States of Innovation: March & April 2024
State Health and Value Strategies is launching a new series on the latest health news at the state level. States of Innovation will highlight what states are working on to achieve better, more affordable, and more equitable health for all. As laboratories for innovation in healthcare, states are driving efforts to reduce costs, address inequities, and expand access to coverage and care. States of Innovation will profile the latest state efforts across a range of topics as well as a selection of recent waiver requests and approvals. This inaugural States of Innovation post highlights state activity from March and April, 2024.
In April, two states took steps to address affordability, with California setting a healthcare spending target and New York expanding coverage through its Essential Plan. States also moved to advance health equity, with Virginia hosting a forum on language and disability access. Two states, California and Nevada, are leveraging artificial intelligence (AI) to implement Marketplace innovations. In the latest news in managed care, Michigan awarded new contracts while North Carolina is launching plans for enrollees with serious mental illness.
Also in April, several states took action on maternal health, including Missouri which is increasing reimbursement rates for birthing centers. States continue to increase access to behavioral and mental health, including North Dakota, which expanded the services provided through its program Recovery Talk. In support of reproductive health, Illinois is funding training for abortion providers. To expand access to new over-the-counter (OTC) contraceptives, Pennsylvania is encouraging insurers to cover them with or without a prescription, and New Mexico announced Medicaid coverage for Opill, the first FDA-approved OTC daily birth control pill, and also pregnancy tests and emergency contraception.
A burgeoning trend among states is mitigating the health effects of climate change. In March Arizona appointed the first-ever statewide Chief Heat Officer, while Oregon announced that some Medicaid and CHIP enrollees will qualify for new climate-related benefits.
Lastly, April saw several states submit waiver amendments and requests to the Centers for Medicare & Medicaid Services (CMS), including Connecticut, Colorado and Florida. Also, CMS approved Maryland’s state plan amendment to implement mobile crisis and Massachusetts’ amendment to its 1115 demonstration.
Affordability
California sets a healthcare spending target. The Office of Health Care Affordability (OHCA) board has approved a statewide healthcare spending target phased in over time, initially starting at 3.5% for 2025 and 2026, lowered to 3.2% for 2027 and 2028, before reaching 3% for 2029 and beyond. The target will apply to healthcare entities, including health plans, provider organizations and hospitals. Beginning in 2026, OHCA can begin progressive enforcement action against entities that exceed the target, including providing technical assistance, requiring an explanation at public meetings, imposing performance improvement plans, and if warranted, assessing financial penalties. California joins a handful of other states with healthcare cost growth targets with the goal to measure spending over time.
New York expanded the Essential Plan. The New York State Department of Health and NY State of Health announced the expansion of the state’s Essential Plan public health insurance program took effect on April 1. The program now includes residents with incomes up to 250% of the federal poverty level, including the Deferred Action for Childhood Arrival population. The expansion brings premium-free, high quality health coverage to an additional 100,000 New Yorkers.
Behavioral and Mental Health
Massachusetts is providing grants to BIPOC-led community based organizations. The Healey-Driscoll administration awarded $2.9 million to 20 organizations led by Black, Indigenous and people of color (BIPOC) to address substance-use in the communities they serve. The grants are awarded through the Redefining Community Wellness program, a new initiative intended to support BIPOC-led organizations committed to addressing substance-use disorder, including by focusing on underlying social, economic, and environmental conditions that can put people at greater risk for substance-misuse.
North Dakota has added outgoing calls to individuals with substance-use disorder to Recovery Talk. The North Dakota Health and Human Services program Recovery Talk has added new features aimed at bolstering its support for individuals facing substance-use disorder. Recovery Talk provides free and confidential assistance to North Dakotans and now offers both incoming and outgoing services. Individuals can call or text anytime they need immediate support. The outgoing services enable peer support specialists to reach out and connect with individuals on a pre-scheduled basis.
North Carolina is funding expansion of crisis centers. The North Carolina Department of Health and Human Services announced a $22 million investment to expand community crisis centers and peer respite care across the state. The investment will increase the state’s capacity for community-based crisis treatment by 20%, helping to ensure people experiencing a behavioral health crisis have alternative options to emergency departments or community and state psychiatric hospitals when seeking care. SHVS published an expert perspective that provides a roadmap for states seeking to expand access to behavioral health crisis services.
