State Health and Value Strategies (SHVS), in partnership with Manatt Health, Georgetown’s Center on Health Insurance Reforms (CHIR), State Health Access Data Assistance Center (SHADAC), Bailit Health, and GMMB developed this resource page to serve as an accessible “one-stop” source of COVID-19 information for states. This resource is designed to support states seeking to make coverage and essential services available to all of their residents, especially high-risk and vulnerable people, during the COVID-19 pandemic. SHVS will update this page frequently with new resources as they become available.
| If you have materials you are willing to share with other states through this page, or if there are topics of particular concern that you would like addressed, please contact SHVS. |
The American Academy of Actuaries Health Practice Council created the Health Equity Work Group with a goal of contributing to efforts to reduce health disparities and improve health equity among groups that have been economically/socially marginalized. The work group is examining actuarial practices and methods in the health area to assess the extent to which they may affect health disparities and recommend changes when appropriate, educate actuaries and other stakeholders on health equity issues, and apply an equity lens to the Academy’s health policy work. Health Equity from an Actuarial Perspective: Questions to Explore introduced the first phase of the work group’s work—an identification of areas in which health actuaries are involved that may affect health equity and development of a list of questions and topics to explore further. Health Equity from an Actuarial Perspective: A Deeper Dive Into Health Plan Pricing Questions is part of a follow-up series and focuses on questions related to pricing health insurance products. Future briefs will focus on questions related to health insurance benefit design, provider contracting and network development, and population health.
The Internal Revenue Service (IRS) has now released more information about how consumers can receive relief from repayment of excess advance premium tax credits for 2020 under the American Rescue Plan. The information is directly relevant to many 2020 marketplace consumers. While this provision will have a positive impact on marketplace consumers, it could also create confusion given the timing and will require some quick communications. Several state-based marketplaces (SBMs) have expressed interest in language that can be used to provide consumers with information about this new tax relief. State Health and Value Strategies has developed the following template language that SBMs can adapt and use in consumer-facing communications.
The American Rescue Plan Act (ARPA) was signed into law on March 11, 2021 as a signature effort to assist in the recovery from the COVID-19 pandemic and the related economic downturn. Included as part of the sweeping legislation is a program to fully subsidize COBRA coverage for six months starting in April of 2021. This expert perspective provides a short overview of COBRA and mini-COBRA, the major elements of the ARPA COBRA Assistance program, and considerations for state policymakers related to the program.
On March 11, President Biden signed an approximately $1.9 trillion COVID-19 relief bill—the American Rescue Plan Act of 2021 (“the American Rescue Plan,” ARPA). The American Rescue Plan includes myriad health care provisions, focused primarily in two areas: first, it provides funding the Biden administration requested to carry out its COVID-19 response plans; second, it enacts significant but largely temporary coverage policies. Although all health care coverage provisions of the bill are temporary, many will have a lasting impact. This timeline provides the start and end dates for key health care provisions to help states plan for implementation and future policymaking. The provisions covered include: marketplace and commercial insurance, Medicaid and state and local funding.
On Tuesday, March 23, State Health and Value Strategies hosted a webinar to discuss how to best communicate with consumers and other stakeholders so residents can take full advantage of new financial help through the Marketplace, free COBRA plans, and more provided by the American Rescue Plan. The webinar was the third in a series that SHVS is hosting on the American Rescue Plan Act of 2021. Experts from GMMB walked through key questions to consider, thoughts on audience segmentation, initial messaging and potential outreach tactics. We also heard from states on their real-time communication plans for rollout.
On Friday, March 12, State Health and Value Strategies hosted the first of three webinars to address key provisions of the American Rescue Plan Act of 2021. The $1.9 trillion budget reconciliation package was signed into law by President Biden on March 11. The bill is wide-ranging, seeking to support Americans as we continue to recover from the fallout of the COVID-19 pandemic and economic downturn. The first webinar explored changes to private insurance, including Marketplaces. Tax expert Jason Levitis and Joel Ario from Manatt Health explored the premium tax credit changes and COBRA subsidy and outlined decision points for state policymakers and consumers.
On Friday, March 12, State Health and Value Strategies will host the first of two webinars to address key provisions of the American Rescue Plan package. The $1.9 trillion reconciliation budget bill is moving quickly through Congress. The bill is wide-ranging, seeking to support Americans as we continue to recover from the fallout of the COVID-19 pandemic and economic downturn. This first webinar will explore changes to private insurance, including Marketplaces. Tax expert Jason Levitis and experts from Manatt Health will explore the premium tax credit changes and COBRA subsidy and outline decision points for state policymakers and consumers.
