In This Week’s Update:

• Expanding access to affordable contraception
• State updates: AK, CO, DC, IL, MI, MO, MS, NC, NM, OR, PA & WA
• Outreach materials for open enrollment
• Children’s coverage technical advisory group

Expanding Access to Affordable Contraception
Last week, the Biden-Harris administration proposed a rule to expand coverage of affordable contraception under the Affordable Care Act. Under the proposed rule, most group health plans and health insurance issuers would be required to cover over-the-counter contraceptives without cost sharing or a prescription. In its States of Innovation series, State Health and Value Strategies (SHVS) has been tracking the work states are engaged in to increase access to reproductive healthcare. The series is easily searchable for states interested in learning more about reproductive healthcare efforts in other states.

Recommendations for Compensating Beneficiary Advisory Council Members
Also last week, SHVS published an issue brief, State Strategies to Compensate Beneficiary Advisory Council Members. As states implement the new requirement to create and support a Beneficiary Advisory Council (BAC), fair compensation of Medicaid enrollees serving as BAC members is an important component of shifting from a transactional to a transformative relationship with members. The issue brief offers considerations for determining how to fairly compensate BAC members for their time and expertise without adversely affecting their eligibility for Medicaid and other programs. Updates follow.

State updates: AK, CO, DC, IL, MI, MO, MS, NC, NM, OR, PA & WA 

• Colorado – Governor Polis and Lieutenant Governor Primavera announced the launch of the Colorado Hospital Price Finder, a tool to increase price transparency. The tool complements the state-generated price transparency initiative announced earlier this year.
• Illinois
  • The Illinois Department of Healthcare and Family Services announced that the 19 Certified Behavioral Health Clinics participating in a federal Medicaid Demonstration Program are now offering mental healthcare and substance-use treatment services under this new model. The model increases access to behavioral healthcare, including crisis care for individuals who may otherwise experience challenges accessing the services they need.
  • Governor JB Pritzker and the Illinois Department of Public Health (IDPH) kicked off a three-day Minority Health Conference as IDPH is working to implement the Healthy Illinois 2028 State Health Improvement Plan, one of the key pillars of addressing structural racism as a public health crisis.
  • Michigan – Governor Gretchen Whitmer announced a new program, “Take Control of your Birth Control” to ensure Michigan families have access to free contraception including over-the-counter oral birth control pills, emergency contraception, condoms, and family planning educational resources through community partners and federally qualified health centers during the month of November. The program is funded using $5.6 million secured in the state’s budget to support family planning.
• Mississippi – In preparation for implementation of the new Consolidated Appropriations Act, 2023 requirements on the provision of Medicaid and CHIP services to incarcerated children and youth, the Mississippi Division of Medicaid created an online survey to collect feedback from affected carceral facilities and released a fact sheet.
• Missouri – The Missouri Department of Social Services’ MO HealthNet Division, which administers the state’s Medicaid program, announced that CMS approved a state plan amendment that enables the state to begin reimbursing for doula services. A forthcoming provider bulletin will provide details on Medicaid billing, service definitions, and reimbursement rates. 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.
• New Mexico – Following Governor Lujan Grisham’s executive order issued in response to severe flooding in Chavez County, the New Mexico Office of Superintendent of Insurance issued an emergency order requiring health insurers to provide grace periods for premium payments, refill prescriptions early, cover out-of-network services, waive patient cost-sharing and prior authorizations, and cover replacements of essential medical supplies that were left behind due to evacuations.
• North Carolina – The North Carolina Department of Health and Human Services announced $2.9 million in federal funding to help increase crisis counseling services for people impacted by Hurricane Helene. The funding is part of the Crisis Counseling Assistance and Training Program administered by the U.S. Substance Abuse and Mental Health Services Administration, which is available to states to address behavioral healthcare needs and support relief for people in disaster-impacted communities.
• Oregon
  • The Oregon Health Authority (OHA) released an analysis of insurance payment data, indicating that while many Oregon insurers are increasingly rewarding healthcare providers for the quality of care they deliver, only about half of the state’s insurers are meeting the goals of an agreement that calls for adopting more value-based healthcare payments. A related OHA analysis found Coordinated Care Organizations (CCOs), or insurers that cover Oregonians with Medicaid insurance, were most likely to use value-based payments.
  • OHA announced 2025 rates for Oregon Health Plan care coordination. OHA will pay 3.1% more per month in 2025 for CCOs to provide Medicaid benefits to eligible Oregonians. As a result, OHA will pay an average of $529.89 per-member-per-month next year for CCOs to coordinate the medical, dental and behavioral healthcare services for most of the state’s Medicaid enrollees.

• Pennsylvania – Governor Josh Shapiro signed a bill into law ensuring health insurance coverage for speech therapy for children who stutter. The law requires health insurance companies to cover speech therapy for children aged two to six diagnosed with stuttering, offering financial relief to families.
• Alaska, the District of Columbia, and Washington – CMS approved essential health benefits benchmark plan applications for plan year 2026 and beyond for Alaska, the District of Columbia, and Washington. Alaska received approval to add coverage for hearing aids, massage therapy, nutritional counseling, chiropractic and temporomandibular joint disorder care; the District of Columbia received approval to expand coverage for infertility treatments; and Washington received approval to expand coverage for human donor milk, hearing aids, and artificial insemination.