| Mar 23, 2020

Medicaid Coverage and Access

e.g., eligibility and enrollment (including appeals), benefits and cost-sharing (prior authorization, refills), individual market coverage, Employee Retirement Income Security Act (ERISA) flexibilities

If you have materials you are willing to share with other states through this page, or if there are topics of particular concern that you would like addressed, please contact SHVS.

STATE HEALTH AND VALUE STRATEGIES RESOURCES

SHVS/Manatt Health. Targeted Options for Increasing Medicaid Payments to Providers During COVID-19 Crisis  State Health & Value Strategies hosted a webinar in which experts from Manatt Health walked through tools states can use to increase payments to providers through both fee-for-service and Medicaid managed care, despite COVID-19 driven changes to utilization.

SHVS/Manatt Health.  COVID-19: CMS Issues Guidance for States About New Increased Medicaid and CHIP Matching Rate  Manatt Health’s analysis of CMS’ guidance for states about new increased Medicaid and CHIP matching rate. 

SHVS/Manatt Health/Georgetown CHIR.  Implications of Health Care Provisions for States in the Second COVID Stimulus Bill  Webinar slides and recording that explores the key health care provisions in the second COVID-19 stimulus bill.

SHVS/Manatt Health. State Medicaid and CHIP Strategies to Respond to the COVID-19 Public Health Crisis  This expert perspective, written by experts at Manatt Health, discusses strategies state Medicaid and CHIP agencies can pursue as part of their response to COVID-19.

SHVS/Manatt Health. Responding to COVID-19: State Strategies for Medicaid and Commercial Health Insurance Oversight  Webinar recording and slide deck from webinar hosted on March 18, 2020.

——————————————————-

OTHER RESOURCES

STATE TEMPLATES AND TOOLKITS

SHVS/GMMB.  Targeted Options for Increasing Medicaid Payments to Providers During COVID-19 Crisis This toolkit identifies more immediately available tools that can help ensure payments continue flowing to providers despite substantial utilization changes.

CMS.  Section 1135 Waiver Flexibilities  This page includes federal background information on Section 1135 waivers and a CMS-developed template for states and territories. 

CMS. Federal Disaster Resources  This page catalogs CMS’s approved COVID-19 State Section 1135 waivers. 

CMS. 1115 Application Process  This page includes guidance and a template for COVID-19 1115 waiver demonstrations. 

CMS. State Plan Flexibilities  This page includes guidance and templates for the Medicaid State Plan Disaster Relief SPA and CHIP Disaster Relief SPA.

Kaiser Family Foundation.  Medicaid Emergency Authority Tracker: Approved State Actions to Address COVID-19  This page includes details on Section 1135 waivers and 1915 (c) Waiver Appendix K strategies.

——————————————————-

FEDERAL STATUTE AND GUIDANCE

CMS/CMCS. COVID-19 Frequently Asked Questions (FAQs) for State Medicaid and Children’s Health Insurance Program (CHIP) Agencies  These updated FAQs for state Medicaid and CHIP agencies address available resources for emergency preparedness and response efforts, and flexibilities related to eligibility and enrollment, benefits, cost-sharing, financing, and workforce.

Congress.  H.R. 6201 Families First Coronavirus Response Act   Second COVID-19 response / stimulus bill.

CMS. Families First Coronavirus Response Act – Increased FMAP FAQs 

CMS. Coverage and Benefits Related to COVID-19 Medicaid and CHIP

CMS. COVID-19 Resources for States Compilation of resources for state on Medicare, Medicaid, and CHIP, including transcripts and recordings of all-state calls.

CMS. Coronavirus Waivers and Flexibilities  Resources on waivers and flexibilities available to states and providers.

CMS. Podcasts and Transcripts: COVID-19 Stakeholder Calls Recordings and transcripts of CMS calls on COVID-19 with states and other stakeholders.

——————————————————-

ANALYSIS

Manatt Health.  Summary of Healthcare Provisions of COVID-19 Stimulus Package #3 (CARES Act)

Manatt Health.  Summary of Key Healthcare Provisions in the Second COVID-19 Stimulus Bill

Urban Institute. Quickly Expanding Medicaid Eligibility as an Urgent Response to the Coronavirus Pandemic

National Committee for Quality Assurance (NCQA).  COVID19: HEDIS Reporting and NCQA Accreditation Changes  NCQA has made modifications to HEDIS and accreditation requirements for Medicaid and Commercial plans related to COVID19.

——————————————————-

STATE EXAMPLES AND MODELS

Alaska.  Insurance Coverage for Telehealth AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March. 

California.  DHCS COVID‑19 Response  CA developed a robust, centralized COVID-19 resource page that provides guidance related to providers, HCBS, and federal requests/waivers.

Massachusetts. Updated Coverage and Payment Policies MA developed a managed care plan bulletin that outlines requirements for coverage and billing related to COVID-19.

Massachusetts.  Coverage Provided Via Hospital-Determined Presumptive Eligibility MA developed an All Provider Bulletin that summarizes the State’s Hospital-Determined Presumptive Eligibility process.

Massachusetts.  MassHealth Coverage and Reimbursement Policy for Services Related to Coronavirus Disease 2019 MA developed a managed care plan bulletin that outlines requirement’s for coverage and billing related to COVID-19.  

Massachusetts.  March 15 2020 Telehealth Order  In MA, through executive order, Governor Baker expanded access to telehealth services in all commercial insurers and MassHealth programs, waived all cost-sharing for any medically necessary treatment delivered via telehealth related to COVID-19 at in-network providers, waived any prior authorization barriers needed to obtain medically necessary telehealth services, and established a 24-hour process to allow medical professionals to receive a license to practice in Massachusetts

Minnesota. CHAPTER 70–S.F.No. 4334 AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March. 

Mississippi.  Reeves Administration announces temporary Medicaid changes in response to coronavirus outbreakMS Division of Medicaid is allowing beneficiaries to access telehealth services from home; promoting the use of personal cellular device, computer, tablet, or other web camera-enabled device to seek and receive medical care; and waiving limitation of the use of audio-only telephonic conversations until April 30, 2020.

Mississippi. Public Notice MS submitted a Medicaid State Plan Amendment Telehealth Emergency Waiver to allow for telehealth service flexibilities during a state of emergency.

New Jersey. Governor Murphy Signs Legislation to Expand Telehealth Access and Expedite Licensure of Out-of-State Professionals AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March. 

New York. Department of Financial Services Adopts New Emergency Regulation Requiring Insurance Companies to Waive Cost Sharing for In-Network Telehealth Visits NY waived cost-sharing for telehealth visits with in-network providers.

New York.  Continuing Temporary Suspension and Modification of Laws Relating to the Disaster Emergency  NY allowed out-of-state providers and providers in New York that are not currently registered to provide telehealth services. 

Vermont. Vermont House Passes Telehealth Bill Amid Coronavirus Concerns  AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March. 

West Virginia.  House Bill 4003 AK, MN, NJ, VT, and WV introduced or enacted telehealth legislation to increase telehealth access and coverage during the month of March.