HMA Weekly Roundup

Alaska

Alaska Submits Section 1115 Waiver Request to Extend Medicaid SUD, Behavioral Health Program. Alaska submitted on March 1, 2023, a Section 1115 waiver request to extend the current Medicaid substance use disorder (SUD) and behavioral health program demonstration. The request to the Centers for Medicare & Medicaid Services seeks to maintain the waiver, with only minimal changes. The demonstration’s goal is to implement a data-driven, integrated behavioral health system of care for Alaskans with serious mental illness, severe emotional disturbance, and/or substance use disorders. Alaska has not yet been able to fully implement the waiver programs and is seeking to do so with this extension. The public comment period ends April 9, 2023. Read More

District of Columbia

District of Columbia Starts Public Awareness Campaign Ahead of Medicaid Redeterminations. The District of Columbia Department of Health Care Finance announced on March 8, 2023, that it has begun outreach, urging Medicaid beneficiaries to update contact information and renew coverage during the upcoming eligibility redeterminations process. Grassroots outreach will be through neighborhood and citywide events, virtual meetings, an advertising campaign that directs beneficiaries on steps to renew, and a toolkit to assist in outreach from community-based organizations and government agencies. Read More

Mississippi

Mississippi Hires Staff, Contractors to Assist With Medicaid Redeterminations. Mississippi Today reported on March 14, 2023, that the Mississippi Division of Medicaid has hired 22 new workers and 100 contractors to assist with Medicaid redeterminations. The state launched an awareness campaign in January and invited community partners to assist in urging beneficiaries to update contact information. The state has not published its public health emergency unwinding plan yet. Read More

Mississippi Hospitals Expect Big Cut in Supplemental Payments Under Proposed Change. Mississippi Today reported on March 9, 2023, that Mississippi hospitals expect supplemental payments from the state Hospital Access Program will drop to about $40 million from an expected $450 million this year because of a proposed change to the payment model. The Mississippi Division of Medicaid submitted the proposal to federal regulators, seeking to peg payments to the difference between commercial and Medicaid rates. Read More

Montana

House Committee Adds Budget Provision to Extend Postpartum Medicaid Coverage. The Montana Free Press reported on March 14, 2023, that the Montana House Appropriations Committee added a provision to the state budget bill to extend postpartum Medicaid coverage from 60 days to 12 months. The budget now moves to the House floor for a debate. Read More

New Hampshire

New Hampshire Senate Gives Preliminary Approval to Continuing Medicaid Expansion. The Associated Press reported on March 9, 2023, that the New Hampshire Senate gave preliminary approval to a bill to continue Medicaid expansion in the state. The bill now heads to the Finance Committee. Read More

New York

New York Has Almost $10 Billion in Surplus Federal Funding for Basic Health Option. Crain’s New York reported on March 9, 2023, that New York has $9.9 billion in surplus federal funding for its Essential Plan basic health program option. The Basic Health Program, included in the Affordable Care Act, provides states with 95 percent of the federal subsidy available to enrollees who purchase silver plans through the Exchange. The funding can only be used for enrollees in the Essential Plan. Read More

Legislature Recommends 10 Percent Increase in Medicaid Reimbursement Rates for Hospitals. Crain’s New York reported on March 15, 2023, that the New York State Assembly and Senate both recommended a 10 percent increase in Medicaid reimbursement rates for hospitals in their budget resolutions. Governor Kathy Hochul’s budget proposal included an increase of five percent. The Senate and Assembly also both proposed increasing the Medicaid reimbursement rates for nursing homes. Read More

Senate Passes Bill to Create Directory of Doulas for Medicaid Beneficiaries. WNY News Now reported on March 8, 2023, that the New York Senate passed a bill that would require the state to maintain a directory for doulas accepting Medicaid. The bill now moves to the Assembly. Read More

North Carolina

Senate Gives Initial Approval to Medicaid Expansion Bill. The Associated Press reported on March 14, 2023, that the North Carolina Senate gave initial approval to a Medicaid expansion bill. The bill also includes changes to hospital certificate of need rules. The bill will require a second Senate vote and a House vote before it goes to Governor Roy Cooper, who is expected to sign it. Read More

Senate Passes Bill to Contract With Statewide Health Plan for Children in Foster Care. The Winston-Salem Journal reported on March 8, 2023, that the North Carolina Senate passed a bill (Senate Bill 156) to contract with a statewide, prepaid health plan for children in foster care. The plan would cover physical and behavioral health services. Any qualified vendor can submit a bid, including any of the state’s six contracted managed care organizations. Currently, Medicaid coverage for children in foster care is handled at the county level. The bill now moves to the House. Read More

North Dakota

North Dakota Seeks Public Comments on Ending Medicaid Technology Dependent Waiver. The North Dakota Department of Health and Human Services announced on March 8, 2023, that it is seeking public comments on an amendment to terminate the state’s Medicaid 1915(c) Technology Dependent waiver. No individuals are currently participating. Public comments will be accepted until March 31. Read More

Oklahoma

House Passes Bill to Extend Postpartum Medicaid Coverage. KOCO reported on March 14, 2023, that the Oklahoma House passed a bill to extend postpartum Medicaid coverage from 60 days to 12 months by instructing the Oklahoma Health Care Authority to seek a federal Medicaid waiver. The bill also extends coverage to women who are within 205 percent of the federal poverty level instead of 133 percent. The bill now goes to the state Senate. Read More

Oregon

Oregon Medicaid CCO Purchases Hotel to Create Housing for Individuals with Behavioral Health Needs, Health Care Professionals. OPB reported on March 12, 2023, that Medicaid coordinated care organization (CCO) CareOregon purchased a hotel for $8 million and plans to turn it into housing for individuals with behavioral health needs and health care professionals. CareOregon’s Columbia Pacific CCO will run the building in partnership with Clatsop Behavioral Health. Read More

