October 30 Update

In Last Week’s Update:

  • New Unwinding Resources
  • FAQs Concerning Termination of Coverage for Children
  • What’s New for 2024 Marketplace Enrollment
  • Leveraging Race and Ethnicity Data to Advance Health Equity
  • Data on Residential Redlining
  • State updates: CA, CO, GA, HI, IL, LA, MD, MT, NC, NE, NJ, PA, VA, WA & WV


New Unwinding Resources 

Last week, CMS published an interactive map and updated table of the section 1902(e)(14) waivers approved for states and territories to facilitate unwinding, including strategies to support ex parte processes. To support states as they work to make changes to their systems to enable ex parte renewals at the individual level, SHVS published a new toolkit they can use to identify common policies and/or operational processes that, if adjusted, could improve ex parte rates and renewal functionality. The toolkit is also intended to facilitate internal, cross-divisional Medicaid agency discussions across policy, operational, and information technology systems to preserve coverage for eligible enrollees. As a reminder, SHVS experts are available to help states troubleshoot challenges related to improving eligibility and enrollment processes.

Also last week, CMS released frequently asked questions (FAQs) about the termination of coverage for children during a continuous eligibility (CE) period due to unpaid premiums. The FAQs are a follow up to the recently published State Health Official (SHO) letter providing guidance on the requirement in Section 5112 of the Consolidated Appropriations Act, 2023 that all states must adopt 12-months of CE for children effective January 1, 2024. In addition to the FAQs, CMS also published a slide deck that provides further information on operationalizing CE for children after an ex parte renewal. As a reminder, SHVS published an expert perspective summarizing CMS’ SHO on CE and is planning additional programming on the implementation of CE for children, so stay tuned. Updates follow.


What’s New for 2024 Marketplace Enrollment

The annual open enrollment period (OEP) for Affordable Care Act (ACA) Marketplace coverage kicks off November 1 in most states. A number of new and ongoing policy challenges will impact the Marketplace in 2024, including special enrollment opportunities tied to the Medicaid unwinding, continuing enhanced financial assistance and administrative flexibilities designed to reduce barriers to enrollment. A blog post from the Georgetown Center on Health Insurance Reforms provides a summary of these and other recent policies that consumers may encounter this year. Additional policies that will impact the Marketplace include the proposed coverage expansion for recipients of the Deferred Action for Childhood Arrivals (DACA) program, modified automatic re-enrollment policies, diminished coverage requirements for COVID-19 services, the updated failure to file and reconcile rules, a more lenient household income verification process, door-to-door enrollment assistance, expanded price comparison tools and a new State-Based Marketplace that launched in Virginia. To support states in their OEP outreach efforts, SHVS has created sample messages and accompanying social media graphics available in English and Spanish.


Leveraging Race and Ethnicity Data to Advance Health Equity

Data on patients’ healthcare access and quality by race and ethnicity are essential to developing effective interventions that advance health equity. But while efforts to collect such data are growing, little is known about the extent to which patient race and ethnicity data are being used to address inequities. Moreover, less attention has been paid to efforts to collect the race and ethnicity data of healthcare providers, which could also inform effective interventions to advance equity. An issue brief from the Urban Institute looks at examples, promising practices, remaining challenges and next steps to use race and ethnicity data to advance health equity. The brief draws on publicly available resources and interviews with leaders and analysts in the healthcare sector familiar with or engaged in efforts to collect and use individual or healthcare provider race and ethnicity data to reduce health inequities. As a reminder, SHVS published an issue brief on the collection of race and ethnicity data by Medicaid programs in the 50 U.S. states, the District of Columbia, and the five U.S. territories.

Data on Residential Redlining

Medicaid expansion narrowed racial and ethnic disparities in health coverage, but few studies have explored differential impact by exposure to structural racism. A new article published in Health Affairs analyzes data on historical residential redlining in U.S. metropolitan areas from the Mapping Inequality project, along with data on uninsurance from the American Community Survey, to test whether Medicaid expansion differentially reduced uninsurance rates among nonelderly adults exposed to historical redlining. The difference-in-differences analysis compared uninsurance rates in Medicaid expansion and nonexpansion states both before (2009–2013) and after (2015–2019) the state option to expand Medicaid pursuant to the ACA took effect in 2014. The study found that Medicaid expansion had the greatest impact on lowering uninsurance rates in census tracts with the highest level of redlining. Within each redline category, there were no significant differences by race and ethnicity. The results highlight the importance of considering contextual factors, such as structural racism, when evaluating health policies. States that opt not to expand Medicaid delay progress toward health equity in historically redlined communities.


