1115 Demonstration Facilitation Tool: Crosswalk of Requested Reentry Demonstration Features to Federal Requirements and California’s Approved Demonstration
On January 26, 2023, the Centers for Medicare & Medicaid Services (CMS) approved California’s request to amend the California Advancing and Innovating Medi-Cal Section 1115 demonstration. On April 17, 2023, CMS released a State Medicaid Director Letter (SMDL), “Opportunities to Test Transition-Related Strategies to Support Community Reentry and Improve Care Transitions for Individuals Who Are Incarcerated.” The following tool can be used as part of a state’s discussions with CMS regarding a requested demonstration’s proposed features as compared with the reentry requirements outlined in the SMDL and California’s section 1115 demonstration approval.
Compendium of Medicaid Managed Care Contracting Strategies to Promote Health Equity
The Compendium identifies approaches states are taking within their Medicaid managed care programs to promote health equity and highlights examples from states to further illustrate how they are implementing specific approaches and includes excerpts from state contract and procurement documents. The Compendium synthesizes information across select states and categorizes their approaches to support cross-state learning. State policymakers and Medicaid officials can use the Compendium to develop managed care procurements or update and operationalize key managed care contract provisions.
Buying Value
The Buying Value website, which is supported and maintained by State Health and Value Strategies in partnership with Bailit Health, hosts a suite of resources to support states interested in designing a measure set that will align with other priority national measure sets, as well as those that may already be in use in a state or region. The Buying Value Measure Selection Tool assists states in aligning measure sets. The Buying Value Benchmark Repository, is a database of non-HEDIS and modified HEDIS measures in use by state purchasers and regional health improvement collaboratives and associated performance levels.
Tracking Medicaid Enrollment Growth During the COVID-19 Pandemic Databook
The Tracking Medicaid Enrollment Growth During the COVID-19 Pandemic Databook provides a comprehensive, detailed look at Medicaid enrollment trends to-date. Using Medicaid enrollment data from over 40 states, the Databook provides a comprehensive, detailed look at Medicaid enrollment trends from the beginning of the COVID-19 pandemic through December 2022. The Databook provides enrollment detail by state across four eligibility categories: expansion adults, children (including those enrolled in CHIP), non-expansion adults, and aged, blind, and disabled individuals. It also compares enrollment trends across expansion and non-expansion states. The latest version of the Databook (as of March 2023) has been updated through December 2022.
Ensuring Compliance With Federal Renewal Requirements: State Diagnostic Assessment Tool
As states begin the herculean task of redetermining eligibility for 91 million enrollees in Medicaid and the Children’s Health Insurance Program, they are readying their systems, staff, and vendors that support Medicaid eligibility operations. Using this diagnostic assessment tool, states can take the critical step of evaluating their compliance with federal regulatory requirements for conducting redeterminations and renewals. The tool aims to help states qualify for the sustained enhanced Federal Medical Assistance Percentage, avoid corrective action imposed by CMS, promote continuity of coverage and care during unwinding, and make long-term improvements to eligibility and enrollment infrastructure.
Infographics on the Unwinding Provisions in the Consolidated Appropriations Act (CAA)
These infographics provide an overview of the key changes to the parameters for unwinding enacted by the Consolidated Appropriations Act (CAA) as well as an illustrative continuous coverage unwinding timeline under the CAA. The infographics are intended to help states communicate internally or with key stakeholders about the Medicaid continuous enrollment condition provisions in the CAA and can be downloaded to use in communications.
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.
Open Enrollment Period 2022-23 Messaging
The open enrollment period for the plan year beginning 2023 will begin on November 1, 2022, and marketplaces will be encouraging consumers to sign up for health coverage. This open enrollment period will see a continuation of enhanced subsidies and for some states, implementation of a fix to the so-called “Family Glitch.” This document includes research-based messaging to support outreach and enrollment, addressing common barriers consumers have to getting and keeping health coverage.
Addressing Health-Related Social Needs Through Medicaid Managed Care
States are using a variety of approaches to measure and incentivize Medicaid managed care (MMC) entities to address unmet social needs that can contribute to poor health outcomes, lower quality care, and higher medical expenditures. This toolkit identifies examples of approaches states are taking through their MMC programs to address health-related social needs. States interested in implementing specific strategies related to SDOH can use this toolkit to develop managed care procurements or update and operationalize key contract provisions. This toolkit was co-funded by the Health Foundation of South Florida.
Medicaid Managed Care Procurements: A Toolkit for State Medicaid Agencies
Implementing a statewide, competitive procurement for Medicaid managed care is one of the more important things state purchasers do to improve value. This toolkit is designed to help states develop a procurement process focused on improving program performance in specific areas valued by the state. It guides Medicaid agencies through key action steps and considerations in the major phases of the procurement cycle: 1) strategic procurement planning, 2) solicitation development, 3) bid review and selection, 4) contract execution, readiness review and implementation, and 5) contract management.