Pennsylvania

Governor Proposes $500 Million for Mental Health Services in Schools in Fiscal 2024 Budget. Pennsylvania Governor Josh Shapiro proposed on March 7, 2023, $500 million to increase mental health services in schools in his fiscal 2024 budget. He is also proposing $4 million to create three community-based programs to reduce or prevent admissions to state facilities, an additional $17.6 million toward reducing the waiting list for home and community-based services, and $1.9 million in resources for long-term care facilities. Read More

South Dakota

Lawmakers Propose Fiscal 2024 Budget with Medicaid Expansion. The Argus Leader reported on March 9, 2023, that South Dakota lawmakers proposed a fiscal 2024 budget that includes Medicaid expansion as well as funding increases for hospitals and certain community support providers. Read More

Washington

Washington Pauses Apple Health Reprocurement Efforts to Focus on Medicaid Redeterminations. The Washington Health Care Authority (HCA) announced on March 13, 2023, that it will pause reprocurement efforts for the Apple Health Medicaid managed care program while it focuses on Medicaid redeterminations. It has been over 10 years since the state last procured Medicaid managed care plans. HCA announced last year that it was aiming for new contracts to be implemented January 1, 2025. Read More

West Virginia

Legislature Passes Hospital Certification of Need Bill. The Associated Press reported on March 9, 2023, that the West Virginia House passed a bill to eliminate certificate of need requirements for hospitals seeking to improve or add services if the hospital spends less than $100 million on facility or medical equipment acquisitions, expansions, or improvements. Currently, the minimum is $5 million. The bill already passed the Senate. Read More

Wyoming

Wyoming Could Disenroll Up to 15,000 Medicaid Beneficiaries When Redeterminations Begin. The Casper Star Tribune reported on March 9, 2023, that 10,000 to 15,000 Medicaid beneficiaries in Wyoming could lose coverage when redeterminations begin, according to a spokesperson for the state Department of Health. The state began contacting beneficiaries and resuming eligibility screenings in early March. During the public health emergency Medicaid enrollment in the state increased from 58,500 to more than 77,000. Read More

National

AHIP Leads Coalition to Offer Support During Redeterminations. Becker’s Payer Issues reported on March 9, 2023, that a new coalition, Connecting to Coverage Coalition (CCC), led by AHIP and 15 other healthcare organizations, will offer support to individuals and stakeholders during the Medicaid redetermination period. CCC will offer a website with resources for Medicaid members to navigate the process and offer healthcare navigators with toolkits and best practices for connecting with members. Read More

Biden’s Proposed Fiscal 2024 Budget Includes Mandatory Minimum Medicaid MLR. Modern Healthcare reported on March 9, 2023, that President Biden’s fiscal 2024 budget proposal would require all Medicaid and CHIP managed care plans to meet a minimum medical loss ratio (MLR) of 85 percent. The proposed budget also reduces out-of-pocket costs for Medicare enrollees and includes $150 million for home and community-based services, $100 million for crisis response programs, and $400 million for the Health Resources and Services Administration and Substance Abuse and Mental Health Services Administration programs. Read More

CMS Releases Guidance to State Medicaid Agencies on Third-Party Liability Requirements. The Centers for Medicare & Medicaid Services (CMS) released on March 8, 2023, guidance to state Medicaid agencies on two new third-party liability (TPL) requirements. The first concerns a new law that bars liable third-party payers from refusing payment solely because an item or service did not receive prior authorization. The second concerns allowing a state to create a lien over injury settlement proceeds attributable to future medical expenses. Read More

HHS Says 27 Prescriptions May Have Lower Coinsurance through Inflation Rebate Program. The U.S. Department of Health and Human Services (HHS) announced on March 15, 2023, that 27 prescription drugs may have lower Medicare Part B beneficiary coinsurance, starting on April 1, through the Medicare Prescription Drug Inflation Rebate Program. HHS will also discourage drug companies from increasing prices faster than inflation. The rebate program will save eligible beneficiaries between $2 and $390 per average dose. Read More

HHS Secretary Becerra Urges States to Minimize Medicaid Coverage Losses During Redeterminations. CNN reported on March 9, 2023, that HHS Secretary Xavier Becerra sent letters to state governors urging them to adopt measures to minimize coverage losses during the Medicaid redetermination period. If states do not comply, they will risk losing enhanced federal Medicaid funding for the remainder of the year. States will also be required to report monthly renewals and terminations, among other metrics. Read More

MACPAC Makes Recommendations on Medicaid Data Collection, Drug Coverage. The Medicaid and CHIP Payment and Access Commission (MACPAC) recommended on March 15, 2023, that federal regulators improve the collection of race and ethnicity data in Medicaid, increase transparency and improve the collection of nursing facility payment data, give state Medicaid programs greater flexibility in following Medicare drug coverage decisions, and examine payment policy for the nation’s safety net hospitals. MACPAC made the recommendations in its March 2023 Report to Congress on Medicaid and Children’s Health Insurance Program. Read More

Researchers Develop Medicare Advantage Health Equity Dashboard. HealthITAnalytics reported on March 10, 2023, that researchers developed a dashboard, presenting health equity performance data on Medicare Advantage plans. Details on the Health Equity Summary Score were published in The American Journal of Managed Care. Read More

U.S. Senator Introduces Bill to Increase Medicaid Funding for HCBS. The Senate Special Committee On Aging announced on March 9, 2023, that Senator Bob Casey (D-PA) introduced the Home and Community-based Services (HCBS) Access Act, which aims to reduce waiting lists for home care services. The bill would increase Medicaid funding for HCBS, provide grant funding to states, provide training and support for family caregivers, and provide other resources for states. Read More