States of Innovation: May 2024

State Health and Value Strategies’ States of Innovation series profiles the latest health news at the state level, highlighting 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 features the latest state efforts across a range of topics as well as a selection of recent waiver requests and approvals. This States of Innovation highlights state activity in May 2024.

In an effort to address the issue of affordability, New Mexico is expanding out-of-pocket assistance for the Marketplace, while Rhode Island and Oregon published yearly reports tracking healthcare cost growth in their states. In May, several states took steps to increase access to children’s coverage and care. Arizona implemented continuous enrollment for children, while Arkansas, Connecticut and Massachusetts are piloting or implementing new benefits for children. Pennsylvania took steps to protect LGBTQ+ children while Rhode Island published a report on the mental health of trans teenagers. 

States also took steps to engage the community and advance health equity in May. Connecticut solicited feedback on how to support aging, while North Carolina promoted its new community engagement initiative. Minnesota created the Office of American Indian Health and Nevada is seeking feedback on how its public option can reduce health disparities. 

Also in May, several states took action on maternal health, including Nevada, whose state plan amendment to implement postpartum Medicaid expansion was approved. A burgeoning trend among states is addressing the burden of medical debt, with Connecticut enacting legislation that prohibits the reporting of medical debt to credit rating agencies. States also continue to increase access to mental and behavioral health, including California, Michigan, Nebraska, New Jersey and Oregon. As states with approved section 1115 waivers to provide coverage for justice-involved populations prior to their release roll out implementation, Washington is inviting carceral institutions to participate in the state’s initiative. 

Several states took steps in May to support reproductive and women’s health, including Arizona, California, Iowa, New Jersey and North Carolina. States continue to implement strategies in support of the unwinding of the Medicaid continuous coverage requirement, such as New Jersey which announced it is extending the special enrollment period for individuals no longer eligible for Medicaid. 

Lastly, May saw states receive approval of groundbreaking waiver requests and state plan amendments from the Centers for Medicare & Medicaid Services (CMS), with both Delaware and Tennessee receiving approvals to provide a supply of diapers to post-partum parents and Hawai’i the first state approved to provide pallitative care in community-based settings to Medicaid enrollees. 

Affordability

New Mexico is expanding out-of-pocket assistance to Marketplace enrollees. The Office of the Superintendent of Insurance and the Health Care Authority published guidance for the Health Insurance Marketplace Affordability Program for plan year 2025. The program will expand out-of-pocket assistance to more New Mexicans and adopt policies to reduce premiums and improve retention for lower-income enrollees.

Rhode Island published a report on growth in healthcare spending. The Office of the Health Insurance Commissioner (OHIC) released its annual report, “Health Care Spending and Quality in Rhode Island” and a chartbook of healthcare spending in the state. The report presents findings from analyses performed by OHIC to gain insight into the factors affecting healthcare spending growth in the state in 2022 and provides recommendations to keep annual spending growth below the state’s cost growth target.

Oregon released its annual report on cost growth trends. The report provides insight into healthcare spending in the commercial, Medicaid, and Medicare markets statewide, and for 30 health plans and 53 provider organizations. More than half of plans and provider organizations met the cost growth target. The report allows health insurers and large providers to see where they stand in comparison to others and help focus their efforts on containing healthcare costs.

Children’s Coverage and Care 

Arizona implemented continuous enrollment for children. The Arizona Health Care Cost Containment System (AHCCCS) announced that since implementation of continuous coverage for children eligible for Medicaid and CHIP, AHCCCS has continued coverage for more than 155,000 children under the age of 19.

Arkansas is piloting three new mental health programs for children. The Arkansas Department of Human Services announced that it is launching three new pilot programs aimed at supporting early diagnosis of mental health issues and prevention of a mental health crisis among children enrolled in Medicaid. The pilots will run through March 2025. 

Connecticut is increasing access to home visits for newborns. Governor Ned Lamont announced that a state pilot program has provided at-home nurse and community health worker assistance to the families of more than 500 newborns since October 2023. Known as Family Bridge, the program aims to ease transition from hospital to home for the parents of newborn babies by having a nurse or community health worker visit their home following birth. Family Bridge is available to all families at no cost.

Massachusetts is investing in student mental health. The Healey-Driscoll administration announced a $13 million investment in the Bridge for Resilient Youth in Transition program, an in-school program supporting students who have fallen behind academically due to challenges with their mental health. Administered by the Department of Mental Health, the funding includes $3 million in American Rescue Plan Act funds and $10 million from the Massachusetts Behavioral Health Trust Fund.

Pennsylvania is taking action to prevent the use of conversion therapy on LGBTQ+ minors. The Shapiro administration announced five state Boards have adopted new policies making clear that conversion therapy on LGBTQ+ minors is harmful. The new policies notify licensees that all five Boards consider the use of conversion therapy to be unprofessional, harmful conduct that may subject any licensee engaging in it to administrative discipline.

