September 6 Update

In This Week’s Update:

  • Enrollment and Eligibility Proposed Rule
  • Expanding Equitable Telehealth Access
  • Assessing Physician Acceptance of Medicaid Patients Using State Health Compare
  • State updates: AZ, CA, FL, IA, LA, MN, MO, NC, NE, NH, NJ, RI & WI

Enrollment and Eligibility Proposed Rule

Last week, CMS announced a new proposed rule that seeks to simplify Medicaid and CHIP application and redetermination processes. The proposed regulations include provisions to: (1) extend verification and renewal processes that currently apply to MAGI populations and to non-MAGI populations; (2) eliminate access barriers for children enrolled in CHIP by prohibiting premium lock-out periods, waiting periods, and benefit limitations; (3) establish timeliness requirements for redeterminations in Medicaid and CHIP; and (4) ensure seamless transitions across Medicaid and separate-CHIP programs. Comments on the proposed rule, which will be published in the Federal Register on September 7, must be submitted to the Federal Register no later than November 7, 2022. Our technical experts are in the process of reviewing the proposed rule and we will be getting more information out to you shortly. 

In case you missed it, last week CMS announced it is investing $98.9 million in grant funding to 59 returning Navigator organizations for the 2023 open enrollment period to help consumers navigate enrollment through the Marketplace, Medicaid, and CHIP. The announcement marks the single largest Navigator funding award provided to date and includes $12.5 million to support additional direct outreach, education, and enrollment activities aimed at helping eligible individuals transition from Medicaid/CHIP to Marketplace coverage. Updates follow.


Expanding Equitable Telehealth Access: Federal Funding Opportunities to Support Universal Broadband

Despite the important role of telehealth in enabling access to care during the public health emergency (PHE), there is growing recognition that a “digital divide”—the gap between individuals who use or have access to telecommunications and information technologies and those who do not—is a social determinant of health that exacerbates existing disparities in healthcare access and outcomes. The Biden administration and Congress have committed historic amounts of funding to: (1) build infrastructure in support of universal broadband access; and (2) launch planning, mapping, equity, and adoption projects that address the digital divide. A new expert perspective published by State Health and Value Strategies describes recent federal funding initiatives and outlines considerations for state policymakers as they evaluate how to direct funding toward healthcare priorities. In particular, there is a key upcoming deadline for states to submit plans to the Treasury for ARP’s Capital Projects Fund on September 24, 2022.


OMB Launches New Public Listening Sessions on Federal Race and Ethnicity Standards Revision

In June, the Office of Management and Budget (OMB) announced a formal review to revise OMB’s Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity. This Directive provides minimum standards that ensure the federal government’s ability to compare race and ethnicity information and data across federal agencies, and also helps to understand how well federal programs serve a diverse America. Earlier this year, Dr. Karin Orvis, Chief Statistician of the United States, convened an Interagency Technical Working Group of federal government career staff representing over 20 agencies across the federal government, including almost every CFO Act agency and recognized statistical agency that collect or use race and ethnicity data, as well as the Equal Employment Opportunity Commission. The Working Group has begun developing a set of recommendations for improving the quality and usefulness of federal race and ethnicity data and now invites public input through virtual, bi-monthly listening sessions. These listening sessions will begin Thursday, September 15, 2022. Learn more here.


Assessing Physician Acceptance of Medicaid Patients Using State Health Compare

There has long been concern that providers are less likely to accept Medicaid patients than patients with other types of health insurance coverage, making it difficult for individuals with Medicaid coverage to get healthcare when they need it. In the U.S., nearly all physicians accept new patients with private insurance, but only about three quarters accept new patients with Medicaid coverage. Though this trend is clear nationally, there is a large degree of variation across the states in how likely physicians are to accept new patients with Medicaid coverage compared to other forms of insurance. A new State Health Access Data Assistance Center (SHADAC) blog post examines state-level trends using SHADAC’s State Health Compare, which has two state-level measures related to physician acceptance of new Medicaid patients. State Health Compare allows users to compare rates of physician acceptance of new patients by coverage type (Medicaid, private, and Medicare) and to compare rates of physician acceptance of new Medicaid patients by characteristics of the physician’s practice, along with more than 40 other state-level measures of health insurance coverage; health behaviors; access, affordability, and use of care; public health; and related social and economic factors.


