October 23 Update

In Last Week’s Update:

  • Communicating Enrollee Reinstatement Notice Language
  • Open Enrollment: Social Media Messages
  • New Jersey’s budget to Address Medical Debt
  • Continuous enrollment for children
  • Infant and early childhood mental health
  • State updates: AZ, CA, CO, FL, IA, KY, MI, MN, MO, MT, NC, NM, NY, OR, SC & WA

As many states are implementing mitigation strategies to ensure compliance with the federal requirement to conduct ex parte renewals at the individual level. This week, State Health and Value Strategies (SHVS) published a new blog about its model Medicaid reinstatement notice language, which is intended to provide states with models for communicating key information to enrollees regarding their reinstatement. States can tailor and modify the templates for their programs and specific mitigation plans. The expert perspective also includes tips for writing and disseminating effective notices, based on enrollee feedback.


Open Enrollment: Social Media Messages

SHVS also published sample messages and social graphics for the upcoming open enrollment period, which are designed to support states during the simultaneous Medicaid unwinding. States can use this content in their outreach efforts to communicate important Marketplace enrollment opportunities to consumers, including those that are transitioning from Medicaid coverage. As a reminder, we have created a one-stop resource page with links to all of our unwinding communications resources for states.

Also last week, I co-wrote an op-ed that describes how New Jersey is taking the lead on addressing medical debt. In the op-ed I highlight how New Jersey’s latest state budget includes a provision to address medical debt that hasn’t gotten the attention it deserves. I hope you find the op-ed helpful in thinking about how your state might approach the issue of medical debt, which has significant health equity implications. Updates follow.


Continuous Enrollment for Children: State Options When New Information is Reported at Renewal

Following recent sub-regulatory guidance on the requirement in the Consolidated Appropriations Act, 2023 that all states adopt continuous eligibility (CE) for children effective January 1, 2024, CMS released a slide deck providing further information on operationalizing CE for children after an ex parte renewal. (For more information on CMS’ State Health Official Letter on CE, see this SHVS expert perspective.) The CMS slide deck reviews two options for how to treat new information that could impact a child’s eligibility. In instances where the child is initially determined eligible via an ex parte review and the parent or guardian subsequently provides new information that could impact the child’s eligibility, the state may either: 1) treat the ex parte determination as a final determination effective following the end of the current coverage and CE period. Under this option, the state would not consider the new information submitted as part of the child’s renewal at the end of the 12-month CE period; or 2) hold the final determination of eligibility for the child until the parent’s eligibility determination is made. Under this option, the state would consider the new information submitted as part of the child’s renewal at the end of the 12-month CE period. This guidance applies to states that already have CE for children in place through the existing state plan option, and it will apply to all states starting in 2024.

Support for Infant and Early Childhood Mental Health

report from the Georgetown Center for Children and Families discusses five states’ journeys to strengthen Medicaid support for infant and early childhood mental health. California, Colorado, Michigan, North Carolina and Washington offer lessons for other states seeking to more effectively prevent, identify and address mental health conditions among young children in Medicaid. The lessons speak to the importance of leadership, strategic partnerships, advocacy, incremental progress, Medicaid policy levers and addressing the full continuum of care from prevention to treatment. States seeking to apply the lessons from these and other states can get started in a number of ways depending on state policy context and political will.


Dental Affordability Problems and Potential SolutionsSurveys across multiple states revealed that people with insurance still go without critical services due to cost, with dental care being the most frequently cited. Respondents across insurance types go without dentures, root canals, extractions, and many other dental services. Looking to Medicaid as an example, an upcoming webinar hosted by the Healthcare Value Hub on October 26, at 2:00 p.m. ET, will explore the impacts of going without dental care on the whole body and other high-cost medical conditions, as well as the reasons why people go without care, such as limited coverage for dental care and a lack of providers accepting certain insurance types. It will also capture policy solutions and strategies for state administrators and advocates for low- and middle-income communities to expand access to affordable care.


