Did You Miss Them? Top State Health and Value Strategies Publications From 2022

By Heather Howard and Sally Mabon, State Health and Value Strategies

States remained at the center of health policy action again in 2022. As the pandemic entered its third year, states have been planning in earnest for the unwinding of the federal public health emergency (PHE). They have also been exploring innovative ways to improve the health and well-being of Medicaid enrollees through new Section 1115 Medicaid demonstrations and leveraging Medicaid to advance health equity. At State Health and Value Strategies we have been busy supporting states in these efforts, and wanted to share a selection of publications and resources on these topics and more.

Helping States Prepare for the Unwinding of the Public Health Emergency

Medicaid enrollment has increased by over 19 million people during the pandemic, due largely to the continuous coverage requirement, which prohibits states from disenrolling almost all individuals from Medicaid. At the end of the PHE, states will no longer be subject to the continuous coverage requirement, and a projected 15 million people, or 17% of current Medicaid/CHIP enrollees, are at risk of losing health coverage. The following resources were designed to help states prepare for what will be the largest coverage event since enactment of the Affordable Care Act (ACA), and one with significant equity implications in the absence of strategies that minimize the loss of coverage.

• Unwinding of the Public Health Emergency: What’s Next for States. This webinar reviewed making permanent or terminating temporary COVID-19 flexibilities and returning to normal eligibility and enrollment processes. Presenters highlighted the intersection with our dynamic policy environment.
• Planning for the End of the Continuous Coverage Requirement: Communications Resources for States. This set of pages provides communications resources—including template notices and a message guide—designed to support states as they prepare for the various stages of work needed to inform stakeholders and consumers about the upcoming end of the Medicaid continuous coverage requirement.
• Supporting Continuity of Coverage from Medicaid into the Marketplace: Post-PHE Considerations for States. This expert perspective highlights state strategies to maximize continuity of coverage for consumers coming off Medicaid and needing to transition to the marketplace and focuses both on minimizing gaps in coverage and on maximizing successful enrollment overall.

Supporting State Innovation

States continue to leverage powerful tools to advance the health of their residents. Recent Section 1115 Medicaid demonstrations represent innovative new efforts to finance programs addressing health-related social needs. States also continue to incentivize Medicaid managed care entities to address health disparities and the unmet social needs that contribute to poor health outcomes. Finally, as the ACA’s preventive services benefit faces challenges in federal courts, states are exploring ways to ensure their residents maintain coverage of these essential services.

• Recent Updates to Section 1115 Waiver Budget Neutrality Policy: Overview and Implications for States. This issue brief summarizes the key policy changes established through the Oregon and Massachusetts Section 1115 waiver renewals (and reinforced through the Arizona and Arkansas approvals) and discusses key implications for states.
• Addressing Health-Related Social Needs Through Medicaid Managed Care. This toolkit identifies examples of approaches states are taking through their Medicaid managed care programs to address health-related social needs. States interested in implementing specific strategies related to social determinants of health can use this toolkit to develop managed care procurements or update and operationalize key contract provisions.
• Federal Court Decision Threatens the ACA’s Preventive Services Benefit: State Options to Mitigate Harm to Consumers. This expert perspective examines the potential implications of the Braidwood Management Inc. v. Becerra ruling for the ACA and the opportunities available to states to mitigate the impact on consumers.

Advancing Health Equity

As COVID has laid bare the health disparities rooted in structural racism, states have recognized the importance of collecting and monitoring data that is disaggregated by race, ethnicity, and language and the value of leveraging managed care contracts to advance equity. Also, in recognition of the burden the pandemic has placed on people who are uninsured, state policymakers are increasingly focused on strategies to increase access to affordable healthcare coverage for non-citizen populations. Finally, the worsening maternal health crisis looms large for state health officials, especially since Medicaid accounts for 75% of all public expenditures for family planning services and covers close to half of all births nationally.

• Collection of Race, Ethnicity, Language (REL) Data on Medicaid Applications: New and Updated Information on Medicaid Data Collection Practices in the States, Territories, and District of Columbia. This issue brief documents how race, ethnicity and language data are collected by the Medicaid programs in the 50 U.S. states, the District of Columbia, and five U.S. territories.
• Reaching Non-Citizen Communities: Resources to Support State Outreach and Education to Drive Healthcare Enrollment. The resources in this toolkit were designed to support outreach and education efforts to drive enrollment in new or existing health coverage programs for non-citizens; they were informed by research and developed for states to customize based on their unique needs, program eligibility criteria, and environments.
• State Strategies to Improve Maternal Health and Promote Health Equity Compendium. This compendium provides information on strategies to improve maternal health outcomes and synthesizes research about the national state-of-play, including state examples, across four domains: maternal health models, quality improvement, workforce and benefits, and eligibility and enrollment/coverage expansion.
• Medicaid Managed Care Contract Language: Health Disparities and Health Equity. This document provides excerpts of health disparities and health equity language from Medicaid managed care contracts and requests for proposals from 17 states and the District of Columbia.