September 11 Update

In Last Week’s Update:

  • CMS All-Hands-On-Deck Strategy to Support Children and Families
  • CMS Announces Model to Redesign Healthcare Delivery and Improve Equitable Access
  • Protecting Consumers from Medical Debt
  • State updates: AZ, CA, CO, GA, IL, MO, NC, NJ, NM, NY, OK, OR, PA, TN, VA, WI & WV


CMS All-Hands-On-Deck Strategy to Support Children and Families

CMS posted on the Unwinding and Returning to Regular Operations after COVID-19 landing page a new “all-hands-on-deck” resource outlining strategies that stakeholders can employ to support coverage continuity and care for children and families as states unwind the federal Medicaid continuous coverage requirement. The PowerPoint presentation highlights strategies that states may consider for children if not already in place, such as using available Medicaid and CHIP data to streamline transitions for children moving between programs, and adopting available federal flexibilities (e.g., Targeted SNAP Strategy, Express Lane Eligibility). It also underscores the need to protect groups of children experiencing disproportionate impact—like those under age three (going through the renewal process for the first time), with special health needs, and in immigrant or mixed-status families. CMS encourages states to partner with schools, local education agencies, and community-based organizations to engage directly with families to support the redetermination process. With this resource and CMS’ August 30 State Medicaid Director Letter, CMS seeks to mitigate coverage loss during unwinding and beyond for children and other individuals who continue to be eligible but are at risk of being inappropriately disenrolled. For more information on CMS’ new guidance, see the new summary, CMS Guidance on Conducting Eligibility Redeterminations at the Individual Level.


CMS Announces Model to Redesign Healthcare Delivery and Improve Equitable Access

CMS also unveiled a transformative step to test a state’s ability to improve the overall healthcare management of its state population. The States Advancing All-Payer Health Equity Approaches and Development Model (“AHEAD Model”) aims to better address chronic disease, behavioral health and other medical conditions. Under the AHEAD Model, participating states will be better equipped to promote health equity, increase access to primary care services, set healthcare expenditures on a more sustainable trajectory and lower healthcare costs for patients. The AHEAD Model represents the next iteration of the CMS Innovation Center’s multi-payer total cost of care models. States participating in AHEAD will be accountable for quality and population health outcomes, while reducing all-payer avoidable healthcare spending to spur statewide and regional healthcare transformation. More information about the AHEAD Model and the application process is available here.


Protecting Consumers from Medical Debt

Nearly 40% of U.S. adults are burdened by medical debt incurred from healthcare costs they are unable to pay off. Disproportionately affecting women, people of color, and families with low income, medical debt disrupts lives and leads many to forgo needed care. In a new report from the Commonwealth Fund, researchers from Georgetown University examine the laws and regulations designed to protect patients from medical debt. Many states have acted to fill gaps in what are generally lax—and often unenforced—federal standards. But researchers say additional steps are needed, including measures to improve patients’ access to financial assistance, ensure that nonprofit hospitals earn their tax exemptions, and protect people against aggressive billing and collections practices. The report is paired with an interactive 50-state map of protections against medical debt.

State updates: AZ, CA, CO, GA, IL, MO, NC, NJ, NM, NY, OK, OR, PA, TN, VA, WI & WV

