October 16 Update

In This Week’s Update:

  • New States are Providing Coverage Transition Data
  • Sexual Orientation & Gender Identity Data Collection: Best Practices
  • Aligning policies with birthing people’s preferences
  • Investing in social determinants of health
  • Leveraging Medicaid to Improve the Healthcare Delivered to American Indians and Alaska Natives
  • State updates: AZ, CO, IA, MN, NC, NE, NJ, PA & VA


New States Providing Coverage Transition Data

Last week, State Health and Value Strategies updated our expert perspective that monitors states reporting transitions to Marketplace coverage to reflect the additional four states—California, Connecticut, Minnesota and Washington—that are now publishing transition data. SHVS also published an updated version of our expert perspective that tracks states publishing unwinding data to incorporate context of the recent CMS data release. Both expert perspectives feature an interactive map with links to state reporting, tables tracking the unwinding indicators that states are reporting on, and select data highlights of state dashboards. SHVS will continue to update the expert perspectives as more states publish unwinding data.


Sexual Orientation & Gender Identity Data Collection: Best Practices

Also last week, SHVS published a new issue brief, Collection of Sexual Orientation and Gender Identity Data: New and Updated Information on Medicaid Data Collection Practices and Federal Activity. Medicaid is an important source of coverage for LGBTQI+ populations, but few states collect data that can be used to understand and improve health for these individuals. This issue brief documents how information describing sexual orientation and gender identity (SOGI) data is currently collected at the federal level and in state Medicaid applications, summarizes the recent consensus recommendations for how to ask questions that measure SOGI data, and highlights recent federal action on this topic. The issue brief also spotlights Oregon’s ongoing efforts to improve the collection of SOGI data. Updates follow.


Aligning Maternal Health Policies with Birthing People’s Preferences and Experiences

Documenting the birthing experiences and preferences of Black, Indigenous, and Latinx pregnant and parenting people is critical to informing and shaping policy conversations around initiatives and programs designed to improve outcomes and mitigate maternal and infant health inequities. A new Urban Institute brief seeks to add to this conversation by documenting the preferences and lived experiences of people of color who recently gave birth. The findings are based on focus groups and phone interviews conducted in 2022 and 2023 with recently pregnant/postpartum women as well as stakeholder interviews with maternal health experts, advocates, and clinicians. Individuals shared that they often felt powerless to make informed decisions throughout their pregnancies that may have been improved by more comprehensive, patient-centered care. Other preferences expressed included overwhelming support for extending postpartum Medicaid coverage to 12 months to access care over a longer period and shifting the maternity care model from a clinical focus to a more holistic approach to include screenings and support for the social determinants of health.

Value of Investing in Social Determinants of Health

A new toolkit published by the Institute for Medicaid Innovation represents phase one of a multipart suite of resources to allow Medicaid managed care organizations (MCOs) to articulate the business case for launching, leading, or expanding initiatives focused on inequities and social determinants of health. The goal of this work is to equip Medicaid MCOs, state Medicaid agencies, and partners, including provider and community-based organizations (CBOs), in taking meaningful steps forward in investing in social determinants of health to improve health equity. The toolkit shares guidance on how to build and sustain trusted relationships between Medicaid MCOs and CBOs as building blocks to address the social determinants of health, further the goals of whole-person care, and improve health and wellbeing.


Leveraging Medicaid to Improve the Healthcare Delivered to American Indians and Alaska Natives

An upcoming webinar, hosted by the National Academy for State Health Policy, will explore two states’ strategies for working together with Tribes to leverage Medicaid, deliver better care to American Indians and Alaska Natives (AI/AN) and address health disparities. AI/AN populations experience higher rates of infant mortality, as well as many chronic and behavioral health conditions. During the pandemic, higher rates of infection, hospitalization, and death also disparately impacted AI/AN. The rural nature of most reservations, provider shortages, lack of culturally relevant care, and Indian Health Service funding that, historically, has not met AI/AN health needs, all contribute to these disparities. The webinar will explore strategies implemented by Arizona’s Medicaid agency and the Washington State Health Care Authority and will offer both state and AI/AN perspectives on each.

