Dec, 06, 2024

State Health Updates

  • Arizona – The state submitted a request to CMS to amend the state’s section 1115 waiver to expand coverage for former foster care youth. The Arizona Health Care Cost Containment System is required by HB 26 passed by the Legislature in 2022 to seek approval from CMS to provide continuous enrollment in Medicaid to youth formerly in the custody of the Arizona Department of Child Safety between the ages of 18 and 26. 
  • California – Covered California, the state’s official health insurance Marketplace, announced the first-year results of its health plan accountability program, the Quality Transformation Initiative (QTI), aimed at improving healthcare outcomes and reducing disparities for members. The QTI establishes financial incentives for insurance companies by requiring payments for failing to meet specified benchmarks for measures that include blood pressure and diabetes control, colorectal cancer screening, and childhood immunizations.
  • District of Columbia – The DC Health Benefit Exchange Authority voted to make the treatment and long-term management of HIV free for enrollees in DC Health Link’s Essential Plans, the District’s standardized plans. Starting in plan year 2026 enrollees can get free primary care visits, laboratory tests, and generic HIV medications. 
  • Florida – CMS approved Florida’s section 1115(a) demonstration, “Florida’s Children’s Health Insurance Program Eligibility Extension.” Approval of the demonstration will allow the state to increase the income eligibility threshold of its separate CHIP program from 210% to 300% of the federal poverty level.
  • Massachusetts – The state submitted a request to amend its section 1115 demonstration “MassHealth” to expand services for members enrolled in One Care and Senior Care Options (SCO) plans to live in their communities, as well as other changes to facilitate enrollment in SCO.  
  • Minnesota – The Health Economics Program of the Minnesota Department of Health has released findings from the state’s transparency initiative on the federal 340B Drug Pricing Program. The report focuses on net 340B revenues generated in 2023 from discounted drugs purchased by participating healthcare organizations.
  • New Jersey
    • Governor Phil Murphy signed a bill into law requiring healthcare professionals to ensure all patients have the opportunity to develop a comprehensive, personalized postpartum care plan consistent with their unique and anticipated needs. The legislation requires healthcare professionals to offer pregnant patients a postpartum planning session as early as the first trimester of pregnancy. It also requires healthcare facilities to ensure that postpartum care information is provided to all patients receiving maternity care services prior to being discharged at the end of a pregnancy.
    • The New Jersey Department of Banking and Insurance issued a bulletin providing guidance to insurers on the implementation of a state law that caps out-of-pocket costs (OOP) for certain medicines to advance the affordability of prescription drugs. The guidance outlines requirements established by enacted legislation limiting OOP cost of insulin at $35 per month and capping OOP costs for EpiPens and asthma inhalers at $25 and $50 respectively for a month’s supply.
  • New York
    • Governor Kathy Hochul announced a statewide campaign to raise awareness of New York’s paid prenatal leave policy, which takes effect on January 1, 2025. The policy, signed into law in April, gives workers the ability to take paid leave for any pregnancy-related medical appointments.
    • Superintendent Adrienne A. Harris announced that the New York State Department of Financial Services has adopted new market conduct regulations to govern pharmacy benefit managers (PBMs) operating in the state. The adopted rules will help protect New Yorkers’ access to prescription drugs, prohibit business practices that increase the cost of drugs, and ensure that small independent pharmacies compete on a level playing field with large pharmacies affiliated with PBMs.
  • North Carolina – Governor Roy Cooper and North Carolina Health and Human Services Secretary Kody Kinsley celebrated the one-year anniversary of Medicaid expansion in the state by announcing nearly 600,000 North Carolinians, many of whom live in rural communities, have enrolled.
  • Utah – The state submitted a request to CMS to amend the state’s 1115 demonstration to provide traditional healing services to Medicaid enrollees who are members of an American Indian or Alaska Native (AI/AN) tribe.