October 4 Update

In This Week’s Update:

  • SHVS Webinar on Afghan Refugee Guidance
  • Interim Final Rule on Surprise Billings
  • Strategies for Open Enrollment Outreach
  • State Updates: AK, AZ, AR, CA, IA, IL, KS, KY, ME, MN, MO, NC, NE, NJ, NM, NY, PA, TX & WV
  • No Surprises Act Enforcement
  • Long-term Services and Supports
  • Leveraging COVID-19 Relief for Cross-Sector Data Sharing


State Guidance for Afghan Refugees

CMS released  guidance to help states understand what health coverage options are available to Afghan evacuees. Tens of thousands of Afghans who fled the Taliban last month are awaiting resettlement, with many having already arrived in the U.S. living on military bases and states are preparing to accept evacuees who will eventually be resettled in their communities. Refugees are in need of access to medical care, as measles and other infections spread and newcomers grapple with the trauma associated with fleeing their home country. On Wednesday, October 6 State Health and Value Strategies (SHVS) is hosting a webinar that will provide an overview of eligibility standards for refugees and strategies that states can deploy to expeditiously enroll people into health coverage in order to access care. See the webinar registration information below to register.


Interim Final Rule on Surprise Billings

HHS, the Department of Labor, and the Department of the Treasury, along with the Office of Personnel Management, released an interim final rule “Requirements Related to Surprise Billing; Part II” related to the No Surprises Act. The interim final rule implements additional protections against surprise medical bills under the No Surprises Act, including provisions related to the independent dispute resolution process, good faith estimates for uninsured (or self-pay) individuals, the patient-provider dispute resolution process, and expanded rights to external review. SHVS is planning programming on the interim final rule, so stay tuned.


Strategies for Open Enrollment Outreach

In advance of the upcoming open enrollment period, SHVS has published an expert perspective How State-Based Marketplaces Can Maximize Consumer Outreach during Open Enrollment. For many state-based marketplaces (SBMs), the next annual open enrollment period represents a renewed opportunity to build on the hard work and lessons learned from this past year and this expert perspective highlights key messaging and outreach strategies SBMs are employing to conduct outreach, provide enrollment assistance, and clearly communicate with consumers what health coverage options are available for them in 2022.


