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.|
As a condition of receiving enhanced federal funding under the Families First Coronavirus Response Act (FFCRA), states are prohibited from terminating individuals enrolled in Medicaid as of March 18, 2020, or determined eligible on or after that date. These continuous coverage requirements run through the end of the month of the public health emergency (PHE), which was recently extended to October 22, 2020. Absent a further extension of the PHE, states have three months to implement a plan for unwinding the FCCRA continuous coverage requirements which are otherwise set to terminate on October 31, 2020. States will also need to identify which newly obtained eligibility and enrollment flexibilities they would like to make permanent beyond the termination of the PHE–especially in the context of emerging information that suggests that the duration of COVID-19 pandemic may extend well into 2021.
States quickly mobilized to implement emergency federal authorities (e.g., Section 1135 waivers, 1915(c) Waiver Appendix K, emergency Section 1115 waivers) and state-level regulatory flexibilities to respond to the COVID-19 pandemic; now they must determine which flexibilities to scale back or sustain, taking into account fiscal implications. The interaction of the stimulus package dates, the Public Health Emergency, and the President’s National Emergency Declaration, among other factors, are complex, and states are actively grappling with decision making regarding which flexibilities they need and want to keep, and how. This Excel workbook is intended to serve as a tool for states as they strategize about reopening and plan for the next phase of the COVID-19 pandemic. Specifically, states can utilize this template to conduct both a primary analysis as they determine which flexibilities to unwind or maintain and a secondary analysis to plan for operational and implementation implications. The workbook has been updated to reflect the renewal of the Public Health Emergency as of July 23, 2020.
COVID-19 has significantly reduced health care utilization in the United States. Of great concern to states is that Medicaid beneficiaries safely access medically needed services. There are already worrisome indications that many beneficiaries are not receiving such care and it is incumbent on states to take steps with their Medicaid plans to make sure needed services are delivered during the course of the pandemic. This expert perspective recommends three categories of state Medicaid program activities to facilitate the delivery of needed services.
On Friday, July 10, State Health and Value Strategies hosted a webinar during which experts from Manatt Health presented key findings from a new COVID-19 state resource guide, funded by The SCAN Foundation. People who use long-term services and supports (LTSS), including individuals dually-eligible for Medicare and Medicaid, are particularly vulnerable to contracting COVID-19. COVID-19 has had a devastating impact on people with complex care needs receiving care in nursing homes and other congregate care settings, in particular. In the resource guide, Manatt Health identifies federal and state Medicaid flexibilities available to state officials and other stakeholders and how those flexibilities are being deployed during COVID-19 to help ensure access to LTSS. The webinar provided examples of how states are ensuring continued access to LTSS by expanding the types of settings in which services can be delivered, bolstering pay and other supports for LTSS providers, and addressing barriers to care created by the COVID-19 pandemic.
On Thursday, June 4, State Health and Value Strategies (SHVS) hosted a webinar during which experts from Manatt Health discussed the fiscal implications for states and Medicaid programs of the COVID-19 pandemic, the emerging economic downturn, and recent legislation to address these twin crises, including the Families First Coronavirus Response Act (“Families First”) and the Health and Economic Recovery Omnibus Emergency Solutions (“HEROES”) Act. The Databook is a follow-on product to the webinar. As discussed in the Overview, each table in the Databook displays projected changes in federal and state Medicaid and CHIP expenditures during calendar years 2020 and 2021 across all fifty states and the District of Columbia for a given scenario and policy response. Taken together, the Databook provides estimates that span across a range of plausible scenarios reflecting increased enrollment and per enrollee spending growth and changes to the duration of the federal Public Health Emergency.
A brief by the Kaiser Family Foundation examines how much fiscal relief states can expect from the increase in the FMAP under FFCRA under different assumptions about the duration of the relief, how the FMAP increase provides broad fiscal relief to states and the factors that affect how much relief is available across states.
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.
The Urban Institute simulates the potential changes in health insurance coverage due to skyrocketing unemployment rates. The analysis estimate that 10.1 million people will lose employer coverage tied to a lost job. Of those individuals, Urban estimates that 28 percent will enroll in Medicaid and 3.5 million people will become uninsured.
