September 3 Update

In This Week’s Update:

CMS Guidelines on Eligibility Renewals
Last week, the Centers for Medicare & Medicaid Services (CMS) released a CMCS Informational Bulletin (CIB) and accompanying slide deck to support states facing renewal backlogs. With this guidance, CMS is providing states additional time—until December 31, 2025—to complete Medicaid and CHIP eligibility renewals, address persistent backlogs in processing redeterminations, and achieve compliance with federal renewal timeliness requirements. State Health and Value Strategies (SHVS) published an expert perspective providing an overview of the CIB.

 

States Demonstrating the Business Case for Multisector Efforts: An Emerging Value Framework
States are increasingly supporting a variety of interventions to address health-related social needs (HRSNs) due to the proven and promising impact of these approaches. Commentary from the National Academy of Medicine explores how states are making the business case for multisector partnerships to address HRSNs. Multisector partnerships like Accountable Communities for Health are not just delivering health services—they’re becoming civic assets and driving systems change to create healthier, more equitable, and resilient communities.

 

Streamlining Enrollment in Covered California for Californians Transitioning From Medi-Cal
California enacted Senate Bill 260 in 2019, instructing Covered California, the state’s official health insurance Marketplace, to automatically enroll eligible individuals transitioning off Medi-Cal in a subsidized Marketplace plan, while allowing them to opt out or choose a different plan. Launched in May 2023, the program facilitated the enrollment of 112,000 Medi-Cal transitioners by March 2024. In a report published by the California Health Care Foundation, researchers from Georgetown University examine the key policy and operational decisions California made to implement Senate Bill 260, the early results, and considerations for other states interested in establishing similar facilitated enrollment programs.

 

Midwifery Learning Collaborative Case Studies
The Institute for Medicaid Innovation launched the national Medicaid and Midwifery Learning Collaborative in 2021, an intensive, three-year initiative to provide technical assistance to state-based teams and advance midwifery-led models of care for those enrolled in Medicaid. The case studies from the five state-based teams selected to participate—Arizona, California, Kentucky, Michigan, and Washington—provide an overview of how each state is working to improve birth outcomes. Each team consisted of leaders from four key groups: state Medicaid agencies, Medicaid health plans, community-based organizations, and provider groups, including midwives of all credentials.

 

State updates: CO, CT, LA, MA, ME, NC, NM, NY, PA & TN

  • Colorado – Colorado submitted a request to amend its Medicaid section 1115 demonstration to incorporate a HRSN program and provide housing and nutrition services for eligible populations.
  • Connecticut – During the Connecticut Healthcare Benchmark Steering Committee’s August meeting, researchers presented findings from an analysis of Connecticut’s healthcare affordability index. The index assesses residents’ ability to afford healthcare without sacrificing basic needs like housing, food, transportation, and childcare. The analysis found that 13% of state households couldn’t afford healthcare in 2022, and projected that more households would be unable to afford basic needs in 2024.
  • Louisiana – The Louisiana Department of Health (LDH) is seeking feedback from healthcare providers and stakeholders on the state’s upcoming proposal for CMS’ Transforming Maternal Health (TMaH) Model, which aims to provide up to $17 million over a 10-year period to selected Medicaid agencies. LDH will host two meetings to discuss the TMaH model and its requirements and seek feedback on the draft proposal.
  • Maine – Maine Bureau of Insurance Superintendent Bob Carey announced approval of the 2025 health insurance rates for Maine’s individual and small group market. The approved rates increase by 8.6% for individuals and 9.4% for small employers and will take effect on January 1, 2025.
  • Massachusetts – The Massachusetts Health Connector published a report on the state’s ConnectorCare pilot expansion, the Marketplace’s financial assistance program which was approved in the fiscal year 2024 state budget to pilot increased eligibility limits from 300% to 500% of the federal poverty level. The report provides detail on the over 51,000 enrollees in the pilot, including their plan choices and premium savings.
  • New Mexico – The New Mexico Health Care Authority is seeking stakeholder feedback regarding the state’s new federal authority to connect Medicaid-eligible individuals in incarceration to needed services prior to their release. Two online meetings are scheduled in September to educate healthcare providers and the state, county, and local jails and prisons who serve these populations about this change and to involve stakeholders in the program design.
  • New York
    • Governor Kathy Hochul signed legislation to expand resources for women’s health services. S.5910-B/A.4060-A requires menstrual products in public colleges and universities. S.6146-A/A.5729-A requires commercial health insurers to provide coverage for tattooing performed by a physician as part of breast reconstruction surgery.
    • Governor Hochul announced more than $24 million to expand HealthySteps, a program that supports young families with mental and physical health development for children under three years old. The funding will support up to 50 new HealthySteps sites. The program is administered by the New York State Office of Mental Health, which pairs pediatric physicians with child development specialists to provide services for children and their families in a pediatric healthcare setting.
  • North Carolina – The North Carolina Department of Health and Human Services announced a $4.5 million investment in the NC Child Treatment Program, a statewide initiative to train mental health providers in trauma-informed treatment models for children with complex behavioral health needs. The investment is part of the department’s ongoing efforts to strengthen the child behavioral health workforce and build a continuum of services to improve outcomes for children and families.
  • Pennsylvania – The Pennsylvania Departments of Human Services (DHS), Health (DOH), Drug and Alcohol Programs (DDAP), and the Pennsylvania Insurance Department (PID) launched a planning process to develop a maternal health strategic plan. DHS, DOH, DDAP, and PID will launch an online survey and host community events in September and October to gather input from Pennsylvanians with lived experience in maternal health. The strategic plan will include priorities centering on equity and diversity, with a focus on increasing access to high-quality care, expanding and diversifying the maternal healthcare workforce, and addressing behavioral health and substance-use disorder services and supports.
  • Tennessee – Tennessee requested to amend their Medicaid section 1115 demonstration entitled “TennCare III.” The proposed amendment would extend TennCare coverage to additional working individuals with disabilities, with the goal of removing barriers to employment for individuals with disabilities who, but for their income and resources, would otherwise qualify for coverage under the TennCare demonstration.