September 12 Update

In This Week’s Update:

  • Public Charge Rule and Preventive Services Decision
  • Protecting Coverage for Postpartum Individuals
  • Requesting an Extension of Nurse Aide Training
  • Aligning in Crisis: Strategies & Tools to Leverage Federal Funding
  • State Updates: DE, IN, ME, MN, NC, NJ, NY, OK, TN & WV

Public Charge Rule and Preventive Services Decision

Last week, the Department of Homeland Security (DHS) issued a final rule on the “Public Charge Ground of Inadmissibility.” Consistent with the proposed rule, the final rule largely reinstates the approach to “public charge” determinations that DHS previously applied. As stated in the Health and Human Services announcement, “DHS will not penalize individuals who choose to access the vast majority of health-related benefits and other supplemental government services available to them, including most Medicaid benefits (except for long-term institutionalization—such as residing in nursing home—at government expense) and the Children’s Health Insurance Program (CHIP).” SHVS is in the process of developing resources to help drive enrollment specific to immigrant populations in light of the chilling effect public charge has had on health coverage enrollment.

Also last week, a federal district court judge in Texas issued a ruling in a lawsuit that seeks to strike down the ACA’s requirement that health plans cover and waive cost-sharing for preventive services. SHVS published an expert perspective that examines the potential implications of the ruling for the ACA and the opportunities available to states to mitigate the impact on consumers. Updates follow. 


Protecting Coverage for Postpartum Individuals

For more than two years, states have maintained coverage of their Medicaid enrollees as a condition of receiving enhanced federal Medicaid funding under the Families First Coronavirus Response Act, resulting in considerable increases in coverage for all Americans, including pregnant and postpartum individuals. When the federal Medicaid continuous coverage requirement expires, states will redetermine eligibility for nearly all Medicaid enrollees, including roughly 1.7 million people enrolled in a Medicaid or CHIP pregnancy eligibility group. This new issue brief reviews proactive strategies that states can deploy to support postpartum individuals in maintaining health coverage and access to care when the Medicaid continuous coverage guarantee ends and beyond.


Requesting an Extension of Nurse Aide Training

CMS has again revisited its emergency policies on nurse aides, who are generally required to complete 75 hours of training and pass a Nurse Aide Competency Program within four months of employment with a skilled nursing facility. CMS waived this requirement early in the COVID‑19 PHE. In April guidance, citing safety concerns, the agency announced it would phase out this and other waivers related to long-term care, giving nursing homes until October 7 to come into compliance with the training standard unless they could demonstrate that demand for nurse aide training courses exceeded capacity. Following pushback from industry stakeholders who cited persistent staffing shortages, CMS last week released updated guidance clarifying the parameters for requesting a waiver extension based on insufficient training capacity. Notably, CMS outlined application processes and documentation requirements for waiver requests at the facility, county, or state level. CMS will limit any such waiver extensions to “a timeframe that is as short as possible,” and in no event will any such waiver extend past the end of the PHE. This revised process indicates that, in some circumstances, CMS is willing to reconsider the timeline for phasing out pandemic flexibilities, particularly in light of stakeholder concerns about the infeasibility of returning to pre-pandemic requirements on a specific timeline.  


Aligning in Crisis: Strategies & Tools to Leverage Federal Funding

Local and state governments, community foundations, and other stakeholders have the opportunity to leverage millions in federal funds to develop cross-sector plans that advance equity, shift power to local communities, and set the stage for positive, long-term change. A new webinar hosted by Aligning in Crisis, with support from the Robert Wood Johnson Foundation, will discuss ongoing and new funding opportunities, including a recent $3.9 billion CDC Notice of Funding Opportunity and the second disbursement of American Rescue Plan Act discretionary funds; principles and strategies to guide planning efforts, including the need for cross-sector, community-led collaboration and support from intermediary organizations; and related resources, including a new dashboard that centralizes funding opportunities from legislation, federal department websites,, and other sources. The webinar will take place this Wednesday, September 14.


State Updates

  • Delaware – Governor John Carney signed a bill to support doctors who get mental health treatment. The bill updates the mandatory reporting requirements for Delaware physicians with anxiety, depression, and other mental health challenges to ensure that physicians are able to seek treatment without undue stigma or fear of loss of medical licensure.
  • Maine – Governor Janet Mills announced a new $1.9 million initiative to expand treatment of substance use disorder (SUD) in rural Maine. The funding can be used by behavioral health providers to invest in start-up costs, such as staff training and development, that will allow them to increase the number of patients they serve in rural areas of the state. The new rural SUD expansion grants are federally-funded and offered by the Maine Department of Health and Human Services’ Office of Behavioral Health.
  • Minnesota – The Minnesota Department of Health Services announced that approximately 90,000 Minnesotans will continue to save money on MinnesotaCare (basic health program) premiums through the end of 2025, thanks to the federal Inflation Reduction Act signed last month by President Biden. Until January 2026, people with incomes under 160% of the federal poverty level will not have to pay premiums for MinnesotaCare, and people whose incomes fall between 160% and 200% of the federal poverty level will pay reduced premiums.
  • New Jersey – Governor Phil Murphy announced the creation of an online portal and advisory council to receive input from stakeholders and other members of the public on the use of opioid settlement funds. Executive Order No. 305 establishes an Opioid Recovery and Remediation Advisory Council chaired by Human Services Commissioner Sarah Adelman and comprising relevant stakeholders who will make recommendations regarding the prioritization and effective use of these funds. The online portal will give any member of the public the opportunity to weigh in on how these funds should be used to help those most impacted by the opioid crisis.
  • New York – The New York State Department of Health submitted an application requesting $13.52 billion over five years to fund a new amendment to its 1115 Demonstration waiver that addresses the health disparities and systemic healthcare delivery issues that have been both highlighted and intensified by the COVID-19 pandemic.
  • North Carolina – The North Carolina Department of Health and Human Services announced a Connection to Care Peer Services grant award for peer support services in emergency departments. Because of their shared experience with behavioral health struggles, peers are better able to connect with people in times of crisis and better help people become and stay engaged in the recovery process. The pilot project aims to provide improved coordination of ongoing treatment and recovery and to reduce future utilization of emergency department services for behavioral health needs.
  • Oklahoma – The Oklahoma Health Care Authority (OHCA) released a request for proposals for two dental benefit managers to deliver Medicaid managed care dental services to Medicaid populations including SoonerCare children, pregnant women, and the expansion population. OHCA is requesting proposals to coordinate and deliver Medicaid dental services to the specified Medicaid populations while demonstrating improved dental health outcomes, increased access to care, and increased accountability in SoonerCare, the state’s Medicaid program.
  • Tennessee – The state submitted an amendment to its TennCare III demonstration to CMS proposing changes to the demonstration’s current special terms and conditions. The request includes, among other revisions, changes to the financing of the demonstration, moving from an aggregate cap to a per member per month cap, and revising the framework for reinvestment of demonstration savings.
  • Indiana & West Virginia – The U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services, approved the extension of Medicaid and Children’s Health Insurance Program (CHIP) coverage for 12 months after pregnancy in Indiana and West Virginia. As a result, up to an additional 15,000 people annually—including 12,000 in Indiana and 3,000 in West Virginia—will now be eligible for Medicaid or CHIP for a full year after pregnancy. With today’s approval, in combination with previously approved state extensions, an estimated 333,000 Americans annually in 23 states and D.C. are eligible for 12 months of postpartum coverage. As a reminder, SHVS published an issue brief on the American Rescue Plan’s Act option to extend postpartum coverage.