Recent Updates to Section 1115 Waiver Budget Neutrality Policy: Overview and Implications for States
Section 1115 Medicaid demonstrations are a powerful tool for states to pursue a range of innovative programs aimed at improving the health and well-being of Medicaid enrollees. While not required under federal law or regulation, longstanding federal policy requires that 1115 waivers be “budget neutral” to the federal government—in other words, demonstrations must not increase federal spending relative to a state not pursuing an 1115 demonstration. During the summer of 2022, CMS began to roll out a series of changes to budget neutrality policy through state waiver approvals. This issue brief summarizes the key policy changes established through the Oregon and Massachusetts waiver renewals (and reinforced through the Arizona and Arkansas approvals) and discusses key implications for states.
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 (REL) data are collected by Medicaid programs in the 50 U.S. states, the District of Columbia, and five U.S. territories. This new brief serves as an update to State Health Access Data Assistance Center’s previous brief, providing up-to-date information on Medicaid REL data collection among the states and extending the analysis to include the District of Columbia and the five territories.
State Health and Value Strategies hosted a working session for state officials responsible for operationalizing, refining, and overseeing eligibility and enrollment processes, including redeterminations/renewals and systems changes. The slide deck from the session provides an overview of ex parte processes and includes key ex parte resources in the appendix. The session provided state participants with the opportunity to pose questions to experts from Manatt Health regarding the issues they are facing as they work to improve their ex parte rates in preparation for the end of the continuous coverage requirements.
A growing number of states view extending affordable health coverage to lower-income residents, regardless of immigration status, as a critical step towards narrowing the gap in health coverage, advancing health equity, and improving the overall health and well-being of all residents. This state spotlight reviews California’s approach to expanding health coverage to all lower-income residents, regardless of immigration status, in an effort to help the state’s 3.2 million remaining uninsured, of which 65% are undocumented.
On Wednesday, November 9 State Health and Value Strategies (SHVS) and the Health Foundation of South Florida (HFSF) hosted a webinar that reviewed examples of state approaches to address enrollees’ health-related social needs that do not require an 1115 waiver. During the webinar, experts from Bailit Health reviewed a new SHVS/HFSF resource, Addressing Health-Related Social Needs Through Medicaid Managed Care, described approaches to require and/or incentivize Medicaid plans to address health-related social needs, and facilitated a discussion with state Medicaid officials.
On Wednesday, November 2 State Health and Value Strategies hosted a webinar on the key considerations and requirements for state Medicaid/CHIP agencies at the end of the PHE. The 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, including the recent CMS Proposed Rule on Medicaid and CHIP Eligibility, Enrollment, and Renewal.
Reaching Non-Citizen Communities: Resources to Support State Outreach and Education to Drive Healthcare Enrollment
States are working in various ways to engage and enroll individuals in health coverage regardless of their immigration status. In some cases, states continue to conduct outreach to eligible but remaining uninsured individuals, such as citizen children in families with mixed immigration status. In other cases, states are in the process of expanding coverage options to make new options available for non-citizens. The resources in this toolkit were informed by research and developed for states to customize based on their unique needs, program eligibility criteria, and environments to support outreach and education efforts to drive enrollment in new or existing health coverage programs.
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. This resource builds on a September 2022 maternal health roundtable convened by State Health and Value Strategies (SHVS) and Manatt Health with California, Louisiana, Maryland, Minnesota, and Tennessee.
CMS Proposed Rule on Medicaid and CHIP Eligibility, Enrollment, and Renewal: Implications for States
On Monday, October 17, State Health and Value Strategies hosted a webinar that provided an overview of the proposed rule released by CMS that seeks to strengthen existing eligibility, enrollment, and renewal operational processes. During the webinar experts from Manatt Health highlighted the intersection with unwinding and the end of the public health emergency, discussed key considerations related to the new policy, IT systems, and operational process changes, and reviewed opportunities for state policymakers to provide comment. The webinar drew on the expert perspective CMS Proposed Rule on Medicaid and CHIP Eligibility, Enrollment, and Renewal that summarizes the proposed rule.
Federal Declarations and Flexibilities Supporting Medicaid and CHIP COVID-19 Response Efforts Effective and End Dates
To help states respond to the ongoing 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 their emergency powers to authorize temporary flexibilities in Medicaid and the Children’s Health Insurance Program. Congress’s legislative relief packages have provided additional federal support for state Medicaid programs, subject to certain conditions. The timeframes for these emergency measures are summarized in the chart, including the effective dates and expiration timelines dictated by law or agency guidance. This SHVS product has been updated to reflect HHS’s October 13 notice renewing the federal Public Health Emergency.