October 31 Update

In This Week’s Update:

  • Open Enrollment Period Begins 
  • Unwinding FAQ
  • No Surprises Act Implementation
  • OEP kicks off next week
  • Birth Equity in Medicaid
  • 50-State Medicaid Budget Survey Archives
  • State updates: CA, GA, IL, ME, NJ, NV, NY, PA, TN & WI


Open Enrollment Period Begins

In advance of the 2023 open enrollment period (OEP) that begins November 1, 2022, the Biden administration launched window-shopping for marketplace coverage. Consumers can now visit HealthCare.gov to view detailed information about 2023 health insurance plans and prices offered in their area.


Unwinding FAQ

In case you missed it, CMS released the “COVID-19 Public Health Emergency Unwinding Frequently Asked Questions for State Medicaid and CHIP Agencies.” The FAQs pull together answers to questions that states have asked over the past two years as part of CMS’ All State Calls and in response to the various pieces of sub-regulatory PHE unwinding guidance. CMS also released a slide deck to support continuous coverage unwinding efforts which includes information on ex-parte renewal requirements and strategies to increase ex-parte renewal rates. 


No Surprises Act Implementation

The No Surprises Act, which went into effect this year, shields people from medical bills they receive for care delivered by an out-of-network provider during an emergency visit or in other circumstances beyond the patient’s control. How well the law works, however, depends in part on the states, which are tasked with enforcing its protections. In their new report, experts from Georgetown’s Center on Health Insurance Reforms explain how states are partnering with the federal government to implement the law, including their decisions around enforcement, payments to out-of-network providers, and additional protections that go beyond federal standards. They also examine which states have payment determination processes that are more favorable to providers, with potential inflationary effects. Ensuring the law’s success, the authors say, will require not only rigorous oversight from state and federal agencies but education for consumers on what to do if they receive a bill they believe is incorrect.


Birth Equity in Medicaid

The Institute for Medicaid Innovation and Every Mother Counts are launching a national learning series centered on community-based doula care and perinatal community health workers (CHWs). The learning series aims to support the creation and strengthening of pathways for Medicaid stakeholders—including Medicaid agencies and health plans, provider groups, and professional associations—to expand access to quality, respectful, and equitable maternity care. Research shows that community-based perinatal support services provided by doulas and perinatal CHWs constitute a high-value healthcare practice. Despite the significant benefit of these supports, accessing them can be difficult and current Medicaid financing of doulas varies state to state and continues to present challenges of parity, equity, and sustainability. The new community-based doula and perinatal CHW learning series will consist of eight, free 60-minute web-based learning sessions that will provide a roadmap for Medicaid stakeholders to explore next steps for implementation of this model. Registration information is available here.


50-State Medicaid Budget Survey Archives

The Kaiser Family Foundation (KFF) archive page provides access to reports stemming from the 50-state Medicaid budget surveys published annually since 2000 by KFF. The page includes reports based on the annual surveys as well as shorter mid-year updates that were conducted in select years. The report based on the annual survey is traditionally released each fall and tracks trends in Medicaid spending and enrollment, as well as Medicaid policy actions around eligibility and enrollment, provider rates, provider taxes/fees, premiums and cost-sharing, benefits and pharmacy, long-term care and delivery system and payment reform.


State updates: CA, GA, IL, ME, NJ, NV, NY, PA, TN & WI

  • California – Governor Gavin Newsom and the Department of Health Care Services announced that roughly 286,000 older adult Californians are receiving full scope Medi-Cal as a result of the expansion of comprehensive preventive care and other services to all income-eligible adults 50 years of age and older, regardless of immigration status.
  • Illinois – The Pritzker administration announced an expansive Illinois Safe Sleep Support program. The program, led by 12 government and community agencies, aims to address sudden unexpected infant death (SUID), one of the leading causes of infant mortality. The program will focus on outreach and education to expand community-based promotion of safe sleep practices, promote resources to improve safe sleep environments, identify SUID disparities, and address opportunities for improvement.
  • Maine – In September, Maine announced that the weighted average health insurance premiums for small businesses will fall by 0.8% from 2022 to 2023. A recent Health Affairs Forefront article by Commissioner Jeanne Lambrew of the Maine Department of Health and Human Services describes how Maine was able to achieve this decrease, the first such reduction in average small group health insurance premiums in Maine since at least 2001.
  • Nevada – The Nevada Department of Health and Human Services submitted a request for a new five-year section 1115 demonstration intended to expand statewide access to oral health services for diabetic Nevadans over the age of 21, by utilizing the comprehensive diabetes treatment and management models of federally qualified health centers.
  • New Jersey – Governor Phil Murphy and Attorney General Matthew J. Platkin announced that a combined $20 million in state and federal grants would be made available through the Community-Based Violence Intervention Program and Hospital-Based Violence Intervention Program to work with victims in the wake of violent incidents and with individuals and communities impacted by gun violence.
  • New York – NY State of Health, the state’s official health plan marketplace, announced its continued partnership with Rite Aid to help New Yorkers find a health plan that fits their needs and budget. Certified enrollment assisters will be available at Rite Aid locations across the state to provide information about affordable coverage, answer questions and make enrollment appointments.
  • Tennessee – Tennessee submitted an amendment to the TennCare III demonstration proposing to continue to provide the enhanced home and community-based services (HCBS) supports currently approved under emergency authority in response to the COVID-19 PHE, beyond the expiration of the PHE. This amendment will allow Tennessee to continue providing an enhanced array of HCBS supports for individuals with disabilities on an ongoing basis.
  • Wisconsin – The Wisconsin Department of Health Services received CMS approval to provide housing supports for low-income Wisconsin families in need. Those who are eligible include families with children 18 and younger and individuals who are pregnant who have low income (below 200% of the federal poverty level) and do not have housing. Wisconsin is the first state to implement this type of housing benefit through a Children’s Health Insurance Program (CHIP) Health Services Initiative (HSI). The HSI option allows states to use a portion of CHIP funding to implement initiatives that improve the health of children.
  • Georgia and Pennsylvania – CMS approved both states’ extension of Medicaid and CHIP coverage for 12 months after pregnancy under the American Rescue Plan (ARP) Act. As a result, up to an additional 57,000 people in Georgia and Pennsylvania will now be eligible for Medicaid or CHIP for a full year after pregnancy. In total, an estimated 418,000 Americans across 26 states and the District of Columbia now have expanded access to postpartum coverage as a result