In This Week’s Update:

• FEMA Disaster Relief Fund Grants and Eligibility Determinations
• CDC Order on Residential Evictions
• SHVS Expert Perspective on Open Enrollment
• COVID-19 State Updates: AZ, DC, NC & WI
• Other State Updates: AZ, CA, MI, OK, OR & WI
• COVID-19 Recession’s Effects on Health Insurance Coverage
• Medicaid’s Role in Addressing Racial Health Disparities
• State Practices for Contracting with Managed Care Organizations

 

FEMA Disaster Relief Fund Grants and Eligibility Determinations

After enhanced federal unemployment payments authorized by the CARES Act expired at the end of July, President Trump directed the Federal Emergency Management Agency (FEMA) to use Disaster Relief Fund (DRF) grants to continue to provide enhanced unemployment assistance (via a “Lost Wages Grant” to states) in lieu of a new COVID-19 stimulus bill. As of Sept. 2, FEMA has approved Lost Wages Grants for 45 states. Providing unemployment assistance via the DRF has raised questions about whether lost wages assistance payments must be counted as income for purposes of determining eligibility for Marketplace, Medicaid, and Children’s Health Insurance Program (CHIP) applicants. The CARES Act had specifically excluded these payments from being counted for the purposes of determining Medicaid and CHIP eligibility (but not Marketplace eligibility). Now that the payments are financed via the DRF, whether they “count” as income is less clear because the federal income eligibility rules that apply to Marketplace and most Medicaid and CHIP applicants count unemployment payments—but exclude certain qualified disaster relief payments. State Health and Value Strategies (SHVS) is exploring this question with the Centers for Medicare & Medicaid Services, the Department of Treasury, and the Internal Revenue Service, and is developing programming for states to explain policy and implementation considerations.

 

CDC Order on Residential Evictions

The Centers for Disease Control and Prevention issued a new order to halt certain residential evictions until 2021 to prevent the further spread of COVID-19, effective immediately. The order does not relieve tenants of their obligation to pay rent, but prevents property owners from evicting tenants who meet certain criteria. In order to apply for coverage under the order, tenants must earn no more than $99,000 this year, provide evidence of efforts to obtain state and local rental assistance, and demonstrate their inability to cover rent payments and that eviction would cause them to become homeless. The order does not provide any funds for rental support.

 

SHVS Expert Perspective on Open Enrollment

Last week SHVS published a new expert perspective that highlights several examples and strategies that states can pursue to help ensure a successful open enrollment period this year.

 

COVID-19 State Updates: AZ, DC, NC & WI

• Arizona – The Arizona Health Care Cost Containment System (AHCCCS) suspended all Medicaid disenrollments per federal requirements at the start of the Public Health Emergency (PHE). In anticipation of the expiration of the PHE scheduled for October 22, 2020, AHCCCS will begin to request eligibility information from members whose eligibility requires additional information. While no member will be disenrolled—regardless of eligibility—until after the PHE ends, AHCCCS will begin sending requests for information in the September member notifications.
• District of Columbia
  • Mayor Muriel Bowser has mandated that all DC-licensed health insurers cover COVID-19 testing with no cost sharing for certain high-risk residents. This requirement, to be administered through the DC Department of Insurance Securities and Banking, runs through the duration of the PHE.
  • The Department of Housing and Community Development notified more than 30 District-based nonprofit organizations that they will receive funding from the COVID-19 Nonprofit Support Grant. The grants, which total nearly $1.5 million, will support housing and community development nonprofits that have experienced an increase in administrative costs, constituent requests, or other disruptions to normal operations due to COVID-19.
• North Carolina – The North Carolina Department of Health and Human Services (NCDHHS) has added new data to the COVID-19 Data Dashboard on the average turnaround time for COVID-19 testing. Located on the Testing page, the graph shows the average daily turnaround time based on data from all laboratories that report electronically to NCDHHS.
• Wisconsin – The Department of Health Services is accepting applications for Wisconsin’s program to provide relief for specific types of health care service providers to offset losses or expenses they incurred due to the COVID-19 pandemic. The funding is supported by the federal CARES Act.