Health Equity
California is engaging Medicaid members to inform a health equity roadmap. The California Department of Health Care Services (DHCS), in partnership with the California Health Care Foundation, launched the Health Equity Roadmap initiative to engage Medi-Cal members of Black, Indigenous, and communities of color in DHCS’ collective work to eliminate health disparities and advance health equity for Medi-Cal members. For more information about how states can implement effective community engagement to establish and maintain trust and improve the accessibility and quality of services, see the SHVS issue brief Transformational Community Engagement to Advance Health Equity.
Virginia Medicaid is hosting a virtual forum on language and disability access. The Department of Medical Assistance Services is hosting a two-hour forum open to the public and focused on the theme “Translations, Language Taglines and Strategies for Identifying Frequently Used Languages.” A panel discussion will explore how state agencies and Medicaid stakeholders handle translations to enhance accessibility for individuals with limited English proficiency and people with disabilities.
Marketplace Innovations
California is using AI to streamline enrollment. Covered California, the state’s official health insurance Marketplace, announced that it is leveraging Google Cloud’s AI solutions to automate parts of the documentation and verification process when residents apply for coverage. Once the solution is live in June, residents will be able to securely upload their documents through the Covered California online application and receive instant verification status.
Nevada’s Marketplace is offering interactive virtual support through AI. Nevada Health Link, the state’s official health insurance Marketplace, announced the successful integration of AI into its Marketplace platform. Nevada is the first Marketplace to receive CMS approval for the use of AI-based interactive virtual agents to enhance the customer service experience. This AI-driven tool offers callers natural language interactions that answer common questions and requests instantaneously, augmenting the call center’s normal business hours by operating round-the-clock support to individuals seeking help with basic needs such as password resets and finding enrollment assistance.
Managed Care
Michigan awarded contracts for the state’s Medicaid managed care program. The Michigan Department of Health and Human Services awarded Comprehensive Health Care Program contracts for Michigan’s Medicaid health plans, which serve nearly two million Michigan residents receiving coverage through Medicaid and the Healthy Michigan Plan.
North Carolina is launching managed care plans for individuals with serious mental illness. The North Carolina Department of Health and Human Services announced the July 1 launch of Tailored Plans, a new kind of managed care health plan for approximately 210,000 enrollees with a serious mental illness, a serious emotional disturbance, a severe substance-use disorder, an intellectual/developmental disability (I/DD), or a traumatic brain injury. The plans will cover doctor visits, prescription drugs, and services for mental health, substance-use, I/DD and traumatic brain injury in one plan.
Maternal Health
Michigan is incentivizing hospitals to participate in a new quality program for maternity care. The Michigan Department of Health and Human Services will begin providing maternal health quality payments to hospital birthing units fully participating in the Michigan Alliance for Innovation on Maternal Health (MI AIM) that have committed to participating in the Joint Commission Maternal Levels of Care (MLoC) Verification Program. MI AIM is a quality initiative program dedicated to improving the culture of maternal safety through the implementation of early recognition patient safety bundles (sets of practices that improve the quality of care provided during delivery and in the postpartum period). The MLoC Verification Program provides hospitals with an independent, external evaluation of their organization’s maternal health expertise, equipment and resources.
Missouri is increasing payment rates for birthing centers. The MO HealthNet Division increased the freestanding birth center facility fee-for-service maximum allowable rate. A freestanding birth center is defined as a facility, not licensed as part of a hospital, which provides maternity care for low risk births. The new fee-for-service rate for a vaginal delivery will be $2,200, up from $800. For ideas on how states can leverage payment to improve maternal health outcomes, see the recent SHVS issue brief Maternal Health Providers: Enhancing Health Equity Through Payment Parity.
Pennsylvania is funding community based organizations to support maternal health. The Department of Health announced $1.8 million in grant funding for community-based organizations to help address maternal health. Organizations can apply for funding to develop and lead regional coalitions that will select and implement recommendations from the 2024 Pennsylvania Maternal Mortality Review Committee report to improve maternal health at the local level.
