October 21 Update

In This Week’s Update:

  • Expanding Access to Traditional Healthcare Practices
  • CMS Guidance on Medicaid Coverage for Children
  • SHVS webinar: The Expiration of the PTC Enhancements: State-Specific Impacts
  • Tackling Medical Debt: Lessons from North Carolina
  • Affordability in Employer Versus Private Non-Group Coverage Before ARPA
  • Understanding and Mitigating Behavioral Health Workforce Shortages
  • State updates: CA, CO, LA, MD, MI, MS, NC, NJ, NM, PA & WA

Expanding Access to Traditional Healthcare Practices
Last week, CMS approved section 1115 demonstration amendments requested by four states that allow, for the first time ever, Medicaid and CHIP coverage of traditional healthcare practices provided by Indian Health Service facilities, Tribal facilities, and urban Indian organizations. The four states that received approval are ArizonaCaliforniaNew Mexico, and Oregon.

 

CMS Guidance on Medicaid Coverage for Children
Also last week, State Health and Value Strategies (SHVS) published an expert perspective that provides an overview of CMS’ recently released EPSDT guidance, which represents CMS’ most comprehensive discussion of EPSDT requirements in over a decade. Updates follow.

 

SHVS webinar: The Expiration of the PTC Enhancements: State-Specific Impacts—Tuesday, October 29, 2024, 3:00 to 4:00 p.m. ET.
SHVS will host a webinar discussing the expiration of the enhanced premium tax credits (PTCs) currently set to expire at the end of 2025. During the webinar, experts from the Urban Institute will present recent research to estimate the impact of the enhancements on coverage and consumer costs, discuss timing considerations for states related to the expiration or possible extension of the enhanced PTCs, and a state official from CoveredCalifornia, the state’s official health insurance Marketplace, will share state-specific implications. Register: https://princeton.zoom.us/webinar/register/WN_-33rxiHGQhSYqLbssxp3UQ#/registration 

 

Tackling Medical Debt: Lessons from North Carolina
Medical debt is the predictable and all too pervasive result of the U.S.’ expensive and fragmented healthcare payment and delivery system. Millions of low- and middle-income Americans struggle with medical bills after seeking the care they need to live healthy, flourishing lives. In a new Health Affairs Forefront article, North Carolina’s Department of Health and Human Services (NCDHHS) Secretary Kody Kinsley describes the state’s approach to address medical debt and offers lessons learned for other states. NCDHHS’ strategy pairs one-time medical debt relief for low- and middle-income consumers with new protections to shield consumers from medical debt in the future.

 

Affordability in Employer Versus Private Non-Group Coverage Before ARPA
A new report from the Urban Institute assesses differences in healthcare affordability between families with employer-sponsored insurance and those with private non-group coverage obtained through or outside the health insurance Marketplaces. The analysis finds that families with non-group insurance faced significant affordability problems before the American Rescue Plan Act, suggesting the expiration of the enhanced subsidies could exacerbate difficulties they may face in paying for coverage and care. Efforts to mitigate health costs for families with non-group coverage are important components of a policy agenda for addressing the nation’s healthcare affordability challenges.

 

Understanding and Mitigating Behavioral Health Workforce Shortages
The United States is experiencing a severe mental health crisis, with one in three adults reporting mental illness or substance-use issues in 2023. Despite effective treatments being available, significant barriers prevent many individuals from accessing care. A new report from Georgetown University’s Center on Health Insurance Reforms explores strategies and key recommendations for state policymakers to enhance the supply and distribution of behavioral health providers.

 

State updates: CA, CO, LA, MD, MI, MS, NC, NJ, NM, PA & WA

  • California – On October 29, the Department of Health Care Services and the California Prevention Training Center will host the Chosen Family: Contraception for Transgender and Gender Diverse People webinar. Transgender and gender diverse (TGD) people represent a growing subset of patient populations, yet many continue to report a lack of provider knowledge when it comes to TGD health. This webinar will build upon TGD health terminology and competency essentials by reviewing evidence-based recommendations for contraceptive counseling.
  • Colorado – Governor Jared Polis and the Colorado Division of Insurance announced that reinsurance will save Coloradans almost $493 million on approved plans and premiums for 2025. Colorado Option plans will continue to offer savings for enrollees, with an average premium change of 4.6% for Colorado Option plans compared to an average increase of 6.1% for non-Option plans.
  • Louisiana – The state submitted a request for a new five-year Medicaid section 1115 demonstration entitled “Louisiana Reentry Demonstration.” This demonstration aims to provide Medicaid coverage to qualified individuals prior to their release from prison or jail. The state seeks to cover Medicaid services, including case management, medication-assisted treatment, and a 30-day supply of prescription drugs, among other services.
  • Maryland – Governor Wes Moore announced that the U.S. Department of Transportation has awarded the Maryland Department of Planning a $1.76 million SMART grant to pilot the use of aviation technology. The program will focus on improving access to healthcare resources in rural communities on Maryland’s eastern shore.
  • Michigan
  • Mississippi – Governor Tate Reeves announced that Cindy Bradshaw will succeed Drew Snyder as Medicaid Director, effective October 31, 2024. Cindy Bradshaw has been serving as Medicaid’s Deputy Executive Director for Eligibility since April 2023. Congratulations Cindy!
  • New Jersey
    • Governor Phil Murphy announced the state’s second round of medical debt elimination, totaling $120 million in debt abolished for 77,000 New Jerseyans. For this round, the state is leveraging $900,000 in American Rescue Plan funds and is working with the Atlantic Health System to identify and purchase qualifying medical debts. Through the state’s partnership with Undue Medical Debt, $220 million has been eliminated for 127,000 residents to date. As a reminder, SHVS has an expert perspective tracking state efforts to cancel medical debt and prohibit medical debt reporting to credit agencies.
    • Attorney General Matthew J. Platkin and the Division of Consumer Affairs announced new adopted rules promoting greater transparency in prescription drug pricing. The new rules establish registration, reporting and compliance requirements across the prescription drug supply chain. The Division will use this information to produce an annual report on emerging trends in prescription drug prices, used to help the newly created Drug Affordability Council formulate legislative and regulatory policy recommendations focused on prescription drug affordability.
  • New Mexico – New Mexico’s Medicaid program is now accepting registrations from primary care providers to participate in quality payment incentives through the Medicaid Primary Care Payment Reform Value-Based Payment program. The multi-year program pays incentives to providers who meet quality metrics for healthcare delivery and includes reporting requirements and incentives aimed at improving patient health.
  • North Carolina – Governor Roy Cooper issued an executive order to allow the North Carolina Department of Health and Human Services (NCDHHS) to better support healthcare needs as the state’s response to Hurricane Helene continues. The executive order directs the state’s Medicaid program to create and review its clinical coverage policies to address the needs of individuals in the aftermath of the hurricane; permits the temporary waiver of certain regulations to enable flexibility in the administration of the Medicaid program during the state of emergency; and allows NCDHHS to provide temporary regulatory flexibility for the Medicaid program due to the displacement and closure of critical healthcare and other local facilities.
  • Pennsylvania – The Pennsylvania Insurance Department announced that the 2024 Transparency in Coverage Report is now available, including information for consumers on what to do if their insurance company denies their claim. The report also outlines data on claims, claim denials, and appeals information for health insurers doing business in the state.
  • Washington – The Washington Health Benefit Exchange and the Health Care Authority announced that Cascade Select public option plans will be available in all Washington counties for the first time in 2025. Washington’s public option plans are designed and procured by the state, allowing for more affordable, high-quality plans.