| Nov 1, 2021

Resources for States on Unwinding the Medicaid Continuous Coverage Requirement

State Health and Value Strategies (SHVS) developed this resource page to serve as an accessible one-stop source of information for states in “unwinding” when the Medicaid continuous coverage requirement ends. The Families First Coronavirus Response Act (FFCRA) Medicaid “continuous coverage” requirement has allowed people to retain Medicaid coverage and get needed care during the pandemic. When continuous enrollment is discontinued, states will restart eligibility redeterminations for Medicaid enrollees. While most people will continue to be eligible for Medicaid or Marketplace coverage, the potential for loss of coverage for millions of Americans due to “administrative” reasons is significant, and Black, Latino(a) and other people of color will be most at risk. This resource is designed to support states planning for this major coverage event, including developing processes that prioritize coverage retention following the conclusion of the continuous coverage requirement.

SHVS will update this page frequently with new resources as they become available.

SHVS Resources and Tools

SHVS technical assistance resources on the unwinding of the public health emergency

Please click on the links below to access topic-specific resources.

Health Equity
Data/IT Eligibility and Enrollment Policy/Operations Consumer Communications and Outreach
Oversight and Monitoring Medicaid and Marketplace Integration Federal Resources

 

 

Expert Perspectives

January 14, 2022

New Requirements to Cover Over-the-Counter COVID Tests: Implications for State Insurance Regulators

On January 15, 2022, health insurers will be subject to new federal requirements to cover and waive cost-sharing for over-the-counter diagnostic tests for COVID-19 for the duration of the federal public health emergency. Past federal guidance required insurers to fully cover COVID-19 tests, but allowed them to require enrollees to first obtain a health professional’s determination that a test is medically necessary. The new requirements, published January 10, enable consumers to obtain the tests directly from pharmacies or online retailers without being seen by a health professional. With case rates surging and the costs of over-the-counter COVID-19 tests ranging from $14 to $34, this new benefit should provide significant financial relief to privately insured individuals. This expert perspective focuses on key provisions of the new coverage requirements as well as health equity considerations and implications for state insurance regulators.

New CMS Guidance on Community-Based Mobile Crisis Services

On December 28, 2021, the Centers for Medicare & Medicaid Services (CMS) released a State Health Official letter providing guidance on the scope of and enhanced payments for qualifying community-based mobile crisis intervention services for Medicaid enrollees experiencing a mental health or substance use disorder crisis. The CMS guidance comes as the United States is grappling with staggering need for mental health and SUD services that has grown as a result of the COVID-19 pandemic. This expert perspective provides an overview of the new guidance and reviews the requirements for community mobile crisis services.

 

January 7, 2022

The Proposed 2023 Notice of Benefit & Payment Parameters: Implications for States

On December 28, 2021, the Centers for Medicare & Medicaid Services released its proposed Notice of Benefit & Payment Parameters for plan year 2023. This annual regulation governs core provisions of the Affordable Care Act, including operation of the health insurance marketplaces, standards for insurers, and the risk adjustment program. This expert perspective focuses on provisions of the proposed rule that are of particular import to the state-based marketplaces and state insurance regulators.