In This Week’s Update:
- CMS Proposes Standards for Insurance Marketplaces
- Tracking Mental Health/Substance-Use Parity Compliance
- Communicating the BAC and MAC
- Streamlining Information Transfers Between Insurers
- State Public Health and Homelessness Playbook
- State updates: AZ, CA, HI, MA, ME, MI, NE, NY, OR, PA & RI
CMS Proposes Standards for Insurance Marketplaces
On October 4, CMS released its draft Notice of Benefit and Payment Parameters (NBPP) for plan year 2026, with an accompanying fact sheet and letter to issuers. Comments on the proposed rule are due November 12, and the final 2026 NBPP is likely to be issued by January. A summary of the proposed NBPP was published by Health Affairs Forefront and our experts are working on an expert perspective outlining considerations for states and implications for health equity. Stay tuned.
Communicating the BAC and MAC
Under the Ensuring Access to Medicaid Services final rule, state Medicaid agencies will need to create and support a Beneficiary Advisory Council (BAC) and Medicaid Advisory Committee (MAC) by July 2025, with some additional requirements phased-in over a longer time period. SHVS published a template slide deck, designed to support state agencies in communicating internally about the BAC and MAC. The deck provides a high-level summary of the function, objectives, composition, and outcomes of the new advisory groups and can be customized by states to reflect their unique contexts and priorities. SHVS also published a printable companion handout, Getting Input to Improve Medicaid, which states can use to communicate internally about the BAC and MAC.
Streamlining Information Transfers Between Insurers
The Center for Medicaid and CHIP Services (CMCS) explained the transition to “Account Transfer 2.0” (AT 2.0) in a CMCS Informational Bulletin (CIB) released on October 10, 2024. The CIB indicates significant federal investment in improving the process of transferring consumer application information between state Medicaid and CHIP agencies and the Marketplace in the states using the federal platform. SHVS has published an expert perspective which reviews the CIB and highlights opportunities for states to improve account transfer data under the CIB.
State Public Health and Homelessness Playbook
Experiencing homelessness makes it harder to become and remain healthy: people experiencing homelessness are generally sicker than their housed counterparts and more prone to death. Given the relationship between housing and health, state health officials are well-positioned to bring new resources, ideas, ways of working, and capacity to the collaborative effort to make homelessness rare and brief. The State Public Health & Homelessness Playbook, published by Community Solutions, is intended for state health officials and policymakers who want to learn more about how agencies and programs can proactively support efforts to reduce and prevent homelessness. The playbook includes a myriad of examples showcasing innovative and dynamic partnerships between state public health departments, Medicaid, and the homeless response system to improve the health and wellbeing of people experiencing homelessness.
State updates: AZ, CA, HI, MA, ME, MI, NE, NY, OR, PA & RI
- Arizona – The Arizona Health Care Cost Containment System will begin reimbursing Medicaid members who use doula services starting this month, marking a crucial step toward improving maternal and infant health. For information on how states can leverage payment to improve maternal health outcomes, see the SHVS issue brief Maternal Health Providers: Enhancing Health Equity Through Payment Parity.
- California – The Department of Health Care Services announced that three California counties—Inyo, Santa Clara, and Yuba—were approved as of October 1 to begin delivering a targeted set of Medi-Cal services to people returning to communities after incarceration. All California counties are required to implement this initiative before October 1, 2026.
- Hawai’i – The Department of the Attorney General announced the launch of a webpage for those who seek the department’s help with filing assisted community treatment (ACT) petitions in family court, to provide treatment for those with serious mental illnesses or substance-use that can render them dangerous to themselves or others. In 2024, the Legislature provided that the Department of the Attorney General assist with the preparation and filing of ACT petitions and with the presentation of the case at any related court proceeding. The department’s new ACT webpage includes forms and instructions that will facilitate this process, including legal definitions and ways of submitting the necessary information to the department.
- Maine – Governor Janet Mills announced the Maine Senate’s confirmation of Sara Gagne-Holmes to serve as Commissioner of the Maine Department of Health and Human Services.
- Massachusetts – The Healey-Driscoll administration announced $1 million in grants to increase capacity and accessibility for freestanding community birth centers. The Birth Center Capacity and Accessibility grants will support the development and operation of birth centers by covering facility costs, start-up expenditures, and the provision of comprehensive prenatal and postpartum care.
- Michigan – Governor Gretchen Whitmer signed bills to expand access to healthcare and protect healthcare workers. Senate Bill 351 strengthens protections against discrimination for individuals who are currently breastfeeding; Senate Bill 928 eliminates a clause that prevents Medicaid from fully covering birth expenses; Senate Bill 929 repurposes Medicaid funding to allow low-income Michiganders access to a broader range of care centers; Senate Bill 701 supports access in rural Michigan by amending restrictions on the funding Michigan hospitals can receive; and Senate Bills 790 and 791 allow individual homehelp caregivers to unionize.
- Nebraska – The Every Woman Matters (EWM) program has lowered the enrollment age to 21 and increased the eligibility income level to 250% of the federal poverty level to provide broader access to women most in need. The EWM program provides screening for breast and cervical cancers, and women who enroll may be eligible for a pelvic exam, Pap test, clinical breast exam, and screening mammogram based on family or personal history.
- New York – Governor Kathy Hochul signed a package of six bills intended to strengthen New York’s gun laws. The legislative package requires gun sellers to post tobacco-style safety warnings, taking action against dangerous “pistol converters” and provides other new tools and resources to help protect more New Yorkers from gun violence. For more information on gun violence prevention, check out the episode of my podcast, the Princeton Pulse, which discusses a public health approach focused on firearm safety and injury prevention.
- Oregon – Governor Tina Kotek and the Oregon Health Authority announced a residential treatment capacity dashboard to track the state’s progress towards additional behavioral health residential treatment beds and recovery housing units, with the projected goal of adding 465 beds by December 2026. The dashboard includes existing capacity, added capacity based on existing provider contracts, and projected capacity based on contracts in development across bed types.
- Pennsylvania
- The Pennsylvania Insurance Department (PID) announced Pennsylvania’s 2025 ACA health insurance rates, which will save Pennsylvanians approximately $77.2 million in 2025 health insurance premium costs through PID’s rate review process and reinsurance program. Additionally, the Commonwealth will see an increase in marketplace competition for several counties as some insurers will be selling plans in new counties.
- The Pennsylvania Department of Human Services (DHS) announced its intent to increase rates paid in its Behavioral HealthChoices (BHC) program, which provides access to mental health, substance-use disorder, and other behavioral health services for Medicaid enrollees. Once approved by CMS, the new rates to the BHC managed care organizations will be retroactive to July 1, 2024 for their current 2024 contract agreements with DHS.
- Rhode Island – Governor Dan McKee’s Executive Office of Health and Human Services announced the launch of the state’s Certified Community Behavioral Health Clinics (CCBHCs). The CCBHC initiative expands access to behavioral healthcare for all Rhode Islanders, regardless of age, insurance, immigration status, or diagnosis. CCBHCs offer many types of behavioral health services, including 24/7 mobile crisis response, person- and family-centered treatment planning, and community-based mental healthcare for veterans.