services, to serve as Director beginning January 1, 2024.
  • Iowa – As the result of an interim settlement in a lawsuit brought on behalf of Medicaid-eligible children, the state will develop an implementation plan to improve the mental health system in Iowa for children and youth. The plan will include defining clear access points for behavioral health services, including crisis and in-home services and also describe how the state will oversee adequate access and update case management supports to ensure children and families are more successful in the community and at school.
  • Maryland – The Maryland Health Benefit Exchange announced young adults ages 19 through 37 are now eligible for additional discounts through the state’s young adult subsidy program. Previously, the state program only provided savings for adults through age 34. The program’s goal is to encourage more young adults in Maryland to enroll in health coverage. The subsidy works on a sliding scale with the youngest and lowest income young adult paying the least.
  • Massachusetts – CMS approved a community-based mobile crisis state plan amendment that allows Massachusetts to create mobile crisis intervention teams to provide Medicaid crisis services. As a reminder, SHVS published an expert perspective on the enhanced payment available through the American Rescue Plan Act (ARP) for community-based mobile crisis services.
  • Michigan – The Michigan Department of Health and Human Services Division of Maternal and Infant Health has launched a new four-year plan focused on improving birth outcomes for Michigan families. The Advancing Healthy Births plan was developed in consultation with Michigan families and other maternal-infant health experts in the state. Twelve town hall events were hosted by Michigan’s Regional Perinatal Quality Collaboratives to collect community insights and ideas about improving health in the state.
  • Nevada – The Nevada Division of Public and Behavioral Health announced the completion of the 2022 State Health Assessment (SHA), a comprehensive overview of the health status of Nevada residents. The SHA offers an in-depth analysis of the state’s health-related challenges and strengths, along with a range of resources aimed at enhancing health outcomes and reducing disparities in Nevada. The document was developed through extensive collaboration with numerous organizations and individuals and will serve as a roadmap for state, local, and community partners to collaboratively enhance the health of all Nevada communities.
  • North Carolina – The North Carolina Department of Health and Human Services (DHHS) launched a new website with a toolkit of resources to ensure people know about expanded eligibility for Medicaid beginning December 1. The toolkit is the first phase of the state’s outreach efforts and includes new English and Spanish language resources to educate North Carolinians on eligibility and how to apply. DHHS also created a sign-up form for alerts when the application process goes live.
  • Oklahoma – CMS has granted approval for Oklahoma’s 1915(b) waiver for delivery system reform and the proposal to increase supplemental payments to hospitals. These approvals mark a significant milestone in the transition from a fee-for-service system to the new comprehensive health delivery system, SoonerSelect.
  • Washington – As directed by the Legislature, the Office of the Insurance Commissioner has submitted a legislative study report on how balance billing for ground ambulance services can be prevented in the state. Policy recommendations described in the report include the prohibition of balance billing of consumers; reimbursement for ground ambulance services at a fixed rate or at the lesser of a fixed percentage of Medicare billed charges; and mandated coverage for emergency transportation to alternative sites.
  • West Virginia – The West Virginia Department of Health and Human Resources Bureau for Public Health is hosting eight community listening sessions to gather insight on health issues in specific areas of the state as part of the 2023 State Health Assessment. Information gathered will be used to develop the State Health Improvement Plan, a five-year plan to address public health issues and themes by facilitating the prioritization of strategies and activities, identifying collective resources, and determining how to align resources to achieve improvements in health outcomes.