  • Arizona – The Arizona Health Care Cost Containment System (AHCCCS) has incorporated community feedback into its request for federal approval to extend Medicaid reimbursement to parents who provide caregiver services to their minor children with disabilities. Based on public comments and feedback from parents, AHCCCS has added habilitation services to its 1115 demonstration waiver request, which it will submit to CMS in September.
  • California – Covered California, the state’s official health insurance Marketplace, is piloting an outbound call campaign during the unwinding to individuals no longer eligible for Medicaid who have received an automatic plan selection. The campaign launched in late August and will target consumers who have been enrolled in a $0 premium plan with an August 1 start date. Service center representatives will offer assistance with understanding coverage eligibility, opting into coverage and plan choice. The effectiveness of the outbound call campaign will be evaluated on effectuation rates.
  • Colorado
    • The Department of Health and Human Services and the U.S. Department of Treasury announced that the Colorado Division of Insurance will receive $245 million in pass-through funding for its health insurance programs for 2023. This amount includes funds for the Colorado Reinsurance Program, and for the first time, the Colorado Option Program. The funds will go into the Reinsurance Program to continue to lower premiums, as well as provide direct subsidies to lower out-of-pocket costs for eligible Connect for Health Colorado consumers and support the OmniSalud program.
    • The Polis administration in partnership with the Behavioral Health Administration and the Department of Health Care Policy & Financing is expanding existing mobile crisis response and covering a new service, behavioral health secure transportation. Coloradans experiencing a mental health or substance-use crisis will now have expanded access to highly-trained crisis response teams in their communities, and can receive a safe ride to receive behavioral health treatment if needed.
  • Georgia – The Georgia Department of Community Health announced that CHIP premiums will remain suspended through December 31 as renewals are completed.
  • Illinois – Governor Pritzker signed legislation codifying protections for preventive care services that are required under the ACA and include reproductive healthcare services. The law protects Illinoisans’ coverage for many preventive services, such as routine immunizations, vision screenings, some cancer and chronic disease screenings and various mental health services.
  • Missouri – The MO HealthNet Division (MHD) and the state’s managed care health plans are collaborating on a project to educate and inform providers and Medicaid members on benefits and opportunities available to them during and after their pregnancy. MHD released a Maternal and Infant Health Engagement Survey to collect data to improve policies, payment methodologies, and outcomes for pregnant and postpartum individuals and infants.
  • New Jersey
    • Governor Phil Murphy announced his nomination of Justin Zimmerman as Commissioner of the New Jersey Department of Banking and Insurance. As Commissioner, he will lead the department in regulating the banking, insurance and real estate industries as well as operating Get Covered New Jersey, the state’s official health insurance Marketplace. Zimmerman currently serves as Acting Commissioner and will continue to serve in his role pending confirmation by the Senate. Congratulations Justin!
    • Governor Phil Murphy signed a bill requiring school districts to provide menstrual products free of charge in every public school teaching students in one or more of grades six through twelve. Applicable schools will be required to provide menstrual products in at least half of all their female and gender-neutral bathrooms. Any costs incurred by a school district in supplying menstrual products to meet the needs of its students will be borne by the state.
  • New Mexico – BeWellnm, the state’s official health insurance Marketplace, and the New Mexico Office of the Superintendent of Insurance released the state’s Annual Insurance Marketplace Report for 2023. The report offers a comprehensive analysis of individual health insurance market on- and off-Exchange enrollment, small business enrollment, qualified health plan pricing, outreach and enrollment assistance activities, as well as strategies aimed at addressing the challenge of the remaining uninsured population in New Mexico.
  • New York
    • The New York State Department of Financial Services (DFS) approved health insurers’ premium rate increases for 2024, saving consumers and small businesses almost $732 million. In the individual market, DFS reduced insurers’ requested rates by 44%. In the small group market, DFS reduced insurers’ requested rates 52%. In light of the continued increases in costs in healthcare and other consumer goods and services, DFS held insurers’ profit provisions to only 1%.
    • The New York State Department of Health announced several key initiatives aimed at improving maternal and newborn health. Enacted as part of the 2023-24 budget, the state is committing to multiple Medicaid investments that will expand access to prenatal and postnatal care and support better birth outcomes. These include doula coverage, midwifery services, and community health worker coverage.
  • North Carolina – The North Carolina Department of Health and Human Services published a policy evaluation brief and companion chart pack highlighting North Carolina’s approach to telehealth policymaking, both in response to the COVID-19 pandemic and thereafter, to serve as a model to other states undertaking telehealth policymaking and evaluation. The brief includes an overview of the state’s evolution in telehealth policy; the state’s decision-making criteria used to determine temporary and permanent telehealth policy changes; telehealth utilization between March 2020 and December 2022; and considerations for other states.
  • Oklahoma – The Oklahoma Health Care Authority is seeking public input on its proposed rule to implement 12-months continuous eligibility for children on Medicaid and CHIP, effective January 1, 2024, in compliance with the Consolidated Appropriations Act of 2023. 
  • Oregon
    • Oregon Health Authority, in collaboration with Oregon Housing and Community Services, announced proposed timelines to begin offering new Medicaid benefits that eligible members would receive under Oregon’s 1115 Medicaid waiver. If the federal government agrees to the proposal, eligible members would start receiving benefits for climate-related supports in January 2024, housing insecurity in November 2024, and food insecurity in January 2025.
    • The Oregon Division of Financial Regulation finalized the rate decisions for 2024 health insurance for the individual and small group markets. The division issued final decisions with an overall weighted average increase of 6.2% in the individual market and 8.1% for the small group market.
  • Pennsylvania – Pennie, the state’s official health insurance Marketplace, released the state’s inaugural Health Equity Data Report. The report details the impact of policies and procedures created to help reduce inequities experienced by historically marginalized communities, establishes a baseline upon which to measure future efforts to reduce inequities in enrollment, and provides a view into the uninsured rates among different communities to help identify where additional efforts are needed.
  • Tennessee – TennCare, the state of Tennessee’s Medicaid program, announced the implementation of enhanced breastfeeding supports for members. Key features of the new lactation benefits program include lactation consultants, breast pump coverage, and lactation supplies.
  • Virginia – The Department of Medical Assistance Services recently released its 2022 Baby Steps Annual Report that highlights its accomplishments towards improving maternal health outcomes for pregnant and postpartum enrollees.
  • West Virginia – CMS approved a community-based mobile crisis state plan amendment that allows West Virginia to create mobile crisis intervention teams to provide Medicaid crisis services. West Virginia will be able to provide these services by connecting eligible individuals in crisis to a behavioral health provider 24 hours per day, 365 days per year. As a reminder, SHVS published an expert perspective on the enhanced payment available through the ARP for community-based mobile crisis services.
  • Wisconsin – The Wisconsin Department of Health Services announced that grants have been awarded to 15 county, municipal, nonprofit, and tribal nation agencies to make life-saving resources more available in communities with a high need through vending machines in public places stocked with free fentanyl test strips and NARCAN, a medication that can reverse an opioid overdose.