This expert perspective reviews key considerations for states exploring Marketplace insurance subsidies and highlights the experiences in the five states that have established state-based subsidies that supplement the ACA’s premium tax credit and cost-sharing reductions.
On March 11, 2021, President Biden signed an approximately $1.9 trillion COVID-19 relief bill—the American Rescue Plan Act of 2021 (“the American Rescue Plan”). The American Rescue Plan includes myriad health care provisions, focused primarily in two areas: first, it provides funding the Biden Administration requested to carry out its COVID-19 response plans; second, it enacts significant but largely temporary coverage policies. This expert perspectives provides a high-level overview of the private insurance and Medicaid coverage provisions included in the American Rescue Plan.
The American Rescue Plan Act includes several vital provisions that would make comprehensive coverage more affordable and accessible for millions of people. The COVID-19 relief law enhances for two years premium tax credits available through the health insurance marketplaces, boosts financial incentives for additional states to rapidly expand Medicaid, and takes other steps to improve access to health coverage during the health and economic crisis.
The economic shutdown due to COVID-19 prompted an unprecedented spike in unemployment, with more than 33 million people filing claims since mid-March. The Affordable Care Act’s (ACA) marketplaces, along with Medicaid, are important tools in covering the newly uninsured.
In accordance with the Executive Order issued on January 28 by President Biden, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced a Special Enrollment Period (SEP) for individuals and families for Marketplace coverage in response to the COVID-19 Public Health Emergency, which has left millions of Americans facing uncertainty and exceptional circumstances while millions of Americans have experienced new health problems during the pandemic. This SEP will allow individuals and families in states with Marketplaces served by the HealthCare.gov platform to enroll in 2021 health insurance coverage. Beginning February 15, 2021 and through May 15, 2021, these Marketplaces will operationalize functionality to make this SEP available to all Marketplace-eligible consumers who are submitting a new application or updating an existing application. State-based Marketplaces (SBMs) operating their own platform have the opportunity to take similar action within their states.
Several COVID-19 vaccines could be on the market soon. State and federal officials have begun devising strategies for distributing and administering the vaccine and communicating with the public, but an equally important element will be the extent to which health care payers, including private insurers, will cover the costs for recipients. The Affordable Care Act (ACA) requires that most health insurers and employer health plans cover certain preventive services without cost-sharing, including vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). However, ensuring that a COVID-19 vaccine is a free preventive service for all who need it, when they need it, is by no means guaranteed. This expert perspective discusses recent federal efforts to expand private insurance coverage of a vaccine, and provides a roadmap for states to close remaining coverage gaps that could inhibit vaccine uptake.
This year has presented many unique and unexpected challenges, but as open enrollment approaches states are making concerted efforts to connect residents with public and private health coverage options and are anticipating more churn between programs than ever before amid the COVID-19 public health crisis. Millions have filed for unemployment since the pandemic began, many losing their employer-sponsored health coverage or experiencing income loss in the process. As consumers navigate ongoing changes in their income or health coverage, it is more important than ever to clearly communicate with consumers what health coverage options are available for the remainder of 2020 and heading into 2021. This expert perspective lays out key takeaways on messaging to consumers to enroll in coverage this OEP and highlights examples from two states.
A new open enrollment landscape created by the continued health and economic impacts of the COVID-19 pandemic, a national movement calling for racial justice, and the concurrent timing of a presidential election year is raising new challenges for states as they plan outreach and enrollment campaigns. Marketplaces are reimagining their campaign strategies to meet this moment, with plans to operationalize virtual activities, communicate with new and existing audiences, and reflect changing consumer behaviors in their outreach tactics. This expert perspective highlights strategies from SHVS’ 2-part webinar series on preparing for OEP 2021 and features several strategies states can pursue to help ensure a successful open enrollment period this year.
On Wednesday, July 22, State Health and Value Strategies hosted part II of the Preparing for OEP 2021 webinar series that provided a deep dive into effective strategies to consider as states design their outreach and education campaigns for OEP 2021 in a shifting health care environment. Presenters from GMMB explored how the impacts of COVID-19 should inform the marketplace’s tactical campaign approaches for virtual outreach and partnership engagement, digital and social platform usage, and paid advertising and earned media. Participants also heard insights from several state officials from state-based marketplaces along the way. Topics for discussion included coordinating with state agencies, engaging micro-influencers, leveraging social media live streams, hosting virtual enrollment events, developing advertising buys, and considering new earned media hooks. This webinar included a question and answer session during which webinar participants can pose their questions to the experts on the line.
