September 28 Update

In This Week’s Update:

  • Service Use Among Medicaid & CHIP Beneficiaries Age 18 and Under During COVID-19
  • What the Supreme Court Vacancy Could Mean for the ACA
  • COVID-19 State Updates: CA, DC, DE, MD, NY, NC, PA, VA
  • Other State Updates: CO, DE, OK, PA, WA, WI
  • Webinar: Buying Value: Measures that Matter for Quality and Equity
  • Issues to Watch for When Medicaid Maintenance of Eligibility Requirements End
  • Potential Fiscal Impacts of the COVID-19 Pandemic on Medicaid and Early Childhood Services
  • New Subsidized Marketplace Data Available from the 2019 American Community Survey

Service Use Among Medicaid & CHIP Beneficiaries Age 18 and Under During COVID-19

Last week, the Center for Medicare & Medicaid Services released preliminary Medicaid and Children’s Health Insurance Program (CHIP) data revealing that between March and May of this year, rates for vaccinations, primary, and preventive services among children in Medicaid and CHIP declined significantly. Compared to the same time period in 2019, there was a significant drop in critical primary and time-sensitive preventative services for children, including 44 percent fewer (3.2 million) child screening services that assess physical and cognitive development and can provide early detection of autism and developmental delays. State Value and Health Strategies recently published a set of strategies that state Medicaid programs could implement through managed care organizations to support necessary care during COVID-19.

 

What the Supreme Court Vacancy Could Mean for the ACA

Manatt Health has analyzed the implications of the Supreme Court vacancy for the ACA (see the attachment). On November 10, the Supreme Court is scheduled to hear oral arguments in California v. Texas. The Manatt summary reviews the case’s procedural history; answers key questions, including decision scenarios; and outlines potential ramifications should the ACA be struck down. Updates follow.

 

COVID-19 State Updates: CA, DC, DE, MD, NY, NC, PA, VA

  • California – Covered California, the state based exchange, issued a new report Coverage When You Need It: Lessons From Insurance Coverage Transitions in California’s Individual Marketplace Pre- and Post- the COVID-19 Pandemic. The report shows that as of June 2020, 1.53 million people were actively enrolled in Covered California, which represents the highest figure since the marketplace first opened in 2014.
  • District of Columbia – In light of the COVID-19 pandemic, the DC Health Benefit Exchange Authority Executive Board voted to extend DC Health Link’s small business open enrollment policy through calendar year 2022. This action enables small businesses to offer group coverage even if they cannot afford to pay 50 percent of their employees’ premium or they have fewer than two-thirds of eligible employees enrolling.
  • Delaware – Governor John Carney, the Delaware Department of Health and Social Services, and the Delaware Department of Technology and Information announced that COVID Alert DE will be interoperable with Pennsylvania’s exposure notification app, COVID Alert PA, which launched this week.
  • Maryland – Governor Larry Hogan announced that state health officials are conducting a COVID-19 serology testing study for all professional and volunteer firefighters in Maryland. This initiative, currently active in seven jurisdictions, is a key part of the Maryland Department of Health’s ongoing statewide COVID-19 antibody study to determine how many Marylanders have been exposed to COVID-19.
  • New York – Governor Andrew M. Cuomo announced the formation of an independent Clinical Advisory Task Force comprised of leading scientists, doctors, and health experts who will review every COVID-19 vaccine authorized by the federal government and will advise the state on the vaccine’s safety and effectiveness in fighting the virus. In addition, the Governor established a Vaccine Distribution and Implementation Task Force that is charged with designing a COVID-19 vaccination administration program.
  • North Carolina – North Carolina Medicaid enrollees on the NC Innovations Waiver (the state’s approved 1915(c) HCBS wavier) who are attending school virtually due to the COVID-19 public health emergency can now receive waiver support during remote learning. The CMS waiver approval is through an Appendix K, which allows states to submit requests to ease certain waiver requirements during federally declared emergencies. The modification was approved effective August 17, 2020, and will extend through March 13, 2021.
  • Pennsylvania – Governor Tom Wolf and Secretary of the Department of Health Dr. Rachel Levine launched the COVID-19 exposure notification mobile app, COVID Alert PA, to help fight the spread of the virus. The technology, developed by Apple and Google, can detect if a person has been in close contact with another user who later tested positive for COVID-19 and will send a notification to the person’s phone. Since the app launched on Tuesday, there have been more than 70,000 downloads.
  • Virginia – Governor Ralph Northam announced the expansion of the Rent and Mortgage Relief Program (RMRP), which first launched at the end of June with $50 million in federal CARES Act funding to assist households facing eviction or foreclosure due to COVID-19. Landlords can now apply to receive financial assistance for current and past-due rental payments dating back to April 1, 2020 on behalf of their tenants who qualify for RMRP. 