The COVID-19 pandemic is a public health crisis that has triggered an economic crisis. While the federal government acted to provide financial relief, states have faced significant growth in expenditures in response to the pandemic, as well as simultaneous and severe drops in revenue. This expert perspective provides a snapshot of how states are navigating the known and unknown fiscal challenges of the COVID-19 pandemic, given declining revenues and rising spending demands in the context of balanced budget requirements. The strategies that states employ to address the fiscal fallout of COVID-19, will have significant and long-lasting implications for critical health care and safety net programs.
On June 9, the U.S. Department of Health and Human Services (HHS) announced the allocation of $15 billion in funding to be distributed to Medicaid/CHIP providers who did not receive a payment from the $50 billion General Distribution. The below table summarizes the funding allocations, eligibility requirements, and the process to apply. Medicaid/CHIP providers must apply no later than August 3, 2020 (this deadline was formerly July 20, which was extended on July 17). We encourage all Medicaid providers that may be eligible to begin the application process as soon as possible by submitting their Tax Identification Number (TIN) through the CARES Act Provider Relief Fund Attestation Portal.
HRSA issued an updated FAQs for its Claims Reimbursement for COVID-19 Care of the Uninsured program. The July 7 update clarified the methodology for reimbursing claims attributable to Medicaid enrollees with limited benefits
CMS issued dozens of new COVID-19 FAQs for state Medicaid/CHIP agencies addressing questions related to a range of topics (e.g., Presumptive Eligibility, premiums and cost sharing, optional COVID-19 testing group and coding guidance)
Responses to CMS’ questions regarding NH’s directed payment
Responses to CMS’ questions regarding NH’s directed payment
Letter from CMS to NH notifying the state of approval of their directed payment
New Hampshire directed payment preprint submission to CMS
States quickly mobilized to implement emergency federal authorities (e.g., Section 1135 waivers, 1915(c) Waiver Appendix K, emergency Section 1115 waivers) and state-level regulatory flexibilities to respond to the COVID-19 pandemic; now they must determine which flexibilities to scale back or sustain, taking into account fiscal implications. The interaction of the stimulus package dates, the Public Health Emergency, and the President’s National Emergency Declaration, among other factors, are complex, and states are actively grappling with decision making regarding which flexibilities they need and want to keep, and how. This Excel workbook is intended to serve as a tool for states as they begin to strategize about reopening and plan for the next phase of the COVID-19 pandemic. Specifically, states can utilize this template to conduct both a primary analysis as they determine which flexibilities to unwind or maintain and a secondary analysis to plan for operational and implementation implications.
On Thursday, June 4, State Health and Value Strategies hosted a webinar during which experts from Manatt Health presented key results from a financial model examining the Medicaid fiscal implications of the interaction between the COVID-19 pandemic, the emerging economic downturn, and recent policy changes. States and Medicaid programs are entering a time of substantial fiscal uncertainty as they continue to respond to the COVID-19 pandemic while also preparing for a potentially severe recession that is expected to lead to significant budget shortfalls and surges in Medicaid enrollment. During the webinar, Manatt discussed key considerations for states as they develop their own internal forecasts and plan for the challenging times ahead.
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.
Memo from Milliman to Henry Lipman, New Hampshire’s Medicaid Director, presenting updated rates for September 1, 2019 through June 30, 2020, certification of their actuarial soundness, and a description of how New Hampshire established and will administer the new provider payment pool for the directed payments.
CMS hosted an all-state call on June 16th that reviewed key dates for termination of COVID-19 flexibilities and clarified issues related to retaining Meidcaid state plan flexibilities adopted during the public helath emergency once the emergency ends.
HRSA’s Health Center Program released updated COVID-19 FAQs for health centers. The updated FAQs include guidance:• Reminding health centers of their responsibility to seek reimbursement for their costs from third-party payors , and apply their sliding fee discount programs. Third-party payors may have cost-sharing which allows health centers to charge patients for co-payments or coinsurance;• Clarifying that health centers are permitted to request reimbursement through the HRSA COVID-19 Claims Reimbursement for Testing and Treatment of the Uninsured Program but are prohibited from “balance billing” patients for any cost-sharing payments if they do so;• Noting the expectations for health centers to develop and maintain an emergency preparedness communication plan as well as annual training and testing programs.
The short-term bump in federal funding granted to states are welcome fiscal relief, but as the depth of the economic crisis becomes clearer, so does the need for additional and more-targeted support.