State updates: AZ, CA, FL, IA, LA, MN, MO, NC, NE, NH, NJ, RI & WI

  • Arizona – The Arizona Health Care Cost Containment System (AHCCCS) published its revised American Rescue Act (ARP), Section 9817 spending plan, detailing efforts to use enhanced federal funding to strengthen, enhance, and/or expand home and community-based services available to AHCCCS members. 
  • California
    • Covered California, the state’s official health insurance marketplace, announced that the statewide weighted average rate change for dental coverage in 2023 will be a decrease of 1.7%, marking the second year that premiums have decreased.
    • The California Department of Health Care Services announced its intent to award contracts for the state’s Medi-Cal managed care program to Anthem/Blue Cross of California Partnership Plan, Centene/Health Net Community Solutions, and Molina Healthcare of California. Contracts will run from January 1, 2024, through December 31, 2028. The awards can be appealed through September 1, 2022.
  • Florida – Governor DeSantis announced a lawsuit against the U.S. Food and Drug Administration (FDA), alleging that the agency has delayed approving Florida’s proposal for its Canadian Prescription Drug Importation Program. The Florida Agency for Health Care Administration submitted its plan to import cheaper prescription drugs from Canada to the FDA in November 2020.
  • Iowa – The Iowa Department of Human Services announced its intent to award Medicaid managed care contracts for Iowa Health Link, the state’s Medicaid managed care program consisting of traditional Medicaid, Iowa Health and Wellness Plan, and Children’s Health Insurance Program, to Anthem/Amerigroup and Molina Healthcare.
  • Louisiana – The Louisiana Department of Health announced its intent to contract with Magellan Medicaid Administration, Inc. as its Pharmacy Benefit Manager after completing the review of proposals.
  • Minnesota – The Minnesota Department of Health released its first-ever Minnesota Maternal Mortality Report, which examined maternal deaths during or within one year of pregnancy from 2017 to 2018. While the report shows the state’s overall maternal mortality rate is lower than the national average, it also shows stark disparities in mortality—especially among Black and American Indian Minnesotans. Black Minnesotans represent 13% of the birthing population but made up 23% of pregnancy-associated deaths, and American Indian Minnesotans represent 2% of the birthing population, but 8% of pregnancy-associated deaths.
  • Missouri – The state of Missouri submitted a section 1115 demonstration application that seeks authority to reimburse for acute inpatient stays in institutions for mental disease (IMDs) for Medicaid eligible individuals ages 21 to 64 with serious mental illness (SMI). Reimbursement will not be extended to IMDs for residential stays for adults with SMI. Additionally, state operated psychiatric hospitals and facilities will not be classified as IMDs eligible for reimbursement under this demonstration. The federal comment period will be open from August 31, 2022 through September 30, 2022.
  • Nebraska – The Nebraska Department of Health and Human Services (NDHHS) will interview each of the five bidders who responded to the state’s request for proposals to provide Medicaid managed care services. These interviews are an optional part of the procurement process and add to each bidder’s written proposals submitted to the state. NDHHS will interview representatives from each of the five bidding companies the week of September 12. To allow bidders the opportunity to prepare for the interviews, DHHS will adjust its previously shared schedule for announcing the winning bidders and will now announce the winning bidders by Friday, September 23.
  • New Hampshire – The New Hampshire Department of Health and Human Services Division of Medicaid Services released a request for proposals from qualified vendors to provide dental services to eligible and enrolled Medicaid members age 21 and older through New Hampshire’s Medicaid managed care program. The Department will select a dental organization that will work with the state, providers, and members to provide high-quality, value-based dental services on a statewide basis.
  • New Jersey – First Lady Tammy Murphy and Human Services Commissioner Sarah Adelman announced NJ FamilyCare’s Perinatal Episode of Care program, a three-year pilot to test a new alternative payment model for prenatal, labor, and postpartum services statewide. The pilot’s goal is to improve maternity care by encouraging NJ FamilyCare obstetrical providers to broadly engage in all aspects of their patient’s care, from pregnancy through the postpartum period, including emergency room visits and newborn pediatric care. Clinicians who choose to participate in the program are financially incentivized to take on comprehensive responsibility for the quality and cost of their patients’ care.
  • North Carolina – The North Carolina Department of Health and Human Services released the 2022 North Carolina State Health Improvement Plan (NC SHIP), which includes key strategies for health equity, education and economic stability for all North Carolinians. A major focus of NC SHIP is advancing health equity by reducing disparities in opportunity and outcomes for historically marginalized populations across the state.
  • Rhode Island – HealthSource RI, the state’s official health insurance marketplace, announced that a preliminary analysis of the latest Rhode Island Health Insurance Survey shows the state has reached its lowest uninsured rate ever recorded. For the first time, just 2.9% of Rhode Islanders are uninsured, a reduction from the 4.0% the last time the survey was conducted in 2020.
  • Wisconsin – The Wisconsin Department of Health Services launched an online program for Wisconsinites to get free at-home rapid COVID-19 tests delivered directly to them. Wisconsin residents can go to the Say Yes! COVID Test website and place an order for a package of five rapid antigen COVID-19 tests at no cost. Initial supplies will allow each household to order one package that will arrive in one to two weeks.