State Updates 


  • Arizona – CMS extended AHCCCS’ 1115 waiver demonstration authority for a one-year period, through September 30, 2022, while they continue to review the agency’s 2021-2026 waiver renewal application. The extension grants authority to continue specific programs for a sixth year, including the Targeted Investments Program.
  • Arkansas – The Arkansas Department of Health’s Office of Health Equity is partnering with cities to host community vaccination clinics. Clinics will be open to eligible people needing booster shots and to those who have not yet been fully vaccinated. The community clinics are being held to ensure under-resourced communities have equitable access to vaccines and monoclonal antibodies in convenient locations. Participants will receive lunch and an entry to win a $500 raffle. Flu vaccinations will also be available. As a reminder, SHVS recently published an issue brief, Strategies for States to Drive Equitable Vaccine Distribution and Administration, which highlights state opportunities to build a sustainable public health infrastructure and capacity to advance health equity.
  • California
    • Governor Gavin Newsom signed a suite of bills to help address the homelessness crisis and enhance California’s response to people suffering from mental health issues on the streets. The package of bills increases coordination and accountability of the state’s homelessness spending and bolsters the California Interagency Council on Homelessness’ powers through new data mandates and oversight authorities. Further linking housing with health care, the legislation names California’s Health and Human Services Secretary and Housing Agency Secretary as Co-Chairs of the Council. The package also includes legislation that implements new data mandates under the state’s Homeless Management Information System, allowing policymakers to better track and evaluate the effectiveness of homelessness funding around the state.
    • The California Department of Public Health issued a public health order requiring COVID-19 vaccinations for workers in adult and senior care facilities and those employed in in-home direct care settings. Workers covered by this order must have their first dose of a one-dose regimen or their second dose of a two-dose regimen by November 30, 2021.
  • Kansas – To bolster local organizations supporting health equity in communities across Kansas, Governor Laura Kelly announced the “Increase the Reach” Grant Initiative. The program specifically aims to reach groups that have been socially marginalized and those experiencing low vaccination rates, including both racial and ethnic minority populations as well as rural communities, and empower community organizations promoting equitable access to the COVID-19 vaccine for all Kansans. The grants will enable these organizations to expand access to vaccines and increase vaccine uptake among those who are unvaccinated.
  • Minnesota – Governor Tim Walz announced an allocation of $15 million in federal American Rescue Plan funds to help emergency shelters serving vulnerable Minnesotans improve COVID-19 mitigation measures. The funding will support the state’s Emergency Services Program grants, which are awarded to organizations that provide emergency shelter and essential services for people who are homeless. The funds will be competitively awarded, prioritizing investments that acquire or modify shelter spaces to improve prevention of COVID-19 transmission or outbreaks.
  • Missouri – The Missouri Department of Social Services began processing adult expansion benefit applications. Missouri voters approved expansion of eligibility in Missouri’s Medicaid program (MO HealthNet) in a 2020 amendment to the state constitution. After legal challenges, the Supreme Court of Missouri held the expansion amendment to be constitutional.
  • New Jersey
    • Governor Phil Murphy signed into law a comprehensive legislation package aimed at combating food insecurity. The six bills will commit to addressing hunger by expanding access to the New Jersey Supplemental Nutrition Assistance Program (SNAP) and its benefits, bolstering school meal programs, and establishing the Office of the Food Insecurity Advocate. Additionally, the Governor also signed legislation which directs the New Jersey Department of Labor and Workforce Development to include information on SNAP on any materials pertaining to unemployment compensation benefits. 
    • Governor Phil Murphy and members of his administration announced a new web tool designed to link parents, youth, and educators with resources and supports to address youth mental health challenges exacerbated by the ongoing pandemic. The webpage, which is accessible through the state’s COVID-19 web portal or by going directly to covid19.nj.gov/youthhelp, is intended to act as a one-stop web resource for programs, services, and supports that specifically address youth behavioral or emotional health concerns. The site​ will ​continually be improved and updated to provide youth, families, and educators with tools to empower themselves to support their own mental health and demystify and destigmatize the need to ask for help. 
  • New York – New York State of Health, the state-based marketplace, posted a training for assister agency supervisors. The goal of this training is to provide a broad overview of the responsibilities of a primary contact or supervisor of an assister agency and provide resources for managing groups of assisters.
  • North Carolina – Beginning October 4, the North Carolina Department of Health and Human Services’ (NCDHHS) COVID-19 Support Services Program, along with the Food Bank of Central & Eastern North Carolina will provide food assistance to North Carolinians in 34 counties who face food insecurity resulting from the need to isolate or quarantine due to COVID-19. Additionally, NCDHHS is expanding program eligibility to North Carolinians in those counties who are at high risk for severe illness due to COVID-19.
  • Pennsylvania – Department of Community and Economic Development Secretary Dennis Davin and Acting Health Secretary Alison Beam announced a new $5 million grant program to help grassroots organizations with encouraging vaccine-hesitant populations to get the COVID-19 vaccine. This program will provide funding to community organizations to educate their community regarding COVID-19 vaccination to address hesitancy concerns and barriers and to provide direction on where and how to schedule a vaccine appointment. Additionally, Pennsylvania Department of Health Acting Physician General Dr. Denise Johnson also addressed vaccine hesitancy among Latino(a) communities and encouraged unvaccinated people to get a COVID-19 vaccine during a visit to the Pennsylvania Latino Convention. 
  • Texas – The Texas Health and Human Services Commission is awarding more than $531,000 in grants to four rural Texas hospitals to expand telehealth services for children. The grants will help the hospitals expand or implement telehealth services that connect their patients with pediatric specialists and subspecialists through video chats and phone calls.
  • West Virginia – The West Virginia Department of Health and Human Resources’  Office of Drug Control Policy and Bureau for Social Services launched the Sobriety Treatment and Recovery Teams (START) pilot program. START aims to help parents achieve recovery from substance use disorder and keep children in their home when safe or to reunify the family when safety factors have been remediated. The target population for the child welfare-based intervention is families with children ages zero to five with child protective services involvement due to substance use. The program includes intense and coordinated service delivery between child welfare and SUD/mental health treatment providers.
  • Kentucky, Maine and New Mexico – These states were all granted approval by CMS to establish a state-based exchange. All three states will operate as full state-based exchanges during this year’s open enrollment period.   
  • Alaska, Illinois, Iowa, Kentucky, Nebraska, and Pennsylvania — The Center for Health Care Strategies announced that the Medicaid directors from these states have been competitively selected to participate as fellows in the 11th class of the Medicaid Leadership Institute. Funded by the Robert Wood Johnson Foundation, the program offers an opportunity for Medicaid directors and their key staff to enhance the skills and expertise necessary to successfully lead their Medicaid programs, impact key health outcomes, and advance health equity.