 

Other State Updates: AZ, CA, MI, OK, OR & WI

• Arizona – The AHCCCS established the Health Equity Committee earlier this year to examine where health disparities exist within Arizona’s health care delivery system and explore steps that can be taken by the agency and community partners to address them. AHCCCS is hosting four community forums online on September 12, 18, 21, and 29.
• California – Covered California, the state’s official health insurance marketplace, established a new special enrollment period to benefit victims of the more than 500 wildfires in the state. Covered California’s regulations allow it to establish a special enrollment period for people affected by the current statewide state of emergency. 
• Michigan – The Michigan Department of Health and Human Services announced the creation of a new collaborative statewide group, Mi Milk Collective, led by Black women representing hospital systems, community organizations, birth workers, and lactation professionals throughout the state of Michigan dedicated to serving Black families. In honor of Black Breastfeeding Week, Mi Milk Collective has teamed up with Priority Health to create a scholarship dedicated to financially supporting aspiring Black lactation professionals.
• Oklahoma – As the Oklahoma Health Care Authority prepares for the expanded adult Medicaid population, the current Insure Oklahoma premium assistance program will be modified. Insure Oklahoma helps small businesses and their employees access quality health care coverage. As Oklahoma adds the expansion adult population, the Employee Sponsored Insurance program will be revised to cover individuals with qualifying income from 138 to 200 percent of the federal poverty level starting July 1, 2021.
• Oregon – The Oregon Health Authority announced the launch of Healthier Together Oregon, the new State Health Improvement Plan aimed at improving the social influences on health. The 2020-2024 plan, developed over the past year with input from more than 2,500 people across the state, is centered on five priority areas: institutional bias; adversity, trauma, and toxic stress; behavioral health; economic drivers of health, including housing, food security, and living wage; and access to equitable preventive health care.
• Wisconsin – Prevent Suicide Wisconsin, a public-private partnership that includes the Department of Health Services, released a report to guide and support suicide prevention in Wisconsin over the next five years. The report presents the most up-to-date picture of suicidal behavior in Wisconsin based on surveys, death records, and hospital data. It also outlines four strategies and 50 opportunities for action.

 

Making Sense of Competing Estimates: The COVID-19 Recession’s Effects on Health Insurance Coverage

A new report by the Urban Institute compares four studies that project the effects of the COVID-19 recession on employment-based health insurance coverage and the number of uninsured people in 2020. Several estimates have been published in recent months, but they vary widely and are difficult to reconcile. The four studies each attempt to quantify the number of individuals losing employment-based health insurance due to COVID-19-related job loss, with figures ranging from around 5 million to 30 million. Estimates of the increase in the number of uninsured people range from about 3 million to more than 8 million. The value of these competing estimates lies in their transparent use of available data and careful presentation of final results in the context of considerable uncertainty about when and how insurance coverage will change as a result of the COVID-19 recession.

 

How Foundational Moments In Medicaid’s History Reinforced Rather Than Eliminated Racial Health Disparities

The past months have laid bare the inextricable connection between two pandemics in the United States: COVID-19, which is disproportionately affecting Black Americans, and systemic racism, which has set the foundation for the stark health disparities we see today. A Health Affairs blog post explores foundational moments in Medicaid’s history that have led to key facets of the current infrastructure of inequities in health care access, along with the racial disparities and disparate health outcomes that followed. The authors explore these periods and examine policies that states and the federal government can implement to make steps toward health equity.

 

Analyzing Medicaid Managed Care Organizations: State Practices for Contracting with Managed Care Organizations and Oversight of Contractors

The Robert Wood Johnson Foundation published a new issue brief that examines how Medicaid agencies in 40 states select managed care organizations (MCO) to contract with, how contract terms are set, and how performance is evaluated. Medicaid managed care contracts are a business opportunity for managed care companies, and state Medicaid agencies work hard to set payment rates and contract terms and manage a procurement process that will attract strong competing bidders. Researchers interviewed dozens of leaders in state Medicaid agencies, MCOs, advocacy groups, provider associations, and others to gain insights on what has worked well for states in executing their contracting, evaluation, and performance oversight functions.