CCIIO updated its FAQs on risk adjustment for telehealth and telephone services during COVID-19. The FAQs clarify which telehealth and telephone service codes are valid for data submissions for the HHS-operated risk adjustment program.
CCIIO issued guidance outlining temporary flexibilities that allow:• Issuers in the individual and small group markets to offer temporary premium credits for individuals, families and small employers that may struggle to pay premiums because of illness or loss of incomes or revenue resulting from COVID-19. When consistent with state law, issuers may offer premium reductions for one or more months of 2020 coverage. • States to permit issuers to provide premium credits in the same manner (i.e., CMS will not consider a state to have failed to substantially enforce applicable federal requirements).This temporary policy will be in effect until the end of 2020. Issuers wishing to provide premium credits for 2020 coverage must, in advance of providing these credits, receive the applicable regulator’s permission to provide premium credits as outlined in this bulletin, or CMS’s permission in states where CMS is the primary enforcer of the applicable federal requirements.
The Departments of Health & Human Services, Labor, and Treasury (collectively, the “tri-agencies”) published guidance on April 11 in attempt to clarify some of the testing coverage requirements under FFCRA and the CARES Act. However, as calls have increased for more widespread and frequent testing, particularly of at-risk populations such as health care workers, residents and staff of long-term care facilities, and people potentially exposed at protests or rallies, insurers have questioned their responsibility to cover all testing in all circumstances.On June 23, the tri-agencies published new guidance that attempts to answer implementation questions from states, plans, and insurers, including the definition of “medically necessary”, surveillance or workplace related testing, coverage of hospital “facility fees”, and protections against provider balance billing.
The Centers for Medicare & Medicaid Services (CMS) today released the Early 2020 Effectuated Enrollment Report for the Federally-facilitated Health Insurance Exchange. The report confirmed that for the third year in a row, enrollment has remained steady and the number of consumers who paid for coverage in February 2020 increased compared to February 2019. Effectuated enrollment data is a measure of the number of consumers who selected a plan and have taken the additional steps necessary to keep their coverage in effect.
This expert perspective highlights examples employed by DC Health Link, the Oregon Health Authority, and beWellnm and the community-centered outreach they are using to actively enroll and connect consumers to care. The expert perspective also includes best practices surfaced for marketplaces and agencies to adapt their COVID-19 communications and outreach—and beyond—to ensure those with inequitable access to health coverage are prioritized and supported.
CMS released a trends report indicating that 487,000 individuals signed up for coverage on Healthcare.gov through the existing “loss of Minimum Essential Coverage” special enrollment period (SEP) in April and May, representing an increase of 46% from the same time period last year. [moved this sentence to be the final sentence] The Administration did not establish a new SEP in response to the COVID-19 pandemic—a decision that the City of Chicago is challenging in court and a host of Democratic Attorneys General and the House of Representatives have supported. [do we need a link to source for this final statement? totally defer to your typical process]
The COVID-19 pandemic has introduced new challenges for Navigators. To learn more about their experience, and how they are helping consumers manage often unexpected transitions in coverage, this blog post highlights conversations with six navigators across five states using the FFM to hear how they were faring.
The Center for Consumer Information & Insurance Oversight (CCIIO) issued guidance to sponsors of non-federal governmental plans clarifying the following policies:- Requirement to cover COVID-19 Diagnostic Testing and Certain Related Items and Services without Cost Sharing or Medical Management. T- Temporary Period of Relaxed Enforcement of Certain Timeframes Related to Group Market Requirements under the Public Health Service Act (PHS Act).- Expanding and Promoting Access to Telehealth Options and Prescription Drugs during the COVID-19 Outbreak.
As the COVID-19 crisis began to take hold, state-based marketplaces (SBMs) were quick to respond to the first nationwide public health emergency since the Affordable Care Act created new coverage options in states. Informed by conversations with seven SBMs that established an SEP—Colorado, Maryland, Massachusetts, Nevada, New York, Rhode Island and Washington—this expert perspective highlights strategies that successfully drove enrollment, including: leveraging their SBM status to quickly and efficiently operationalize customer service in a new remote environment, directly engaging with existing customers as well as reaching out broadly to new ones, and adapting outreach tactics based on new insights regarding audience needs and behaviors to reach them most effectively.
A paper by the Brookings Institute This paper uses survey data to examine how many people exiting employer coverage become uninsured in normal times, and how the share that become uninsured has changed since implementation of the Affordable Care Act. The authors also make a series of policy recommendations to better support enrollment into Medicaid or Marketplace coverage after a loss of job-based insurance.