To help states respond to the ongoing coronavirus (COVID-19) pandemic, the White House, the U.S. Department of Health and Human Services, and the Centers for Medicare and Medicaid Services have invoked various emergency authorities that allow for temporary flexibilities in the Medicaid and the Children’s Health Insurance Program programs. Congress also has passed legislation that provides additional federal support for state Medicaid programs, subject to certain conditions. The table describes the effective dates of these various provisions as well as the expiration timeline dictated by law or agency guidance; the table also includes current end dates, which are subject to change as federal and state officials take actions to renew or terminate particular authorities.
HRSA created a Coronavirus-related funding FAQ resource page for health centers, providing new information on required progress reports related to the receipt of Coronavirus-related funding awards. Progress reports must include narrative updates on activities related to testing, maintaining or increasing health center capacity and telehealth, among others. The first progress reports will be available for awardees starting July 1, with a submission date of July 10.
The state of Rhode Island submitted a waiver to CMS to use Medicaid funds to provide food, housing, and mobile phone minutes for people who are housing insecure.
CMS issued guidance to states regarding implementation of the Medicaid Optional COVID-19 Testing (XXIII) Group established by the Families First Coronavirus Response Act (FFCRA) for uninsured individuals for COVID-19 testing and testing-related services. This guidance outlines the requirements associated with implementing the new group (including eligibility and enrollment, claiming, and data reporting), and provides guidance on strategies that states may employ to meet these requirements. The guidance also clarifies interactions between the XXIII group and the HRSA COVID-19 Uninsured Program for testing (and treatment) provided to uninsured individuals.
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.
On Thursday, May 21, State Health and Value Strategies hosted a webinar that reviewed potential information technology (IT) investments in responding to COVID-19 and strategies for states to support these investments. As states face the extraordinary challenges of the COVID-19 crisis, IT is an essential tool to support access to health coverage and the safe and effective evaluation, testing, and treatment of patients nationwide. The webinar outlined strategies states can employ to secure current and potential IT investments that enable ongoing Medicaid program operations and advance health information exchange.
As states face the extraordinary challenges of the COVID-19 crisis, information technology (IT) is an essential tool to support access to health coverage and the safe and effective evaluation, testing, and treatment of patients nationwide. Under the current statutory and regulatory framework, state Medicaid agencies are authorized to receive federal funding for Medicaid IT and associated activities, and much of it at an enhanced federal matching level. This issue brief outlines potential IT investments in responding to COVID-19 and strategies for states to support these investments, as well as secure current and future IT investments that enable Medicaid program operations. The issue brief also highlights the Medicaid authorities and the provisions that may allow states more expeditious access and flexible use of these funds.
According to a new analysis by Families USA, in April and May, states began to experience dramatic increases in Medicaid enrollment. This is important context as Congress considers additional proposals that would increase federal matching rates for Medicaid and other flexible funding to relieve some of the pressure on state budgets
The COVID-19 pandemic continues to evolve and bring about significant–and rapidly occurring–changes in care delivery. As a result, states are examining their Medicaid managed care incentive arrangements to evaluate the impact of COVID-19 on their health care quality and cost performance requirements. This expert perspective identifies actions federal and state policymakers have taken to address the impact of COVID-19 on their managed care performance incentive programs, and 2020 quality and total cost of care performance. The examples detailed in the expert perspective can be used to inform state decisions on whether and how to modify Medicaid managed care reporting and performance incentives as a result of COVID-19.
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 issue brief provides insights into the current picture of Medicaid spending and enrollment, as Congress considers providing additional fiscal relief through the federal Medicaid match rate. Nearly all states anticipate growing Medicaid enrollment and spending during fiscal years 2020 and 2021.
On Thursday, April 9 at 2:00 p.m. ET, State Health and Value Strategies hosted a webinar during which experts from Manatt Health walked through tools states can use to increase payments to providers through both fee-for-service and Medicaid managed care, despite COVID-19 driven changes to utilization. As the COVID-19 pandemic continues to progress, providers across the continuum of care are experiencing significant changes in utilization resulting in declining revenue and jeopardizing access to care. The federal government has acknowledged the financial challenges facing providers through supplemental funding included in the three federal stimulus bills enacted to date and several states have submitted Section 1115 waivers requesting CMS approval to establish “disaster relief funds,” paid for with Medicaid dollars, to further assist providers. States are increasingly seeking innovative strategies to leverage Medicaid authorities to support the essential and vulnerable providers on the frontlines of the 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.
