On August 14, 2019, the Department of Homeland Security (DHS) published a final rule, Inadmissibility on Public Charge Grounds. The rule makes significant changes to the standards DHS will use to determine whether an immigrant is likely to become a “public charge”—a person dependent on the government for support—which will have consequences for certain immigrants’ legal status. This document provides answers to frequently asked questions about whom the rule will impact, what benefits are implicated by the rule, and how the rule might be administered.
Leveraging American Community Survey (ACS) Data to Address Social Determinants of Health and Advance Health Equity
State Medicaid programs are increasingly seeking to understand and address social factors that contribute to poor health—such as food insecurity, unstable housing, and a lack of access to social supports—in order to lower costs, improve outcomes for their members, and advance health equity. To inform this work of addressing the social determinants of health (SDOH) and advancing health equity, states and Medicaid officials need data in order to identify priority areas of unmet social and economic needs, execute SDOH initiatives, and monitor and evaluate the impacts of these programs. Increasingly, states are leveraging a broad array of data sources to support efforts to address health equity. While those sources closest to the Medicaid program are the most widely used, each has advantages and disadvantages. This brief focuses on how Medicaid programs can use data from one federal survey, the American Community Survey (ACS), to inform and target interventions that seek to address social determinants of health and advance health equity. This brief also highlights relevant examples from states that use SDOH and health equity measures from the ACS, including which measures and what they are used for.
On Thursday, February 6, at 2:00 p.m. ET State Health and Value Strategies hosted a webinar on guidance issued by the Centers for Medicare & Medicaid Services inviting states to apply for capped funding Medicaid demonstrations. During the webinar, experts from Manatt Health provided states with an initial analysis of the CMS guidance and discussed the potential implications for states.
CMS Guidance Authorizes Medicaid Demonstration Applications That Cap Federal Funding: Implications for States
The Centers for Medicare & Medicaid Services (CMS) issued a State Medicaid Director Letter on January 30, 2020 inviting states to apply for Section 1115 demonstration projects that would impose caps on federal Medicaid funding for the adult expansion and some other adult populations in exchange for new programmatic flexibility. Referred to as “Healthy Adult Opportunity” by CMS, these demonstrations would allow states to choose between two types of capped funding arrangements: a per capita cap or an aggregate cap (i.e., a block grant). In this SHVS issue brief, our colleagues at Manatt Health review the key features of the proposed capped funding demonstrations and highlight the considerations for states.
While Medicaid typically does not pay for housing (room and board), it does pay for some clinical and non-clinical services that can help people obtain and maintain their housing. New federal authorities to cover housing-related services have motivated states to think more broadly about the Medicaid populations who could benefit from access to housing-related services and the types of services that can promote housing stability. State Investments in Supportive Housing provides an overview of the federal authorities under which states are able to cover nonclinical housing-related services for high-need Medicaid enrollees. The issue brief also details how states are using these authorities to invest in supportive housing for diverse high-need Medicaid populations.
On Tuesday, January 14, 2020 at 4:00 pm EST, State Health and Value Strategies hosted a webinar on a proposed rule released by the Centers for Medicare & Medicaid Services (CMS) that would make significant changes to Medicaid supplemental payments and financing mechanisms, including provider taxes and intergovernmental transfers (IGTs). The proposed fiscal accountability rule would, if finalized, sharply limit states’ abilities to use IGTs to fund their Medicaid programs and require many states to redesign aspects of their provider taxes, with resulting serious ramifications for many states’ Medicaid budgets. The webinar, facilitated by experts from Manatt Health, provided an overview of the proposed rule, highlighting the provisions with the most significant implications for states. During the webinar, experts also discussed how the rulemaking process may unfold over the next several months and what states can do to prepare.
Protected: Roundtable Materials: Maternal Morbidity and Mortality: Medicaid’s Role in Addressing the Crisis
On December 10, 2019, delegates from six states and the District of Columbia gathered in Washington, D.C. at a roundtable discussion to talk about potential Medicaid interventions to mitigate the maternal mortality and morbidity crisis. During the roundtable, SHVS and Manatt Health — along with national experts in maternal health and health equity—facilitated a discussion about opportunities for Medicaid to implement coverage, payment and delivery system reforms to improve health outcomes for pregnant and post-partum women, with a particular focus on health equity.
As a follow-up to the November 20th SHVS office hour on the collection of REL data, this resource page provides links to a few resources that were mentioned on the call.
As the opioid epidemic continues, Medicaid programs are applying for SUD Section 1115 Demonstration waivers (SUD waiver) to expand Medicaid-funded treatment options. Some states with approved SUD waivers have formally implemented the American Society for Addiction Medicine (ASAM) Criteria to promote consistency in client placement for SUD treatment. The ASAM Criteria is a clinically driven multidimensional client assessment model that emphasizes treatment outcomes, client-specific lengths of service, and a team-based approach to care. This issue brief draws from the experiences of states that were among the first to implement their SUD waivers to profile how the ASAM Criteria is used within the context of managed care and utilization review, and the challenges and best practices associated with its use.
On Tuesday, October 22 State Health and Value Strategies convened the fifth, and last, webinar in our series SHVS Health Equity Through Managed Care. For many states, eliminating disparities in Medicaid managed care programs means working with their MCO contractors, and implementing contractual requirements that advance health equity. Previous webinars in this series identified measures and MCO performance requirements that help reduce health disparities and improve health equity for a state’s Medicaid population. This webinar, The Medicaid MCO Experience in Addressing Health Equity, profiled the work of one MCO, HealthPartners, in addressing equity issues within its Medicaid line of business. We heard from Brian Lloyd, who manages Health Partners’ organization-wide equity initiative, which includes collecting data to eliminate disparities in care, supporting language access, partnering with communities, and building an organizational understanding of equity, diversity, inclusion, and bias.