Exploring the New Social Care Quality Measures: How Do We Define and Measure Social Needs and High-Quality Social Care?
On Thursday, January 26 State Health and Value Strategies co-hosted a webinar with the Social Interventions Research & Evaluation Network (SIREN) at the University of California San Francisco on the new social care quality measures that will launch from many federal and some state agencies. The measures target a range of payer and delivery system reporting entities. They include requirements around social risk screening and, in some cases, social care interventions. The marked variation across these initiatives highlights a key question: How do we define and measure high quality social care?
Under section 1115 authority, states can waive provisions of Medicaid law and obtain federal approval to fund initiatives not otherwise coverable by Medicaid, provided that proposals are budget neutral to the federal government and further the goals of the Medicaid program. In the past six months, the Centers for Medicare & Medicaid Services (CMS) has approved renewals and/or amendments to several long-standing section 1115 demonstrations, showcasing the Biden administration’s priorities for use of 1115 authority. This issue brief describes how recent approvals in Arizona, Arkansas, Massachusetts, Oregon, and Vermont highlight that states and CMS are leveraging 1115 demonstrations to implement new coverage strategies; address social drivers of health; strengthen the primary care and behavioral health delivery systems; institute value-based payment initiatives; and advance health equity.
Many consumers will find the relationship between Medicaid, the marketplace, and employer-sponsored insurance to be more complicated than ever in 2023 as the unwinding of the continuous coverage requirement begins. Much of the focus of Medicaid unwinding planning in states and the federal government has been on helping eligible people keep Medicaid coverage and steering the millions of people losing Medicaid eligibility toward the health insurance marketplace. Less attention has been devoted to the millions of people who are expected to be eligible for employer-sponsored insurance when their Medicaid coverage ends. This issue brief discusses how state Medicaid agencies, state-based marketplaces, labor departments, and employers can play critical roles in helping people understand and navigate their coverage options.
While much attention has been paid to how states can approach the unwinding of the continuous coverage requirement to prioritize the retention of Medicaid coverage and transitions to marketplace coverage, less attention has been paid to the role of employer-sponsored insurance. To get a sense for the size of the group that might have employer-sponsored coverage as an option, this issue brief discusses the proportion of individuals with an offer of employer-sponsored coverage by income and state, and the proportion of those offers that are considered affordable based on premium cost.
On Wednesday, January 11 State Health and Value Strategies hosted a webinar on the Consolidated Appropriations Act, 2023, an omnibus funding package that includes government appropriations through September 30, 2023 as well as a number of health policy provisions. Included in the package is a date certain for the expiration of the Medicaid continuous coverage requirement, a gradual phase down of the Families First Coronavirus Response Act enhanced federal match rate, and new guardrails to protect against inappropriate coverage loss and smooth coverage transitions. During the webinar, experts from Manatt Health and GMMB provided an overview of the unwinding provisions in the legislation, building on our recent expert perspective, Unwinding Provisions in the 2023 Consolidated Appropriations Act. Presenters discussed open questions and key considerations for state policymakers as they head into the final stretch of planning for the transition back to regular eligibility and enrollment operations.
Recent Updates to Section 1115 Waiver Budget Neutrality Policy: Overview and Implications for States
Section 1115 Medicaid demonstrations are a powerful tool for states to pursue a range of innovative programs aimed at improving the health and well-being of Medicaid enrollees. While not required under federal law or regulation, longstanding federal policy requires that 1115 waivers be “budget neutral” to the federal government—in other words, demonstrations must not increase federal spending relative to a state not pursuing an 1115 demonstration. During the summer of 2022, CMS began to roll out a series of changes to budget neutrality policy through state waiver approvals. This issue brief summarizes the key policy changes established through the Oregon and Massachusetts waiver renewals (and reinforced through the Arizona and Arkansas approvals) and discusses key implications for states.
Collection of Race, Ethnicity, Language (REL) Data on Medicaid Applications: New and Updated Information on Medicaid Data Collection Practices in the States, Territories, and District of Columbia
This issue brief documents how race, ethnicity, and language (REL) data are collected by Medicaid programs in the 50 U.S. states, the District of Columbia, and five U.S. territories. This new brief serves as an update to State Health Access Data Assistance Center’s previous brief, providing up-to-date information on Medicaid REL data collection among the states and extending the analysis to include the District of Columbia and the five territories.
State Health and Value Strategies hosted a working session for state officials responsible for operationalizing, refining, and overseeing eligibility and enrollment processes, including redeterminations/renewals and systems changes. The slide deck from the session provides an overview of ex parte processes and includes key ex parte resources in the appendix. The session provided state participants with the opportunity to pose questions to experts from Manatt Health regarding the issues they are facing as they work to improve their ex parte rates in preparation for the end of the continuous coverage requirements.
A growing number of states view extending affordable health coverage to lower-income residents, regardless of immigration status, as a critical step towards narrowing the gap in health coverage, advancing health equity, and improving the overall health and well-being of all residents. This state spotlight reviews California’s approach to expanding health coverage to all lower-income residents, regardless of immigration status, in an effort to help the state’s 3.2 million remaining uninsured, of which 65% are undocumented.
On Wednesday, November 9 State Health and Value Strategies (SHVS) and the Health Foundation of South Florida (HFSF) hosted a webinar that reviewed examples of state approaches to address enrollees’ health-related social needs that do not require an 1115 waiver. During the webinar, experts from Bailit Health reviewed a new SHVS/HFSF resource, Addressing Health-Related Social Needs Through Medicaid Managed Care, described approaches to require and/or incentivize Medicaid plans to address health-related social needs, and facilitated a discussion with state Medicaid officials.