Conducting Eligibility Redeterminations at the Individual Level: State Diagnostic Assessment Tool
Early unwinding-related renewal data shows that many states have low ex parte renewal rates and high procedural termination rates. One contributing factor that the Centers for Medicare & Medicaid Services and states have identified is that some states are conducting ex parte renewal processes at the household level, rather than at the individual level, as required by federal regulations. This diagnostic assessment tool is designed to assist states in assessing whether they are conducting ex parte and other renewal processes at the individual level in accordance with federal regulatory requirements.
Call Center Strategies to Support Unwinding: State Toolkit
Medicaid, CHIP, Marketplace and integrated human services call centers are experiencing a surge in the number of callers seeking information about their health coverage with the end of the Medicaid continuous coverage requirement. In some states, high call volume is translating into long wait times and high rates of call abandonment, adversely affecting Medicaid and CHIP enrollees who rely on the call center as a critical source of assistance and support. Recognizing the crucial role of call centers in supporting enrollees throughout the eligibility and enrollment process, states can use this toolkit to identify opportunities and explore strategies to improve call center functionality.
State Health Equity Measure Set
The State Health Equity Measure Set provides a standard set of health equity measures that states can use to assess their performance against other states, and inform interventions that strive to improve equity in healthcare access and outcomes within their state. The State Health Equity Measure Set includes 10 population-level measures, which gauge health status, and 19 healthcare measures, which evaluate receipt of, and outcomes associated with, evidence-based health services. All measures have been tested and are in use by national measurement bodies. The Measure Set provides states with the resources to inform policies and program interventions that are focused on reducing disparities in healthcare access, care delivery, and health outcomes for people of color.
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.