State updates: AZ, CA, CO, FL, IA, KY, MI, MN, MO, MT, NC, NM, NY, OR, SC & WA

  • Arizona – The Arizona Health Care Cost Containment System and the Arizona Department of Economic Security are conducting two surveys of members enrolled in the Arizona Long Term Care System and their families. Both surveys ask questions about whether members and families feel safe and protected from abuse and neglect. These surveys are a follow-up to a 2019 survey by the State’s Abuse and Neglect Prevention Task Force, which made recommendations regarding abuse and neglect prevention across state systems.
  • California – The California Department of Public Health is awarding nearly $2.4 million in grants through the Transgender, Gender Nonconforming, and Intersex Wellness and Equity Fund to provide and support clinical services for gender-affirming healthcare across the state. The grants are designed to ensure these populations have access to lifesaving care.
  • Colorado – Connect for Health Colorado Chief Executive Officer Kevin Patterson published a blog post highlighting how the state is preparing for open enrollment. The activities highlighted in the blog include a new ad campaign, new toolkit materials, technology and application system improvements, and this year the Marketplace has moved all call center operations in-house.
  • Florida – The Florida Agency for Health Care Administration initiated the Dental Provider Incentive Program (DPIP) to provide bonus reimbursements to highly performing dental providers who have prioritized the improvement of oral health in Florida. To qualify for enhanced payments beginning October 1, 2024, eligible dental providers must achieve the DPIP Qualifying Criteria for calendar year 2023 services. Qualified providers receive enhanced payments for specific preventive and diagnostic services provided to children under the age of 21.
  • Iowa – The Iowa Department of Health and Human Services will host a series of listening sessions this fall for Iowans who receive community-based services to share their experiences with Iowa Medicaid leaders. This series of events, called HOMEtown Conversations, is part of the Hope and Opportunity in Many Environments (HOME) initiative to redesign Iowa’s Medicaid waiver system. The sessions will take place in-person and virtually.
  • Kentucky – The Kentucky Department for Public Health has launched a new respiratory virus website, CoverYourCough.ky.gov, a one-stop spot for finding information on COVID-19, influenza and RSV.
  • Michigan
    • The public is invited to attend a virtual meeting hosted by the Michigan Department of Health and Human Services (MDHHS) regarding the list of prescription drugs covered under Michigan’s Medicaid health plans known as the Medicaid Health Plan Common Formulary. The purpose of the meeting is to provide an annual forum for the public, stakeholders and interested parties to comment on the prescription list. This forum is in addition to the quarterly written public comment periods.
    • MDHHS has awarded two grants for sickle cell clinic expansion and enhancement. The two awardees, each receiving $100,000, are the Children’s Hospital of Michigan, which will seek to reduce the incidence of stroke among its clinic patients with sickle cell disease, and the Bronson Health Foundation, which will address issues of access to care and quality of care by developing improved referral networks and implementing a sickle cell-specific data collection module. It will also strengthen its care coordination services and patient support activities.
  • Minnesota – The Minnesota Department of Human Services announced it has stopped requiring parents to pay monthly fees for children with disabilities who get their Medical Assistance coverage through the Tax Equity and Fiscal Responsibility Act option, known as TEFRA, or through assessments for Home and Community-Based Services (HCBS). Earlier this year, the Minnesota legislature and Governor Tim Walz approved legislation to eliminate parental fees for children covered through the TEFRA option and HCBS.
  • Missouri – The Missouri HealthNet Division (MHD), the state’s Medicaid agency, is hosting a networking opportunity for providers and MHD managed care health plan representatives on November 13, 2023, at the Governor’s Office Building in Jefferson City. The in-person and virtual event, “Optimizing Missouri’s Managed Care Plan Benefits for Maternal and Infant Health,” will showcase valuable benefits, incentives and resources available to perinatal patients and families including individualized Gestational Care Management for eligible patients.
  • Montana
    • CMS approved a community-based mobile crisis state plan amendment that allows Montana 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.
    • CMS approved a postpartum coverage extension state plan amendment for Montana to extend postpartum coverage for a full year for individuals enrolled in Medicaid. Montana’s approval marks 38 states, D.C., and the U.S. Virgin Islands that have extended postpartum Medicaid coverage for an entire year. As a reminder, SHVS published an issue brief on the ARP option to extend postpartum coverage.
    • New Mexico
      • Governor Michelle Lujan Grisham announced the selection of 11 rural healthcare providers to receive the first tranche of funding through the Rural Health Care Delivery Fund. This initiative will provide crucial funding to rural healthcare providers, enabling them to offer new and expanded services in their communities. The awardees include services for maternal, behavioral and primary care.
      • The New Mexico Human Services Department (HSD) announced the agency is providing an additional 30 days for Medicaid enrollees to submit their renewal applications. The agency is also seeking CMS approval for an additional strategy to mitigate loss of coverage at renewal for children ages zero to six. In the October 17 States of Unwinding post SHVS highlights how New Mexico and other states are leveraging federal flexibilities during unwinding.
  • New York – Governor Kathy Hochul signed legislation to permit Medicaid reimbursement for violence prevention programs serving survivors of community violence. The legislation directs the New York State Department of Health to apply to the federal government to make community violence prevention available to qualifying Medicaid enrollees, as well as determine rates for program service providers.
  • North Carolina – The North Carolina Department of Health and Human Services (DHHS) received final federal approval from CMS to launch Medicaid expansion on December 1, 2023. DHHS is also encouraging individuals to sign up to receive an alert when the application process goes live and to be notified about other timely resources.
  • Oregon – The Oregon Health Authority’s (OHA) Public Health Division has released a new Public Health Equity funding opportunity for community-based organizations (CBOs). This funding, totaling up to $10.25 million, will be flexible, allowing CBOs to develop work that best addresses the needs of the community within specified program areas. OHA’s Community Engagement Team will work with CBOs and programs within the Public Health Division to engage community on long-term public health efforts in the following program areas, rooted in health equity: climate adaptation; communicable disease prevention; and public health emergency preparedness.
  • South Carolina – The South Carolina Department of Health and Human Services announced the creation of a new grant program to improve access to quality medical care in rural and medically underserved areas throughout the state. Through the newly created grant program, the agency expects to distribute at least $15 million in one-time funds to support the creation or improvement of healthcare facilities in rural and/or medically underserved areas.
  • Washington – CMS approved a community-based mobile crisis state plan amendment that allows Washington to create mobile crisis intervention teams to provide Medicaid crisis services authorized under the ARP.