State-based health insurance marketplaces have created new opportunities for people to get covered and have made extra efforts to reach the uninsured
This Health Affairs blog post highlights states’ policy responses to the COVID-19 pandemic, as well as their proactive approaches to addressing a wide range of health concerns.
This Health Affairs blog post describes potential policies to address the rate review process for plans sold on the individual market in light of the COVID-19 pandemic.
An analysis on national and state-level estimates of coverage changes if unemployment rates rise from precrisis levels (around 3.5 percent nationally) to 15 percent, 20 percent, or 25 percent.
CARES Act Provider Relief Fund General Distribution FAQs
This expert perspectives provides an overview of strategies that states can consider to help address gaps in coverage to ensure as many people as possible get access to comprehensive care as the country continues to respond and recover from the COVID-19 health and economic crisis.
This webpage, developed by the Pennsylvania Department of Insurance highlights FAQs and provides coverage information to consumers who have lost their jobs.
Tri-agency guidance extending COBRA, SEP, and other group plan timelines due to COVID-19
This expert perspective summarizes the federal legislation and guidance and discusses actions state departments of insurance can take to encourage greater access to telehealth services.
The University of Minnesota COVID-19 Health Insurance Model (MN-HIM) estimates the number of people at who lost employer-sponsored health insurance (ESI) during the four-week period ending on April 11, 2020. In developing this model SHADAC aimed to create both national and state-level estimates as well as provide a further breakdown between policyholders (age 18-64) and their dependents (adults and children).
This expert perspective considers the policy implications and challenges for states and discusses potential state measures to address sensitive implementation challenges given interactions with eligibility for health care programs and CARES Act unemployment insurance expansion and stimulus payments.
Webinar recording and slide deck from webinar hosted on March 18, 2020.
In response to the COVID-19 pandemic, the federal government is moving rapidly to help states and health care providers respond to mounting needs for new sources of funding and flexibility. Congress has passed three COVID-19 stimulus bills, and the U.S. Department of Health and Human Services has issued guidance outlining new flexibilities available to states and providers, and is working to approve additional requests from states, to award funds appropriated by Congress, and to issue more guidance about such funding. This Q&A provides a moment-in-time update in response to questions SHVS has received about the federal government’s response.
CCIIO issued an FAQ for commercial health insurance issuers on flexibilities related to utilization management and prior authorization.
Webinar slides and recording that explores the key health care provisions in the second COVID-19 stimulus bill.
An expert perspective about state actions to extend grace periods, during which insurance coverage cannot be cancelled for non-payment of premiums, in the individual market in response to the COVID-19 pandemic. This piece highlights the risks to consumers of extending traditional grace periods, when not paired with additional protections, and suggests a range of options for addressing the limitations of grace periods. It also provides a primer on this important issue and describes a couple of wrinkles under the Affordable Care Act (ACA).
New joint guidance from the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury that addresses questions on the Families First and CARES Acts requirements on coverage of COVID-19 related testing services, including, for example, the requirement to cover (without cost sharing) diagnostic tests to rule out other conditions such as influenza.
Federal Guidance on the Families First and CARES Act Legislation
CMS’ toolkit includes CMS and HHS materials on COVID-19.
Information on federal tax provisions, guidance, and operational changes responding to COVID-19.
IRS Notice allowing HDHPs to waive cost-sharing for COVID-19 testing & treatment.
Plain-Language Information about Coverage Options, Eligibility, and COVID-Related Benefits
CCIIO guidance on COVID-19 coverage and catastrophic plans
CCIIO FAQs on telehealth coverage
CCIIO guidance on Rx coverage and COVID-19.
CCIIO guidance on grace periods.
Compilation of COVID-19 FAQs on private insurance issues.
Recordings and transcripts of CMS calls on COVID-19 with states and other stakeholders
Compilation of resources for state on Medicare, Medicaid, and CHIP, including transcripts and recordings of all-state calls
A state-by-state compendium of actions related to COVID-19 coverage.
Summary of Key Healthcare Provisions in the Second COVID-19 Stimulus Bill.
Interactive 50-state map on state DOI actions re: COVID-19
NY allowed out-of-state providers and providers in New York that are not currently registered to provide telehealth services.
NY waived cost-sharing for telehealth visits with in-network providers.
AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March.
AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March.
AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March.
AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March.
AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March.
In MA, through executive order, Governor Baker expanded access to telehealth services in all commercial insurers and MassHealth programs, waived all cost-sharing for any medically necessary treatment delivered via telehealth related to COVID-19 at in-network providers, waived any prior authorization barriers needed to obtain medically necessary telehealth services, and established a 24-hour process to allow medical professionals to receive a license to practice in Massachusetts