Rhode Island released a report on the mental health of transgender youth. The Rhode Island Department of Health is highlighting new data which underscores the health challenges faced by transgender youth in high school. According to the data brief, 71% of Rhode Island high school students who are transgender say they’ve felt sad or hopeless for two or more weeks during the past year.

Community Engagement 

Connecticut is seeking community feedback on challenges to aging well. The Department of Health and Human Services launched a community survey seeking feedback concerning challenges in accessing services to age well or provide care to others within the community. Feedback will help create a long-term plan for how the state and community partners will work together to provide access to services through the lifespan.

North Carolina is engaging community members to address ongoing health disparities. The North Carolina Department of Health and Human Services (NCDHHS) hosted a webinar to discuss the new Community and Partner Engagement Initiative with community members, partners, and leaders. The initiative was launched earlier this year and includes improvements to internal processes for engaging community partners, as well as groups with lived experience.  

For states interested in learning more about how to effectively engage individuals with lived experience, see the SHVS issue briefs Transformational Community Engagement to Advance Health Equity and State Examples of Medicaid Community Engagement Strategies: Two Case Studies. 

Health Equity

Minnesota created the Office of American Indian Health. The Minnesota Department of Health (MDH) launched Minnesota’s statewide Office of American Indian Health. The office was created to improve the health and wellbeing of American Indian communities in Minnesota and to ensure Native communities are represented in all MDH public health activities.

Nevada is seeking to advance health equity with the development of public option plans. The state released a request for information (RFI) to inform the state’s upcoming procurement of the new public option. The state must establish and design a public option program in the individual health insurance market that, in addition to other objectives, seeks to reduce disparities in health access and outcomes. The RFI includes a number of questions about how to achieve health equity goals, including questions about expanding access, the collection of race, ethnicity, language and other demographic data, and rural healthcare program requirements and/or benchmarks.

SHVS has a resource page that serves as an accessible one-stop source of information on health equity for states. For more information about how to integrate health equity into Medicaid managed care contracts, see the recently updated Compendium of Medicaid Managed Care Contracting Strategies to Promote Health Equity. 

Maternal Health

Alabama is increasing access to autopsies for deaths related to maternal health. The Alabama Department of Public Health announced the implementation of the Maternal Autopsy Program which will expand autopsies to be available state-wide and provide greater insight into the cause of maternal deaths in the state.

Nevada received approval to extend postpartum coverage for Medicaid enrollees. CMS approved state plan amendments to extend postpartum coverage in Nevada. Nationally, people across 46 states, the District of Columbia, and U.S.V.I. now have access to Medicaid and CHIP coverage for a full 12 months following pregnancy. 

As a reminder, SHVS published an issue brief on the American Rescue Plan option to extend postpartum coverage. Also see the SHVS issue brief Maternal Health Providers: Enhancing Health Equity Through Payment Parity for ideas on how states can leverage payment to improve maternal health outcomes.

Medical Debt

Connecticut is prohibiting the reporting of medical debt. Governor Ned Lamont announced that he has signed legislation prohibiting healthcare providers and hospitals in Connecticut from reporting a person’s medical debt to credit rating agencies for use in credit reports. It also voids any medical debt that is reported to credit rating agencies. 

For more information on state efforts to prohibit medical debt reporting, see the SHVS expert perspective Mapping State Efforts to Address Medical Debt and a recent Health Affairs Forefront article which examines the burgeoning trend of state efforts to cancel medical debt for just pennies on the dollar.

Mental and Behavioral Health

California to purchase over-the-counter naloxone at a significant discount. Governor Gavin Newsom announced CalRx’s Naloxone Access Initiative’s new partner, Amneal Pharmaceuticals, which has secured FDA approval of an over-the-counter (OTC) naloxone nasal spray product. This new partnership allows the state to purchase CalRX-branded OTC naloxone for $24–almost half of the current market price. Qualifying organizations in the state, including first responders, universities and community organizations can access the state’s naloxone supply for free.

Michigan passed legislation for mental health and substance-use disorder treatment parity. Governor Gretchen Whitmer signed legislation that requires insurers to cover treatments for mental health and substance-use disorder at the same level as physical health services. 

Nebraska launched a map of substance-use disorder resources. The Nebraska Department of Health and Human Services has published a map that features substance-use disorder resources across the state such as sites where no-cost naloxone can be obtained, as well as providers of medications for Opioid Use Disorder, and treatment/recovery services. The state has also created a new dashboard that provides data on overdose rates based on age, over time, and by substance. Data can be viewed by local health departments or state-wide. 

New Jersey awarded contracts to develop crisis diversion homes. Human Services Commissioner Sarah Adelman announced the Department has awarded more than $3.6 million in contracts to develop recovery-oriented crisis diversion homes, which will provide care and services to individuals who have recently experienced a mental health crisis. The crisis diversion homes will serve as temporary transitional housing for 30 days, with the goal of linking individuals to the appropriate therapeutic supports and assisting with discharge to the appropriate community setting.

