Summary of Eligibility and Enrollment Proposed Rule
Last week, State Health and Value Strategies published an expert perspective that provides an overview of the eligibility and enrollment proposed rule released by CMS on August 31. The expert perspective details how the proposed rule seeks to strengthen existing eligibility, enrollment, and renewal operational processes in an effort to close gaps in coverage and extend best practices identified by CMS and states in the course of preparing for unwinding the federal public health emergency (PHE). Comments on the proposed rule are due no later than November 7, 2022.
Also last week, SHVS published an expert perspective detailing the final rule on public charge released by the Department of Homeland Security last week. For more information about the public charge rule, see the issue brief SHVS published on the proposed rule. Updates follow.
Advancing Oral Health Equity for Medicaid Populations
Substantial oral health-related disparities exist across the United States based on race, ethnicity, geography, income, and insurance status, among others. Medicaid—given its size and diversity of enrollees—has significant opportunities to eliminate systemic inequities in oral health access, reduce long-standing disparities, and advance oral health equity. There is limited information, however, on state efforts to improve oral health equity among Medicaid-enrolled populations. A new brief from the Center for Health Care Strategies describes common barriers for addressing oral health equity for Medicaid populations and outlines recommendations to improve oral health access and quality within four key areas: (1) coverage and access; (2) workforce capacity building; (3) partnerships; and (4) payment. The brief highlights opportunities for Medicaid to partner with community-based organizations and Medicaid enrollees to reduce oral health disparities and advance oral health equity.
Analysis of Recent National Trends in Medicaid and CHIP Enrollment
A recent Kaiser Family Foundation analysis examines national and state-by-state Medicaid and CHIP enrollment data through May 2022. Preliminary data for May 2022 show that total Medicaid/CHIP enrollment grew to 89 million, an increase of 17.7 million from enrollment in February 2020 (24.9%), right before the pandemic. Virtually all growth was concentrated in Medicaid, which grew by 27% (17.4 million enrollees) from February 2020 to May 2022. Increases in enrollment may reflect changes in the economy, changes in policy (like recent adoption of the Medicaid expansion in the Affordable Care Act), and the temporary continuous enrollment requirement created by the Families First Coronavirus Response Act. How states manage the large volume of redeterminations during the “unwinding” of the continuous enrollment requirement, as well as how states engage with enrollees and other stakeholders, will impact the continuity of coverage for millions of Medicaid enrollees. As a reminder, SHVS has a one-stop resource page to support states as they plan for unwinding the PHE.
State-Level Trends in Employer-Sponsored Health Insurance
A recent report by the State Health Access Data Assistance Center shows that employer-sponsored health insurance (ESI) remains the largest single source of coverage for most Americans, even during the pandemic as more Americans enrolled in public coverage and fewer in private. Estimates from the Medical Expenditure Panel Survey-Insurance Component, recently produced by the Agency for Healthcare Research and Quality, were used to consider how trends in ESI coverage, access, and cost have evolved over the course of a pre-pandemic baseline (2019) through the first year of the pandemic (2020) and through lifted pandemic-related restrictions (2021). The report also includes 50-state data tables to allow for cross-state and national comparisons of ESI trends from 2017-2021.
State updates: CA, KS, KY, MI, NM, NY, OK, OR & WV
- California – Governor Gavin Newsom signed the Community Assistance, Recovery, and Empowerment Act to enact CARE Court, a framework which will provide more upstream care to individuals with severe mental health and substance use disorders. This will allow families, clinicians, and first responders to make psychiatric referrals ahead of conservatorships and outside the walls of institutions. The law is bolstered by the state’s $15.3 billion in funding to tackle homelessness and $11.6 billion annually in mental health services.
- Kansas – Governor Laura Kelly announced that Kansas has received $9 million in funding from the U.S. Substance Abuse and Mental Health Services Administration to address the behavioral health needs of nearly 40,000 students in the southeast part of the state. The funding will be spread out over five years, and will integrate school-based community health workers into the behavioral health support system for students and families in need.
- Kentucky – Governor Andy Beshear announced the Program of All-Inclusive Care for the Elderly, or PACE, in Kentucky. The program is designed to provide quality, cost-effective, long-term care for people age 55 and older. At present, two providers—Bluegrass Care Navigators and Horizon PACE—have been certified through Kentucky’s PACE program, and the program is seeking more providers to expand the PACE service area.
- Michigan – The Michigan Department of Health and Human Services (MDHHS) issued a call for proposals for the newly created MI Kids Now Mobile Response Grant Program. MDHHS is providing additional funding during fiscal year 2023 to expand Intensive Crisis Stabilization Services for Children. The purpose of the program is to expand access to mobile response teams to address crisis situations for youth who are experiencing emotional symptoms, behaviors or traumatic circumstances that have compromised or impacted their ability to function within their family, living situation, school/child care setting or community.
- New Mexico – The New Mexico Human Services Department (HSD) announced HSD clients now have the option to opt in to receive electronic notices about their benefits. This new tool provides New Mexicans with a single access point to receive and view important notices in their YesNM account. HSD customers are able to opt-in for e-notices by logging in or creating an account at the YesNM portal.
- New York – Governor Kathy Hochul announced $10.25 million in federal funding to bolster harm reduction and expand addiction services for underserved New Yorkers. Administered by the NY State Office of Addiction Services and Supports, $5.75 million is earmarked to support the development of mobile medication units, and $4.5 million is being awarded to help 15 providers establish street outreach units for engaging populations that have difficulty accessing care.
- Oklahoma – A task force created by Oklahoma Governor Kevin Stitt recommended that the state extend Medicaid postpartum coverage to 12 months from 60 days and increase the Medicaid eligibility income limit for pregnant woman to 205% of poverty. The current limit is 138%. Both policy changes will require CMS approval and would extend coverage to 2,500 women in the state.
- Oregon – The U.S. Department of Health and Human Services (HHS), through CMS, approved the Oregon Health Authority’s (OHA) state plan amendment (SPA) to offer Medicaid community-based mobile crisis intervention services for individuals experiencing mental health and substance use crises. This first-in-the-nation SPA was made possible through the American Rescue Plan Act, which became available to states in April 2022. For more on this new option for states to invest in equitable, comprehensive and integrated crisis services, see this SHVS brief.
- West Virginia – Governor Jim Justice and the West Virginia Department of Health and Human Resources (DHHR) announced that due to the critical need for home healthcare workers, DHHR’s Medicaid program will designate additional federal funds to increase rates for Home and Community-Based Service (HCBS) providers. The increase in funding will help recruit and retain the workforce providing HCBS through programs including the Aged and Disabled Waiver, the Intellectual/Developmental Disabilities Waiver, and the Children with Serious Emotional Disorders Waiver. Pending CMS approval, DHHR’s Bureau for Medical Services expects the funds to be available in October 2022.