2023 in Review: Ten SHVS Resources We Recommend
Sally Mabon, State Health and Value Strategies
As we look back at 2023, we want to highlight 10 resources published this year by State Health and Value Strategies that showcase the innovative and hard work states are engaged in to transform healthcare. Unwinding the Medicaid continuous coverage requirement began in April of this year and has consumed much of states’ time and attention. But despite the intensive effort required by unwinding, states have also forged ahead with innovative efforts to expand coverage, improve care, meaningfully engage the diverse communities they serve, and advance health equity. SHVS published resources over the course of this year that document the exciting work states are undertaking and that spotlight new opportunities for innovation. The resources below are ones we wanted to share to celebrate what states have accomplished and to highlight policy opportunities other states may look to for inspiration.
1. States of Unwinding. As states began unwinding the continuous coverage requirement, the SHVS team launched this series to highlight how states are communicating and outreaching to enrollees, leveraging federal flexibilities, promoting transitions to Marketplace coverage and sharing information about unwinding. The series showcases strategies other states might be interested in adopting to minimize coverage losses and support transitions to other forms of coverage. The SHVS team also created a one-stop resource page for states in support of unwinding, and toolkits such as Issue Spotting Common Policy and Operational Barriers to Ex Parte Renewals: State Assessment Tool.
2. New CMS Guidance: 12 Months of Continuous Enrollment for Children Enrolled in Medicaid and CHIP Beginning January 1, 2024. Unwinding has highlighted how the administrative requirements of the eligibility process result in individuals otherwise eligible losing coverage, in particular children. Continuous enrollment reduces the paperwork burden and ensures children retain coverage for longer periods of time at a crucial time of development. With the start of the new year, states must adopt 12-months of continuous enrollment for children as established in Section 5112 of the Consolidated Appropriations Act, 2023. In addition to the expert perspective (EP) on CMS guidance, SHVS also hosted a webinar Preparing to Implement the 12-Month Continuous Enrollment for Children Requirement.
3. State Spotlight: Oklahoma’s Award-Winning Communications Campaign to Promote Medicaid Expansion Enrollment. After voters approved a ballot measure to expand Medicaid, Oklahoma then began the hard work of enrolling eligible individuals across the state. This state spotlight describes the Oklahoma Health Care Authority’s approach to outreach and education in support of overall enrollment goals. Oklahoma’s development and deployment of a data-driven integrated communications plan can be a model for other states who may also move to implement and enroll newly eligible adults in Medicaid expansion.
4. Transformational Community Engagement to Advance Health Equity. On the horizon in 2024 is the release by CMS of the final “Ensuring Access to Medicaid Services” rule, also known as the “Access Proposed Rule.” The Access Proposed Rule would significantly strengthen member engagement in Medicaid by requiring states to create a Beneficiary Advisory Group (BAG) composed solely of people with lived experience and reflecting the diverse population in the Medicaid program. As states prepare to establish BAGs, this SHVS issue brief provides strategies and tactics for engaging members with lived experience and offers options for states to consider when working to advance towards transformational community engagement and achieve their community engagement goals.
5. State Reporting to Monitor the Unwinding of the Medicaid Continuous Coverage Requirement. As states prepared to unwind the continuous coverage requirement at the end of March, 2023, three states (Iowa, Minnesota and Utah) had launched public facing dashboards. To support states as they planned for unwinding, SHVS published an issue brief describing best practices to consider when developing a data dashboard to track unwinding. As more and more states published their data to provide a fuller picture of the impact of resuming eligibility redeterminations and disenrollments, this EP has tracked through an interactive map the format of state reporting. The EP also includes an analysis of the indicators each state is reporting, as well as which states are publishing disaggregated data. To date, a total of 46 states including the District of Columbia have publicly published their own unwinding data in some format.
6. Communicating to Drive Health Coverage Enrollment Among Non-Citizen Populations. Several states are pioneering new programs that extend coverage to non-citizen populations. Building awareness of such programs in a way that reaches and moves non-citizen audiences to action requires a thoughtful approach that is rooted in research and employs culturally and linguistically responsive tactics. This EP shares insights from qualitative research SHVS conducted with Latino/a adults to understand the barriers to coverage, perceptions, and understanding of access to care as more states consider expansions of coverage for non-citizens.
7. Preserving the ACA’s Preventive Services Protections in the Wake of Braidwood v. Becerra: A Checklist of State Options. On March 30, 2023 a federal district court judge issued a ruling in Braidwood Management, Inc v. Becerra, blocking the federal government from enforcing the Affordable Care Act’s requirement that health plans and issuers cover, without cost-sharing, high value preventive services. While the decision has been stayed pending appeal, if allowed to stand, the decision would invalidate life-saving benefits that more than 150 million Americans have relied on for over a decade, including cancer and mental health screenings and medications to prevent heart disease and the transmission of HIV/AIDS. This EP discusses who will be impacted by the court’s decision and the preventive services most at risk, and provides a checklist of actions states can take to maintain access to preventive services.
8. CMS Issues Guidance on Section 1115 Demonstration Opportunity to Support Reentry for Justice-Involved Populations. In January, CMS approved California’s request to amend the state’s section 1115 demonstration waiver to provide a targeted set of Medicaid services to incarcerated youth and adults for up to 90 days prior to release. This first-in-the nation approval was soon followed by CMS guidance, reviewed in detail in this EP. The guidance outlines the opportunity for states through section 1115 demonstrations to support the reentry of justice-involved populations into the community. For states interested in pursuing this opportunity, SHVS also published a tool that can be used to crosswalk a state’s proposed demonstration with the reentry requirements outlined in the CMS guidance and California’s section 1115 demonstration approval.
9. Medicaid Managed Care Strategies to Reduce Racial and Ethnic Health Disparities in Mental Healthcare for Adults. In 2022, over 59 million adults over the age of 18 had a mental illness. Medicaid programs are uniquely positioned to promote greater equity in mental healthcare, as the program plays an outsized role in the financing and delivery of mental healthcare. This issue brief identifies ways in which states can leverage their Medicaid managed care programs to advance their health equity goals.
10. State Facilitated Enrollment Resources. Many states have implemented policies that take advantage of existing consumer-state interactions to help individuals enroll in healthcare coverage more easily. To assist states in their efforts, SHVS has compiled materials that states have created for their facilitated enrollment programs and made them accessible through a one-stop resource page.