Oregon is highlighting risks and resources related to substance-use. The Oregon Health Authority launched a social media campaign spotlighting the public health harms caused by fentanyl, and how people can prevent deadly overdoses in the state. The campaign, “Fentanyl Aware” will focus on teaching people about risks, harm reduction strategies, recognizing and responding to an overdose and Oregon’s Good Samaritan Law.

Coverage for Justice-Involved Populations

Washington is providing pre-release services for individuals leaving incarceration. The Health Care Authority is inviting carceral facilities to join the Reentry Demonstration Initiative, a new voluntary initiative under the Medicaid Transformation Project. This initiative provides essential pre-release services for individuals leaving incarceration, including care management, substance-use disorder treatment and recovery support, and infectious diseases. The first group of carceral facilities implementing the Reentry Initiative will launch on July 1, 2025.

Reproductive and Women’s Health

Arizona is expanding access to free and affordable birth control. Governor Katie Hobbs issued an executive order that takes several actions including making over-the-counter birth control options available at no cost to state employees and requiring the Arizona Health Care Cost Containment System to consider ways it can expand access to contraception for its members.

California is protecting abortion care for Arizonans. Governor Gavin Newsom signed SB 233 which will allow Arizona abortion providers in good standing to temporarily provide abortion care to patients from Arizona who travel to California for that care.

Iowa is increasing access to breast examinations. Iowa Governor Kim Reynolds signed a health insurance bill requiring insurers to cover supplemental and diagnostic testing for breast examinations.

New Jersey is allowing pharmacists to provide contraceptives to patients without a prescription. Governor Phil Murphy announced several actions which together authorize qualified pharmacists to furnish self-administered hormonal contraceptives to patients without a prescription. Interested pharmacists must complete a four-hour training program on patient screening, the selection of a self administered hormonal contraceptive, and patient counseling.

North Carolina announced the expansion of contraceptive services in pharmacies. The North Carolina Department of Health and Human Services (NCDHHS) announced that people statewide will be able to receive contraceptive services at pharmacies without a prescription, including counseling and education from a pharmacist about options for contraception and other preventive services, dispensing of contraception and connection to ongoing care if needed.

Unwinding the Medicaid Continuous Coverage Requirement 

Georgia is installing self-service benefits kiosks at public libraries. The Georgia Department of Human Services and Georgia Public Library Service are partnering to provide self-service benefits kiosks at public libraries. The kiosks provide convenient locations for the public to access Georgia Gateway, the state’s integrated eligibility system, to review, change, or renew their benefits including Medicaid and CHIP.

Kentucky published an update of the federal flexibilities the state has leveraged during unwinding. The Kentucky Cabinet for Health and Family Services released an updated chart of the Department for Medicaid Services’ public health emergency flexibilities and unwinding decisions.

New Jersey is extending a special enrollment period for Marketplace enrollment . New Jersey Department of Banking and Insurance Acting Commissioner Justin Zimmerman announced the department will extend a previously announced special enrollment period (SEP) to make it easier for qualified individuals who are no longer eligible for NJ FamilyCare coverage to enroll with Get Covered New Jersey. The end date of the SEP will be extended from July 31, 2024, to November 30, 2024.

Oregon is making system updates to its Medicaid eligibility system. OHA announced it is making system updates to the ONE Eligibility system, which will enable Oregon to use an improved process for the remaining renewals the state is conducting during unwinding. 

SHVS has a one-stop resource page to support states as they implement unwinding. As states operationalized unwinding, SHVS tracked the work states engaged in through the series States of Unwinding, which showcased strategies for other states to adopt and highlighted how states leveraged federal flexibilities. 

Waiver and State Plan Amendments, Requests and Approvals

Delaware received approval for new services for postpartum enrollees. CMS approved a five-year extension of the “Delaware Diamond State Health Plan (DSHP) Section 1115 Demonstration.” The approval includes authorization for new services for postpartum enrollees, including coverage of two home-delivered meals per day or one medically appropriate shelf stable food box and coverage of up to 80 diapers and one pack of baby wipes for the first 12 weeks of the postpartum period.

Hawai’i becomes the first state to offer community-based palliative care through Medicaid. Governor Josh Green and the Department of Human Services Med-QUEST Division announced that CMS approved a new state plan amendment to cover community palliative care services through Medicaid. This makes Hawai’i the first state to implement palliative care in non-hospital settings, and paves a path to enable other states wishing to cover palliative care services as part of a state plan amendment.

Tennessee received approval expanding coverage and benefits available to Medicaid enrollees. CMS approved an amendment to Tennessee’s section 1115 demonstration, entitled “TennCare III.” This amendment will give the state the authority to, among other initiatives, expand eligibility for parents and caretaker relatives of dependent children up to 100% of the federal poverty level; cover a supply of diapers for infants and young children enrolled in TennCare and CHIP; and enhance home and community-based services available to individuals with disabilities.