Coronavirus (COVID-19) Unwinding Federal Medicaid Flexibilities: Issues and Considerations for States
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.
Federal Declarations and Flexibilities Supporting Medicaid and CHIP COVID-19 Response Efforts Effective and Expiration Dates
To help states respond to the ongoing coronavirus (COVID-19) pandemic, the White House, the U.S. Department of Health and Human Services (HHS), and the Centers for Medicare and Medicaid Services (CMS) have invoked their emergency powers to authorize temporary flexibilities in Medicaid and the Children’s Health Insurance Program (CHIP). Congress has passed legislation that provides additional federal support for state Medicaid programs, subject to certain conditions. The table summarizes the timeframes for these emergency measures, including the effective dates and expiration timelines dictated by law or agency guidance. The chart also includes current end dates, which are subject to change as federal and state officials take actions to renew or terminate particular authorities. This SHVS product has been updated to reflect HHS’s July 23 declaration renewing the federal Public Health Emergency, as well as CMS’s June 30 Key Dates for Termination of COVID-19 Flexibilities Table.
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.
Ensuring Access to LTSS During COVID-19: Exploring a State Resource Guide Produced by Manatt Health and The SCAN Foundation
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.
Analyzing the Fiscal Impact of COVID-19, the Economic Downturn, and Recent Policy Changes: 50-State Databook
As states and Medicaid programs face significant fiscal uncertainty as a result of the COVID-19 public health crisis, the Databook provides 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.
This document provides excerpts of health disparities and health equity contract language from Medicaid Managed Care (MMC) contracts from five states—Michigan, Minnesota, North Carolina, Ohio, Oregon—and Washington, D.C. as well as the contract for California’s Health Exchange, Covered California. The criteria for inclusion in this compendium were contracts that explicitly addressed health disparities and/or health equity. Website links to the full contracts are included where available.
On April 30, 2020, New Hampshire received approval from the Centers for Medicare & Medicaid Services (CMS) to require its managed care organizations (MCOs) to make a directed payment to six types of essential Medicaid providers in order to help them keep their doors open during the COVID-19 pandemic. Numerous states across the country share New Hampshire’s interest in directing MCOs to use some of their capitation funds to support providers facing sharp declines in utilization due to COVID-19. This regulatory analysis provides an overview of New Hampshire’s directed payment and the documents used in the New Hampshire approval.
On Friday, June 12, State Health & Value Strategies hosted a webinar during which experts from Manatt Health and Georgetown reviewed the current telehealth policy landscape and considerations for states as they design their post-apex telehealth policies. This webinar included a question and answer session during which webinar participants posed their questions to the experts on the line.
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.