 

Other State Updates: CO, DE, OK, PA, WA, WI

  • Colorado – Governor Jared Polis, Lt. Governor Dianne Primavera and the Colorado Behavioral Health Task Force (BHTF) released a blueprint to reform the state’s behavioral health system. The BHTF engaged with communities to create the blueprint to make substance use and mental health services more accessible and affordable across the state. 
  • Delaware – The Department of Health and Social Services’ Division of Medicaid and Medical Assistance authorized four health care provider groups to serve as Medicaid ACOs. The ACOs are now authorized to negotiate and enter into agreements directly with the state’s two Medicaid MCOs.
  • Oklahoma – The Oklahoma Health Care Authority announced the development of the agency’s first Diversity and Inclusion Council with the goal to create a fear-free culture within the agency. The Council will focus on four specific areas which include: messaging and metrics, attraction and recruitment, inclusion and retention, and community and partnerships.
  • Pennsylvania – This week, Pennsylvania announced Pennie, the new state-based health insurance marketplace for 2021 coverage. Pennsylvanians can begin shopping for health and dental coverage through Pennie at the start of open enrollment on November 1, 2020 through January 15, 2021. Pennsylvanians currently enrolled through HealthCare.gov will be transitioned to Pennie for their 2021 coverage. 
  • Washington – The Washington Health Benefit Exchange Board announced the certified 2021 Qualified Health Plans and Qualified Dental Plans to be offered through Washington Healthplanfinder during the upcoming OEP taking place November 1 through January 15, 2021. This includes certification of new Cascade Care products, the state public option plans, available for the first time on Washington Healthplanfinder. For the first time in several years, there will be two or more carriers in every county in the state.
  • Wisconsin – Insurance Commissioner Mark Afable and Wisconsin Department of Health Services Secretary-designee Andrea Palm joined with multiple stakeholders to send a letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma to call for an extension to the upcoming 2021 HealthCare.gov open enrollment period until the end of January 2021.

 

Webinar: Buying Value: Measures that Matter for Quality and Equity

Monday, September 28, 2020, 3:00 to 4:00 p.m. ET

State Health and Value Strategies is hosting a webinar that will feature technical experts from Bailit Health discussing the Buying Value suite of resources to support state use of performance measures as they assess and improve value with managed care plans and accountable provider entities. Buying Value consists of two free Excel-based tools: the Buying Value Measure Selection Tool and the Buying Value Benchmark Repository. During the webinar, DaShawn Groves, Project Manager at the D.C. Department of Health Care Finance, will share the District’s experience using the Buying Value suite in the development and monitoring of population health management initiatives in the Medicaid program. Registration (required) at the following link: https://rwjfevents.webex.com/rwjfevents/onstage/g.php?MTID=ed7e95b6dbbbe0f162767eb1e571c0d6b

 

Issues to Watch for When Medicaid Maintenance of Eligibility Requirements End

The Kaiser Family Foundation published an issue brief examining the implications of the expiration of maintenance of eligibility (MOE) requirements. To help support states and promote stability of coverage amidst the COVID-19 pandemic, federal legislation provides a temporary increase in federal Medicaid matching rates to states conditioned on states providing continuous eligibility for existing enrollees and meeting certain other eligibility requirements. The issue brief summarizes what to expect when the MOE requirements end and also reviews the key issues states are likely to face.

 

Potential Fiscal Impacts of the COVID-19 Pandemic on Medicaid and Early Childhood Services

The Center for Health Care Services, in partnership with National Association of Medicaid Directors and ZERO TO THREE, published a blog post that reviews the potential implications for Medicaid and early childhood services of the significant deficits states are facing as a result of the economic downturn. Increasing alignment between Medicaid and early childhood programs can help maximize program and service impact, particularly when resources are limited. The blog post offers opportunities to sustain critical services and draws from the experiences of states participating in Aligning Early Childhood and Medicaid, a national initiative led by the Center for Health Care Strategies with support from the Robert Wood Johnson Foundation.

 

New Subsidized Marketplace Data Available from the 2019 American Community Survey

The State Health Access Data Assistance Center (SHADAC) published a blog post last week on the 2019 estimates of income, poverty, and health insurance coverage from the Current Population Survey Annual Social and Economic Supplement (CPS ASEC) and the American Community Survey (ACS) released by the U.S. Census Bureau. In 2019, for the first time, the ACS asked respondents if they or a family member received a “tax credit or subsidy based on family income” to help pay for their coverage. In the blog post, researchers from SHADAC analyze new estimates of subsidized marketplace insurance coverage.