Upcoming SHVS Webinar – Save the Date!

State Strategies to Support Afghan Refugees in Accessing Health Coverage

Wednesday, October 6 from 4:00 to 5:00 p.m. ET

Tens of thousands of Afghans who fled the Taliban last month are awaiting resettlement, with many having already arrived in the U.S. living on military bases and being processed in Indiana, Maryland, New Jersey, New Mexico, Pennsylvania, Texas, Virginia, and Wisconsin. Other states are preparing to accept evacuees who will eventually be resettled in their communities. Refugees are in need of access to medical care, as measles and other infections spread and newcomers grapple with the trauma associated with fleeing their home country. States are evaluating the tools available to them to ensure their new residents have access to health coverage as they settle in the U.S. SHVS is hosting a webinar during which experts from Manatt Health will provide an overview of eligibility standards for refugees and strategies that states can deploy to expeditiously enroll people into health coverage in order to access care. Presenters will also review new CMS guidance released on September 27, 2021 to help states understand what health coverage options are available to Afghan evacuees. The webinar will include a question and answer session during which webinar participants can pose their questions to the experts on the line. Registration (required) at the following link: https://rwjfevents.webex.com/rwjfevents/onstage/g.php?MTID=ecbaca38bcdbba59ffa65db19d0e33af9


Enforcement of Surprise Balance Billing Protections Under the No Surprises Act

The No Surprises Act (NSA) will protect patients from out-of-network surprise medical bills (also known as balance bills or surprise out-of-network bills). These bills arise when a consumer inadvertently or unknowingly receives care from a provider or at a facility that is not within their insurance plan’s network. The NSA’s protections go into effect beginning on January 1, 2022. Georgetown’s Center on Health Insurance Reforms published a resource that summarizes the NSA’s enforcement framework, potential state approaches to enforcement of existing state-level surprise bill protections, and key enforcement considerations for state policymakers. As a reminder, SHVS also recently published an expert perspective, The No Surprises Act Proposed Rule on Air Ambulances and Enforcement: Implications for States, authored by experts from Georgetown’s CHIR.


NAMD Report on Long-Term Services and Supports

A new report, Medicaid Forward: Long-term Services and Supports, from the National Association of Medicaid Directors (NAMD), describes the stark realities facing the long-term care system, and opportunities for state Medicaid leaders and their federal partners to respond. NAMD’s report, the third part in their three-part Medicaid Forward series, elevates strategies that states–-in partnership with the federal government—can take to strengthen long-term care and better ensure the safety, independence, and choice for people who rely on these critical supports. It focuses on four immediate opportunities for action: (1) Supporting and strengthening the workforce in nursing homes and home- and community-based services, (2) supporting individuals’ natural supports, like family and friends, (3) greater use of telehealth and assistive technology, and (4) refocusing the system on person-centered outcomes and quality improvement.


Funding Opportunity: Leveraging COVID-19 Relief Funding to Advance Sustainable Data-Sharing Policies

To build new opportunities for more sustainable efforts by local or state governments in collaboration with community partnerships, with support from the Robert Wood Johnson Foundation, Data Across Sectors for Health (DASH), in partnership with the Center for Health Care Strategies (CHCS), is awarding $80,000 each to five awardees over 7 months as part of its Learning and Action in Policy and Partnerships (LAPP) program.  Through LAPP, DASH aims to maximize the potential of local and state governments to direct pandemic relief funds to projects invested in shared data infrastructure across health care, social services, and public health with a central focus on equity, meeting communities’ self-determined needs, and supporting systems change for community health and well-being. Access the LAPP brochure to view the application requirements and deadlines and listen to the LAPP Informational Webinar (pre-recorded) for answers to preliminary questions. Applications for this program must be submitted via the RWJF online system by the application deadline of November 12, 2021, at 3:30 PM EST.