State updates: AZ, CO, IA, MN, NC, NE, NJ, PA & VA

  • Arizona – The Arizona Health Care Cost Containment System submitted a request to amend its section 1115 demonstration to allow parents of minor children eligible for the Arizona Long Term Care Services program to receive payment for personal care and habilitation services. Arizona currently has this authority through temporary COVID-19 authorities. The federal public comment period will be open from October 12, 2023 through November 11, 2023.
  • Colorado
    • The Colorado Department of Health Care Policy and Financing announced changes to its renewal packets to reflect feedback from members and advocates. Changes will be reflected in renewal packets sent mid-October, including fewer blank spaces and fewer pages, additional emphasis to sign the renewal packet, and the addition of a color Colorado state seal to the renewal packet envelope window to help prevent it from being mistaken for junk mail.
    • The Colorado Division of Insurance (DOI) announced that it will increase the availability of financial assistance for health insurance in the OmniSalud program to 11,000 individuals in 2024, a 10% increase from 2023. OmniSalud allows Coloradans without documentation (including DACA recipients) and those who are ineligible for federal subsidies to get health insurance that meets the requirements of the ACA. The financial assistance through the DOI’s Health Insurance Affordability Enterprise lowers premiums for qualifying individuals in the OmniSalud program to $0 per month.
  • Iowa – The Iowa Department of Health and Human Services (HHS) announced a new initiative to ensure people in Iowa have access to high-quality behavioral health, disability and aging services in their communities. This initiative, called Hope and Opportunity in Many Environments (HOME), is aimed at redesigning community-based services to help Iowans stay independent in their communities. HHS leadership will visit communities virtually and in-person in October and November to seek feedback from people who use community-based services, caregivers, service providers, case managers, advocates and community members.
  • Minnesota – MNsure, the state’s official health insurance Marketplace, announced five new broker enrollment centers throughout the state. Minnesotans who need health insurance for 2024 can find free application and enrollment help from a MNsure-certified broker at 23 locations.
  • Nebraska – The Nebraska Department of Health and Human Services Division of Medicaid and Long-Term Care will host the next Medicaid listening tour throughout October and November 2023 in communities around the state. During the listening tour—which will include 12 meetings in 10 cities throughout Nebraska, along with two virtual sessions—Nebraska Medicaid will be announcing upcoming changes to the program and providing updates on the continuous coverage unwinding.
  • New Jersey
    • Governor Phil Murphy announced the state’s progress in expanding access to hormonal contraceptives by enabling pharmacists to provide self-administered hormonal contraceptives to patients without a prescription. A joint rule proposal advanced by the state Board of Medical Examiners and the Board of Pharmacy implements legislation that Governor Murphy signed in January. These new services will be available in 2024.
    • The New Jersey Department of Health announced that since it began accepting new applications for harm reduction centers (HRCs) on a rolling basis in July, seven additional HRC applicants have been approved in 2023—effectively doubling the number of approved HRCs in the state. HRCs are community-based programs that offer a safe, trauma-informed, non-stigmatizing space for people who use drugs to access naloxone, sterile syringes, and other safer use supplies and are now authorized to operate in 12 of the state’s 21 counties.
  • North Carolina – The North Carolina Department of Health & Human Services announced an $835 million investment in behavioral health. $700 million of the funds directly support Governor Roy Cooper’s $1B Behavioral Health Roadmap. Some of the key areas funded are services for people experiencing a mental health or substance-use crisis; services to help individuals with behavioral health conditions avoid incarceration; services for children with complex needs and supports for families; and strengthening the behavioral health workforce.
  • Pennsylvania
    • Governor Josh Shapiro signed an executive order directing Commonwealth agencies to collaborate with mental health and substance-use disorder (SUD) stakeholders to streamline and improve the accessibility of mental health and SUD services. The Council is the first-of-its-kind for the Commonwealth and will develop and recommend to the governor a statewide action plan to address any gaps in access, affordability, or delivery of services.
    • The Pennsylvania Insurance Department released Pennsylvania’s inaugural 2023 Transparency in Coverage Report, outlining data on claims, claim denials, and appeal information for health insurers doing business in the Commonwealth. The report found that total claims received and total claims denied increased over the last two years, but the statewide claims denial rate has been stable, between 12.6% and 14.5% of call claims received.
  • Virginia – The Virginia Health Benefit Exchange has officially launched the state’s official State-Based Marketplace, available for consumers to purchase coverage for plan year 2024. The state previously operated the Marketplace through HealthCare.gov.