The California Department of Health & Human Services (DHCS) conducted a survey to gauge county operations during the public health emergency. Results found that all county offices remain available by phone, 60% are open to the public, 40% are available for in-person application interviews and some have developed inventive ways to ensure customer needs are met.
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.
The guidance document outlines COVID-19 emergency declaration “blanket waivers” for healthcare providers and is regularly updated by CMS. Recent updates include: – Revising the existing “”physical environment”” waivers for hospitals to support activities related to both surge capacity and appropriate quarantining and to clarify that it does not modify hospitals’ obligations under the Americans with Disabilities Act (ADA), to “avoid subjecting persons with disabilities to unjustified institutionalization or segregation
CMCS issued an informational bulletin (CIB) to provide states with guidance about temporarily modifying provider payment methodologies and capitation rates under their Medicaid managed care contracts to address the impacts of the public health emergency. The guidance enumerates several options states could choose to adopt and details example state proposals in an appendix. States may effectuate these actions through managed care contract amendments, rate amendments, and state directed payment preprints and CMS noted it is continuing to prioritize and expedite reviews of these COVID-19 related managed care actions.
On Wednesday, April 29 State Health and Value Strategies hosted a webinar, State Strategies to Support Medicaid/CHIP Eligibility and Enrollment in Response to COVID-19. Many states are experiencing an increase in the volume of Medicaid applications due to the COVID-19 pandemic and the resulting economic crisis. During the webinar experts from Manatt Health reviewed strategies states can use to manage and process an increased number of Medicaid applications, and the federal authorities that permit states to do so. Communications experts from GMMB reviewed strategies for messaging to new and existing enrollees.
As the COVID-19 pandemic continues to progress, providers across the continuum of care are experiencing significant changes in utilization resulting in declining revenue and jeopardizing access to care. The federal government has acknowledged the financial challenges facing providers through supplemental funding included in the three federal stimulus bills enacted to date. In addition, several states have submitted Section 1115 waivers requesting CMS approval to establish “disaster relief funds,” paid for with Medicaid dollars, to further assist providers. While it will take some time for waiver requests to be reviewed and for the new federal funds to be released, more immediately available tools can help ensure payments continue flowing to providers despite substantial utilization changes. This Q&A provides a moment-in-time update in response to questions SHVS has received regarding the April 9 Targeted Options for Increasing Medicaid Payments to Providers During COVID-19 Crisis Webinar and corresponding Toolkit.
This webpage, developed by the Pennsylvania Department of Insurance highlights FAQs and provides coverage information to consumers who have lost their jobs.
The Pathways to Coverage for COVID-19 Testing and Treatment for Adults toolkit provides an overview for states of various coverage pathways for individuals, including those who are uninsured, in need of COVID-19 testing and treatment. The toolkit provides varying pathways for Medicaid expansion and non-expansion states.
A recent analysis by the Urban Institute estimates eight different FMAP increase approaches and how they would affect the amount of fiscal relief states would receive.
CMS is implementing modifications to the Medicare Shared Savings Program (MSSP), including to the calculation of shared losses, quality reporting requirements, timelines for increasing financial risk, and the financial methodology for determining benchmark year and performance year expenditures.
As the coronavirus (COVID-19) crisis continues, state Medicaid and Children Health Insurance Program (CHIP) agencies are rapidly pursuing multiple financing strategies to support their responses. CHIP Health Services Initiatives (HSIs) can provide additional financial support to states and local communities serving low-income children. This issue brief provides an overview of CHIP HSIs and identifies ways that states can leverage them as part of their targeted response to the COVID-19 pandemic.
The COVID-19 pandemic is causing dramatic changes in utilization that threaten the financial stability of providers and may jeopardize access to care during and after the national emergency. With elective cases generally cancelled, hospitals have sharply lower utilization and revenue. Some hospitals in hotspots are seeing a surge in COVID-19 related usage, which may offset some or all of the revenue decline and in some cases increase their costs. In addition, many other providers that rely on face-to-face visits—including primary care, behavioral health, and providers of long-term services and supports—are seeing large utilization declines due to social distancing requirements. Federal and state governments have acknowledged and responded to the financial challenges facing providers in several different ways. While it will take some time for waiver requests to be reviewed and for the new federal funds to be released, this toolkit identifies more immediately available tools that can help ensure payments continue flowing to providers despite substantial utilization changes.
