The American Rescue Plan Act of 2021 (ARP) establishes a new state option to extend Medicaid and CHIP coverage for pregnant women for one year following the baby’s birth. ARP’s new state option to extend continuous coverage for one-year postpartum enables states to take a major step towards improving health outcomes for postpartum women and their babies. This issue brief reviews the policy and operational considerations for states who are considering extending postpartum coverage.
The End of the Public Health Emergency Will Prompt Massive Transitions in Health Insurance Coverage: How State Insurance Regulators Can Prepare
Once the public health emergency ends, state Medicaid agencies will need to recommence Medicaid eligibility redeterminations and renewals. As a result, up to 16 million people are projected to lose their Medicaid coverage, and an estimated one-third of these individuals will be eligible for subsidized coverage in the Affordable Care Act (ACA) Marketplaces. Whether a state’s Medicaid agency moves swiftly or slowly to process eligibility redeterminations, the commercial insurance market–and particularly the ACA Marketplaces–could experience a significant growth in enrollment. This issue brief identifies several areas in which state departments of insurance (DOIs) may want to coordinate with other agencies or external stakeholders, issue new regulations or guidance, and establish means for minimizing gaps in coverage or access to services.
On February 17, the Department of Homeland Security (DHS) released its 2022 notice of proposed rulemaking (NPRM) which would largely codify longstanding federal guidance regarding DHS’ authority to refuse a noncitizen’s application for admission or application for visa adjustment (including receipt of a green card) on grounds that they are “likely at any time to become a public charge.” This issue brief provides an overview of key provisions of the 2022 NPRM and includes commentary to describe how the proposed rule differs from the 1999 Field Guidance, as well as how the proposed rule seeks to promote clarity and address the chilling effects caused by elements of the now-repealed 2019 Rule.
Reshaping the Narrative on Public Charge to Reach Immigrant Populations That Need Affordable Health Insurance
Many immigrants and their families are concerned that enrolling in Medicaid/CHIP, Marketplace, and other public health insurance programs will run afoul of public charge rules and jeopardize their immigration status. These fears remain despite the fact that the administration has reinstated longstanding public charge guidance that does not consider the use of Medicaid/CHIP benefits (other than government-funded institutionalization for long-term care) or Marketplace coverage in a public charge determination. This issue brief, the third in a series, Supporting Health Equity and Affordable Health Coverage for Immigrant Populations, provides an overview of the status of the public charge rule and presents strategies to help connect eligible individuals to affordable coverage.
A recognition by leaders and policymakers in many states that longstanding structural racism has caused disproportionate health risks and poorer health outcomes for communities of color is prompting action to prioritize and advance health equity. One key strategy states are using to test new or innovative ideas related to health equity in their Medicaid programs is Section 1115 demonstrations. A new series from State Health and Value Strategies shares strategies for states to consider as they work to advance health equity and address structural racism through Medicaid Section 1115 demonstrations.
Tracking Medicaid Coverage Post the Continuous Coverage Requirement: Using Data Dashboards to Monitor Trends
The Families First Coronavirus Response Act Medicaid “continuous coverage” requirement has allowed people to retain Medicaid coverage and get needed care during the COVID-19 pandemic. When continuous enrollment is discontinued, states will restart eligibility redeterminations, and millions of Medicaid enrollees will be at risk of losing their coverage. The current lack of publicly available and timely Medicaid enrollment, renewal, and disenrollment data will make it difficult to understand exactly who is losing coverage and for what reasons. One effective way to monitor this type of information is through the use of Medicaid enrollment and retention dashboards. This issue brief examines the current status of data collection to assess Medicaid enrollment and retention, summarizes potential forthcoming reporting requirements, and describes some of the best practices states should consider when developing a data dashboard to display this type of information.
Supporting Health Equity and Affordable Health Coverage for Immigrant Populations: CHIP Coverage Option for Pregnant Immigrants and their Children
Under federal regulations, states may provide pregnancy-related care through the Children’s Health Insurance Program (CHIP) state plan to targeted low-income children from conception to birth (the so called “unborn child” option). This option–referred to in this brief as the CHIP coverage option for pregnant immigrants and their children–enables states to provide prenatal, labor and delivery, and postpartum services to pregnant individuals, regardless of immigration status. This issue brief–the second in a series, “Supporting Health Equity and Affordable Health Coverage for Immigrant Populations”–offers considerations for policymakers around the CHIP coverage option for pregnant immigrants and their children, regardless of immigration status.
Conceptualizing Performance Measurement for Social Care Interventions: An Issue Brief for State Medicaid Agencies
Growing recognition that socioeconomic adversity impacts health outcomes has led the healthcare sector to support initiatives that address social determinants of health (SDOH). There is an opportunity to leverage performance measures to further incentivize these interventions and track adoption. This issue brief explores opportunities for state Medicaid agencies to implement performance measures with contracted entities that could strengthen their growing interest in social care and highlights several barriers to those applications.
An extensive body of research reports on poor birth-related outcomes and disparities in maternal mortality and morbidity in the United States, particularly for individuals enrolled in Medicaid. Importantly, Medicaid provides healthcare coverage to individuals who may otherwise not be eligible for coverage until pregnancy, until which time they may have been uninsured or under-insured and have untreated health conditions or lack access to routine care. As states start to tackle institutionalized racism in the healthcare system, they are considering approaches to center health equity by addressing disparities in birth outcomes. This issue brief describes the drivers of birth-related health disparities and identifies purchasing and payment strategies to support state efforts to reduce disparities in birth outcomes. The brief focuses specifically on actions Medicaid agencies can pursue through their managed care programs or directly with provider organizations to promote health equity and improve birth outcomes.
Borrowing Proven Policy Strategies to Vaccinate Kids Against COVID-19: Lessons from Past Successes can Provide a Roadmap for Ensuring Equity in Immunization Efforts
With authorization of the first COVID-19 vaccine for children ages five and older, most kids in the United States are now eligible to be immunized. Recent experience with other vaccines shows the country is capable of vaccinating kids widely and equitably, but the challenges in vaccinating adults against COVID-19 and experiences with other immunizations in children, like the vaccine against the human papillomavirus (HPV), also demonstrate that success is not inevitable. To meet their COVID-19 vaccination goals to vaccinate kids against COVID-19, states can borrow strategies that have historically proved effective in immunizing kids against diseases such as measles and resulted in dramatic reductions in certain vaccination rate disparities. This issue brief highlights state strategies that have led to high childhood vaccination rates—and dramatic strides toward health equity—and identifies how those strategies could be applied in the context of the current COVID-19 crisis.