The unwinding of the Medicaid continuous coverage requirement represents the largest nationwide coverage transition since the Affordable Care Act, with significant health equity implications. Given the intense focus on coverage transitions during the unwinding, some states have initiated plans to publish a data dashboard to monitor progress. To date, the District of Columbia and 15 states have published unwinding data in a visual dashboard format (this does not include states with pre-existing enrollment dashboards that don’t specifically identify unwinding cohorts). This expert perspective now includes an interactive map with the links to all the dashboards and states publishing CMS unwinding reports. SHVS will continue to update the EP and map as more states publish their unwinding data.

The unwinding of the Medicaid continuous coverage requirement represents the largest nationwide coverage transition since the Affordable Care Act. This presents State-Based Marketplaces with an opportunity to target outreach efforts to those audiences who have recently lost Medicaid or CHIP to help eligible individuals retain access to affordable healthcare through the Marketplace. This expert perspective focuses on best practices for timing and strategy in consumer outreach to consumers that are no longer eligible for Medicaid to help states develop a consumer “chase campaign.”

State updates as of May 12 2023.

On Thursday, April 27, CMS released two highly anticipated proposed rules. The first, which focuses on managed care delivery systems, is titled “Managed Care Access, Finance, and Quality.” The second proposed rule, which focuses on fee-for-service delivery systems and program improvements for home and community-based services across delivery systems, is titled “Ensuring Access to Medicaid Services.” Together, these would reshape the federal regulatory landscape for Medicaid and CHIP, particularly with respect to standards for ensuring access to care, transparency and oversight of provider payment rates, engagement of people enrolled in Medicaid, quality measurement, and program accountability. This expert perspective outlines the key provisions in each of the proposed rules.

State updates as of May 5 2023.

Ensuring affordable health coverage and healthcare for immigrant populations in the United States is critical to advancing health equity. In a new series, State Health and Value Strategies (SHVS), with support from the Robert Wood Johnson Foundation, highlights strategies for states to expand affordable health coverage to immigrant populations in the United States. This expert perspective provides an overview of the products included in the series.

As of May 1, an additional 14 states will begin terminating individuals determined ineligible for Medicaid. To prepare Medicaid enrollees for this upcoming deadline, Medicaid agencies and state Marketplaces are doubling down on their outreach and communication efforts. As unwinding progresses, more states are putting out press releases warning enrollees about scams. Beyond communications and outreach, states are also implementing safeguards for individuals who missed the window to sign up for Medicare Supplement policies. This States of Unwinding features updates from Arizona, Colorado, the District of Columbia, Georgia, Idaho, Indiana, Kansas, Lousiana, Massachusetts, Maine, Michigan, Minnesota, Nebraska, New Mexico, Nevada, New York, Oregon, Pennsylvania, Rhode Island, South Carolina, Virginia, Washington and Wyoming. 

On April 17, 2023, the Centers for Medicare & Medicaid Services released its final Notice of Benefit & Payment Parameters for plan year 2024. This annual regulation governs core provisions of the Affordable Care Act, including operation of the health insurance Marketplaces, standards for insurers, and the risk adjustment program. This expert perspective focuses on provisions of the final rule most of interest to State-Based Marketplaces and state insurance regulators.

While designing new programs that extend coverage to non-citizen populations is one part of the puzzle, building awareness of these programs in a way that reaches and moves non-citizen audiences to action will require a thoughtful approach that is rooted in research and employs culturally and linguistically responsive tactics. This expert perspective offers insights on common barriers along the enrollment journey for non-citizen populations, and communications recommendations to effectively drive consumer behavior. The expert perspective 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 well as insights from a qualitative study conducted by the California Health Care Foundation to explore effective messaging strategies.

On April 26, the United States Department of Health and Human Services published a proposed rule aimed at expanding health coverage options for certain recipients of Deferred Action for Childhood Arrivals (DACA) status, a program established under the Obama administration that enables access to certain public benefits for so-called Dreamers—undocumented individuals who were brought to the United States as children and who meet certain other eligibility criteria. This expert perspective reviews the proposed rule, which would add DACA recipients to the list of “lawfully present” immigrants who can receive three types of federally supported health coverage. Public comments on the proposed rule are due by June 23, 2023.