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.
Manatt Health’s analysis of CMS’ guidance for states about new increased Medicaid and CHIP matching rate.
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.
In addition to prohibiting new eligibility restrictions, the Families First MOE prevents states from terminating people’s coverage during the public health emergency. This “continuous coverage” provision not only guarantees that people will be able to access needed care during the pandemic, but also allows state agencies operating with reduced capacity to prioritize enrolling people who lose their jobs and job-based coverage over requiring people to prove they remain eligible.
The COVID-19 pandemic is causing considerable stress on state budgets because of both increasing expenditures and declining revenues. Unlike the federal government, states cannot incur deficits. In this paper, we estimate the fiscal impacts of several approaches for increasing federal Medicaid matching rates, providing state-level estimates for each approach.
An article by CBPP that examines how expanding Medicaid in the public health crisis could allow people to enroll in Medicaid coverage as early as June or July. In addition, retroactive coverage for people signing up this summer and found to be eligible could cover medical costs — including COVID-19 treatment — incurred up to three months prior to actual enrollment.
Webinar slides and recording that explores the key health care provisions in the second COVID-19 stimulus bill.
Medicaid memo to providers summarizing changes to program requirements, including expansion of telehealth coverage, provider licensure, and prior authorization for services, during the COVID-19 crisis. Content on behavioral health was updated in a subsequent memo.
TennCare Guidance on EPSDT/Well Child Visits during COVID-19
This memo clarifies a section of the earlier Medicaid provider memo on flexibilities offered to providers of behavioral health and addiction and recovery treatment.
CMCS issued new Medicaid FAQs regarding the new optional COVID-19 testing Medicaid eligibility group, benefits and cost-sharing for COVID-19-related testing and diagnostic services, the increased FMAP available under Section 6008 of the FFCRA, and other FAQs
This expert perspective, written by experts at Manatt Health, discusses strategies state Medicaid and CHIP agencies can pursue as part of their response to COVID-19.
CMS issued a revised FAQ for state Medicaid and CHIP agencies, initially issued on March 12. The May 5-issued FAQ provides additional guidance on available waiver and state plan amendment authorities during the COVID-19 public health emergency, the Basic Health Plan program, presumptive eligibility categories for Medicaid plans, member enrollment flexibilities during the public health emergency, terms for states receiving the previously announced 6.2 percentage point FMAP increase, and other topics.
This guidance allows practitioners further flexibility in prescribing and dispensing buprenorphine to new and existing patients with opioid use disorder via telephone without examination in person or via telemedicine.
In light of the growing number and diversity of approved 1135 waivers, this Q&A document provides a general primer on Section 1135 to help healthcare stakeholders understand the scope of what HHS and CMS can and cannot do under this emergency authority.
Plain-Language Information about Coverage Options, Eligibility, and COVID-Related Benefits
NCQA has made modifications to HEDIS and accreditation requirements for Medicaid and Commercial plans related to COVID19.
CMS released guidance for rural health care and Medicaid agencies on telehealth flexibilities provided by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act.
Recordings and transcripts of CMS calls on COVID-19 with states and other stakeholders
This bulletin summarizes flexibilities to New York’s Medicaid eligibility and enrollment system–including for new Medicaid applications and eligibility renewals.
MA developed an All Provider Bulletin that summarizes the State’s Hospital-Determined Presumptive Eligibility process.
MA developed a managed care plan bulletin that outlines requirement’s for coverage and billing related to COVID-19.
Summary of Key Healthcare Provisions in the Second COVID-19 Stimulus Bill.
This FAQ includes guidance for behavioral health providers, partners, and the greater community to develop coordinated prevention and response plans for 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.
MS Division of Medicaid is allowing beneficiaries to access telehealth services from home; promoting the use of personal cellular device, computer, tablet, or other web camera-enabled device to seek and receive medical care; and waiving limitation of the use of audio-only telephonic conversations until April 30, 2020.
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