Mitigating the Health Effects of Climate Change
Arizona created a new position to address extreme heat. The Arizona Department of Health Services announced the first-ever statewide Chief Heat Officer to oversee the implementation of the governor’s Extreme Heat Preparedness Plan and work to coordinate partnerships between the state, county health departments, local municipalities, communities, the private sector, and community-based organizations.
Oregon announced climate-related benefits in Medicaid and CHIP. The Oregon Health Authority (OHA) announced that certain Oregon Health Plan (OHP) members may now qualify for new climate-related benefits. Eligible OHP members may receive air conditioners, heaters and air filters, as well as mini refrigeration units for storing medications, or portable power supplies to operate medical equipment. OHA also announced grants to support the capacity of community partners to deliver new health-related social needs services to eligible OHP members.
Reproductive Health
Illinois is funding training for abortion providers. The Illinois Department of Public Health (IDPH) announced it has awarded $2 million to three organizations to provide training that will increase access to safe, high-quality abortions across the state. The grants were awarded by IDPH’s Office of Women’s Health & Family Services to the Midwest Access Project, Planned Parenthood of Illinois, and the University of Illinois Chicago College of Nursing.
New Mexico announced Medicaid coverage for the first FDA-approved OTC daily birth control pill. The New Mexico Human Services Department announced the inclusion of Opill, the first OTC daily oral contraceptive pill, in its coverage for Medicaid enrollees. Additionally, Medicaid enrollees will have access to no-cost pregnancy tests and emergency contraception.
Pennsylvania is encouraging insurers to cover over-the-counter contraceptives. Governor Josh Shapiro announced the Pennsylvania Insurance Department will issue guidance to insurers to provide coverage for OTC contraceptives with or without a prescription. With the launch of the first FDA-approved OTC daily oral contraceptive pill, Opill, Pennsylvania insurers are encouraged to cover OTC contraceptives and are being asked to exempt this medication from the lengthy drug exceptions process as a best practice.
Waiver Amendments, Requests and Approvals
Connecticut is requesting to provide reentry services 90 days prior to release. The state submitted a request for an amendment to its Medicaid section 1115 demonstration, “Connecticut Substance Use Disorder.” The amendment includes limited services for certain individuals 90 days prior to release from the criminal justice system and the provision of services to address the health-related social needs of the state’s justice-involved Medicaid enrollees.
Colorado submitted an amendment for reentry services and continuous enrollment for children zero to three. The Department of Health Care Policy and Financing submitted an amendment to the state’s 1115 waiver on April 1, 2024 seeking: criminal justice reentry services effective July 2025; serious mental illness and serious emotional disturbance inpatient care effective July 2025; continuous eligibility coverage for children zero to three years of age effective January 2026; and continuous eligibility coverage for adults released from Colorado Department of Corrections facilities effective January 2026.
Florida is requesting to raise the income eligibility for CHIP. Florida submitted a request for a new CHIP section 1115(a) demonstration entitled, “Florida Children’s Health Insurance Program Eligibility Extension.” This demonstration aims to increase access to CHIP by raising the income eligibility threshold from 200% to 300% of the federal poverty level.
Maryland received approval to provide mobile crisis services. CMS approved a SPA for mobile crisis services in Maryland. This is the 18th mobile crisis SPA approved. As a reminder, SHVS published an expert perspective on the enhanced payment available through the American Rescue Plan Act for community-based mobile crisis services.
Massachusetts received approval to provide additional services to address health-related social needs. CMS approved Massachusetts’ request to amend the MassHealth Medicaid and Children’s Health Insurance Plan section 1115 demonstration. The amendment will: allow the state to provide additional health-related social needs services; expand Marketplace subsidies to individuals with incomes up to 500% of the federal poverty level and cost-sharing assistance by increasing the income limits consistent with the Medicare Savings Program; provide limited coverage for a set of services for certain incarcerated individuals for up to 90 days prior to release; and expand continuous eligibility to 12 months for adults over age 19 and to 24 months to enrollees over age 65 who are experiencing homelessness.