State updates: CA, CO, GA, HI, IL, LA, MD, MT, NC, NE, NJ, PA, VA, WA & WV

  • California
    • The Department of Health Care Services (DHCS) submitted to CMS a proposed amendment to the California Advancing and Innovating Medi-Cal (CalAIM) program, and a new section 1115 demonstration request, California Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT). In addition to offering six months of transitional rent services as a county opt-in benefit, features of BH-CONNECT include an incentive program to support children and youth involved in child welfare who are also receiving specialty mental health services and a statewide incentive program to support behavioral health delivery systems in strengthening quality infrastructure, improving performance on quality measures, and reducing disparities in behavioral health access and outcomes.
    • The California Health and Human Services’ Center for Data Insights and Innovation announced the inaugural cohort of Qualified Health Information Organizations that will participate in the state’s Data Exchange Framework. The framework is a statewide data sharing agreement that will accelerate and expand the exchange of health information among healthcare entities, government agencies and social service programs beginning in 2024.
  • Colorado – Governor Polis and the Division of Insurance announced that the state’s rate review authority and Reinsurance Program has led to decreased premiums resulting in $411.2 million in savings. The Division also implemented, for the first time, a public hearing process resulting in 25 Colorado Option individual market plans and 24 small group market plans that meet the target 10% reduction in premiums as compared to 2021. Additionally, nearly 20,000 Coloradans will be newly eligible for reduced out-of-pocket costs with deductibles as low as $100.
  • Georgia – The Georgia Department of Human Services announced the establishment of community action treatment (CAT) teams as a behavioral healthcare pilot project for children and youth with significant mental and/or behavioral health needs and conditions. The goal of the pilot is to address underlying issues that often lead to foster care placements. The CAT team model is based on a family-centered approach in which the CAT team helps parents and caregivers in obtaining services and support as well as aid with referrals.
  • Hawaii – The Hawaii Department of Human Services announced the draft of their section 1115 demonstration renewal for 2024 is complete and open for public comment. New requests in the demonstration include Medicaid matching funds related to housing services; continuous eligibility for children ages zero to six and continuous two-year eligibility from the time of first eligibility determination for children ages 6 to 19; targeted services to eligible justice-involved populations 90 days pre-release from incarceration; nutritional supports; Native Hawaiian traditional healing practices; contingency management for enrollees with a qualifying substance-use disorder; infrastructure funding for health-related social need services; and Designated State Health Programs.
  • Illinois – The Illinois Department of Public Health released the third edition of the Illinois Maternal Morbidity and Mortality Report, covering maternal deaths occurring for Illinois residents from 2018 to 2020. Among the key findings are that Black women continue to die at disparately higher rates, specifically due to medical causes including cardiovascular disease and pre-existing chronic medical conditions; and that the leading overall cause of pregnancy-related death is substance-use disorder.
  • Louisiana – The Louisiana Department of Health announced Medicaid members can now request to update their contact information through text messaging. Medicaid members can make sure that they do not miss out on important information from Medicaid by texting the words “Info” or “Information” to 72147. They will receive a text with a link to update their contact information.
  • Maryland – Maryland Health Connection, the state’s official health insurance Marketplace, hosted the Hispanic Health Access Roundtable to discuss critical issues related to health access, legislation, and the expansion of coverage for the Hispanic and Spanish-speaking community.
  • Montana – Governor Greg Gianforte announced the investment of $7.5 million to increase access to behavioral health and substance-use disorder screening, and treatment for pregnant and postpartum women across the state. The investment, comprised of federal funding and private funding from the Montana Health Foundation, will expand behavioral healthcare services for new and expecting moms to all of Montana’s 31 hospitals that deliver babies through the Meadowlark Initiative. Currently, the program is only available in 19 facilities.
  • Nebraska – Nebraska submitted an application to extend their section 1115(a) demonstration titled, “Nebraska Substance Use Disorder (SUD) Section 1115 Demonstration,” which authorizes federal Medicaid matching funds for reimbursement of services delivered to enrollees residing in Institutions for Mental Diseases with SUD. This application seeks authority to continue the SUD demonstration as approved with no changes for an additional five years. The federal comment period will be open from October 20, 2023 through November 19, 2023.
  • New Jersey – Governor Phil Murphy signed a bill to launch a new website—the Reproductive Health Information Hub—providing information on reproductive rights, access and healthcare coverage across New Jersey. The Hub will serve as a one-stop shop for anyone seeking information on reproductive healthcare in the state including information on an individual’s rights under state law.
  • North Carolina – The North Carolina Department of Health and Human Services announced recent updates to the NC State Health Improvement Plan (SHIP), which includes priorities for addressing the full set of factors that impact a person’s health. The NC SHIP also recognizes the pressing concerns related to behavioral health, including mental health, substance-use disorders and suicide prevention as part of whole person health and places particular importance on Medicaid Expansion as a critical element in improving healthcare access and reducing disparities.
  • Pennsylvania – The Department of Human Services announced an expanded list of eligible providers to meet with unhoused patients covered through Medicaid and provide care outside a clinical setting—a practice known as street medicine. Additional eligible providers include dentists, federally qualified health centers, rural health clinics, peer support services, family based mental health services and mental health crisis intervention services.
  • Virginia – Governor Glenn Youngkin announced that Virginia will provide micro-grants to encourage qualifying faith-based organizations and community organizations to improve access to mental health support and address the opioid crisis. A total of nearly $800,000 has been set aside for community organizations to apply for a grant to provide training and direct care for people in their communities who are struggling with behavioral health issues.
  • Washington – Washington Healthplanfinder CEO Ingrid Ulrey announced that the annual open enrollment period for the state’s exchange begins November 1, and this year, for the first time, coverage is also available to non-U.S. citizens in the state through the Marketplace.
  • West Virginia – The West Virginia Bureau for Medical Services (BMS) issued a request for applications for qualified managed care organizations (MCOs) to provide services for the Mountain Health Trust program, the state’s full-risk managed care program for Modified Adjusted Gross Income eligibility categories. Contracted MCOs will support the BMS in providing statewide physical health, behavioral health, and dental services for eligible Medicaid and West Virginia Children’s Health Insurance Program members.