Ex Parte at the Individual Level

Last week, CMS published a table that presents preliminary state-reported information about the ability of states’ systems to conduct automatic renewals, otherwise known as ex parte renewals, at the individual level. As of September 21, 23 states and territories attested to correctly conducting ex parte renewals at the individual level, while 30 states and territories indicated they are not doing so or are still working to reinstate affected individuals. In a press release CMS announced that all 30 states and territories are required to pause procedural disenrollments for impacted people unless they can ensure all eligible people are not improperly disenrolled as a result of the systems issue. As a reminder, states can use the State Health and Value Strategies’ (SHVS) diagnostic assessment tool to assess whether they are conducting ex parte and other renewal processes at the individual level in accordance with federal regulatory requirements.

 

State Strategies to Preserve Coverage

States are diligently working to operationalize the unwinding, and are tracking the creative strategies to minimize coverage losses. To highlight all the hard work states are engaged in and spotlight innovative strategies other states may want to consider adopting, SHVS published a new expert perspective States of Unwinding: How State Officials are Innovating to Support Coverage. SHVS will continue to track and share state efforts to support coverage through the unwinding period. If your state is implementing a new effort to reach enrollees, or if you have questions about how you can implement an example included in the new EP, please be in touch. Updates follow.

 

New Mothers’ Coverage Improved during the Public Health Emergency

The Urban Institute released an issue brief examining coverage changes among new mothers between 2019 and 2021 using American Community Survey data. In March 2020, as part of the Families First Coronavirus Response Act, Congress established a continuous coverage requirement mandating states not disenroll people from Medicaid, including those with pregnancy-related coverage who reached the 60-day postpartum limit. Understanding coverage changes during this period—including for different subgroups of new mothers and across states—is important for assessing how new mothers fared during the public health emergency. The report’s findings suggest a link between the continuous coverage requirement and reductions in uninsurance for new mothers, and subsequently, highlight the need for careful unwinding of pandemic protections, as well as effective implementation of new postpartum extensions and wider adoption of both postpartum extensions and broader Medicaid expansions.

 

Differences in Language Access Across State-Based Marketplaces

Federal regulations require the ACA health insurance Marketplaces to provide free and timely language access services to people with limited English proficiency (LEP). But in analyzing data collection and language services across the 21 State-Based Marketplaces (SBMs) researchers from Georgetown University found that availability and quality of services they offer vary greatly. In an issue brief from The Commonwealth Fund, the authors describe how fewer than half of the SBMs have Marketplace-specific written language access plans, language data collection isn’t standardized across states, the availability of multilingual support is limited and access to written translations varies substantially, as does their quality. The report recommends the implementation of federal policies to update and standardize language access requirements to reduce variation across SBMs and benefit individuals with LEP.

 

Financing Substance-Use Care Treatment and Support Services

A new report developed by the Center for Health Care Strategies with support from The Pew Charitable Trusts outlines 10 principles to guide states in maximizing the use of Medicaid and other funding sources—including federal grants and opioid settlement dollars—to strengthen access to evidence-based substance-use disorder (SUD) services. The report is informed by a national set of stakeholders, including research and policy experts, healthcare providers, state officials, and people with lived experience accessing SUD treatment. The report outlines tangible opportunities to invest in SUD services, including a review of barriers, opportunities for adoption, state examples, and potential policy actions. A companion Principles-in-Action series provides practical checklists to guide state investments in evidence-based SUD services, including peer supports, medications for opioid-use disorder, and harm reduction services. The findings can inform policymakers across the country looking to strengthen evidence-based SUD treatment services in strategic, sustainable and equitable ways.

 

State Updates: CA, CT, DE, MI, NC, ND, NJ, NM, NV, RI & VT

• California – The California Department of Public Health (CDPH) is awarding $16.3 million in grants to tribal entities and community-based organizations to support the state’s Youth Suicide Prevention Media and Outreach Campaign. Additionally, as Californians continue to return to school, CDPH is announcing two new resource hubs for youth, families, caregivers, teachers and schools: the Youth Suicide Prevention Hub and the Back-to-School Mental Health Hub.
• Michigan
  • The Michigan Department of Health and Human Services (MDHHS) is extending the renewal of enrollees undergoing life-saving treatment through May 2024 to ensure these enrollees can keep their healthcare coverage and complete their treatment. The extension for those receiving life-saving treatment applies to enrollees undergoing chemotherapy, radiation, immunotherapy infusions or dialysis who are not able to be renewed through ex parte and do not have other comprehensive health insurance coverage, like Medicare.
  • MDHHS is expanding access to mobile response teams to address crisis situations for young people. Five Community Mental Health Services Programs are receiving more than $900,000 in grants through the mobile response grant program.
• Nevada – The Department of Health and Human Services announced that it reinstated coverage for Nevadans who recently had their coverage end because they did not return their renewal documentation. Due to a change in federal direction on policy in August, the Division of Welfare and Supportive Services (DWSS) was able to reinstate coverage for approximately 114,000 individuals. Individuals whose Medicaid coverage was reinstated last week will receive a notice in the mail from DWSS.
• New Jersey – The New Jersey Department of Banking and Insurance announced the adoption of rules to require comprehensive abortion coverage as part of all health benefit plans regulated by the department. This requirement, which was in place of January 1, 2023 in the individual and small employer health insurance markets, will now be in effect for the fully-insured large employer health insurance market upon plan issuance or renewal.
• New Mexico – The New Mexico Human Services Department announced that the state is proposing to supplement and enhance the Medicaid Turquoise Care Section 1115 renewal application, including continuing to provide personal care services provided by family caregivers to individuals under the Early and Periodic Screening, Diagnostic, and Treatment benefit.
• North Carolina – The North Carolina Legislature approved the state budget for fiscal year 2024 which includes funding for the expansion of Medicaid. In a statement issued following passage of the bill, Governor Cooper highlighted how Medicaid expansion will provide health insurance for 600,000 more North Carolinians.
• North Dakota – The state is seeking public comments on the renewal of its’ Medicaid 1915(c) individuals with intellectual disabilities/developmental disability home and community-based services waiver application. The state is proposing changes to the waiver, including increasing capacity by 150 slots per year and allowing emergency slots to be used for a transition from any institutional setting, in addition to other changes.
• Rhode Island – The Office of the Health Insurance Commissioner (OHIC) for the state of Rhode Island approved the commercial health insurance premiums for 2024. Overall, the OHIC approved weighted average rate changes are 5.9% for the individual market, 3.9% for the small group market and 8.5% for the large group market.
• Vermont – The Vermont Department of Health Access released a request for proposals for organizations to provide business supports to home and community-based services (HCBS) providers through the state’s Medicaid Data Aggregation & Access Program (MDAAP). MDAAP provides incentives to encourage HCBS providers to implement electronic medical records. Proposals are due on October 20, with contracts expected to begin December 1, 2023. 
• Connecticut & Delaware – SHVS published an update of our expert perspective State Reporting to Monitor the Unwinding of the Medicaid Continuous Coverage Requirement to include Connecticut and Delaware as both states are now releasing unwinding data. As a reminder, SHVS is also tracking State-Based Marketplaces that are publicly reporting data on coverage transitions during the unwinding.