States of Innovation: August 2024

In August, states took action to enhance the accessibility of information about services for individuals with disabilities. California released American Sign Language interpretation informational videos, while New Jersey created a new information hub for individuals with disabilities. As the use of artificial intelligence (AI) becomes increasingly commonplace, states are implementing regulations, such as Michigan, which issued guidance in August on the use of AI in the insurance industry. 

Throughout the month of August states took action on maternal health, with Arizona and Texas funding maternity care in rural areas, while Illinois passed legislation requiring private insurers to cover doulas as part of the state’s Birth Equity Initiative. States continue to act on the issue of medical debt, including New Jersey, which is relieving $100 million in debt, North Carolina, which announced that all eligible hospitals will participate in the state’s medical debt relief program, and Rhode Island, which is prohibiting the reporting of medical debt.

States also focused on increasing access to mental and behavioral health in August. Colorado launched a campaign to promote the state’s 988 mental health line, while Massachusetts announced funding to support community based organizations serving communities disproportionately affected by the opioid epidemic. New York announced additional funding for preventing gun violence. Other states took steps to increase access to reproductive and women’s health, such as New Jersey, which established a menstrual hygiene benefit and North Carolina, which is expanding access to free oral contraceptives. Two states expanded services for children and youth in August: New Jersey established a diaper benefit program for families receiving cash assistance, while New York announced an expansion of the HealthySteps program. 

Lastly, August saw many states seek or receive approval from the Centers for Medicare & Medicaid Services (CMS) for waiver and state plan amendments and requests, including Louisiana which is looking to provide pre-release services to justice-involved individuals and Nevada, which received approval to provide mobile crisis services. 

Accessibility

California developed resources to promote accessibility of Medicaid services. The Department of Health Care Services released three new American Sign Language (ASL) Interpretation videos covering topics important for Medi-Cal members. The ASL videos include information about interpreter services, billing protections, and a pilot program that aims to simplify the transition from Medi-Cal  to Medicare for those who are newly eligible.

New Jersey created a new website to enhance access to services for individuals with disabilities. Commissioner Sarah Adelman and State Chief Innovation Officer Dave Cole launched a Disability Information Hub website. The Hub will serve as a one-stop shop to connect New Jerseyans with disabilities, their families, caregivers, and advocates with state services and resources in an accessible format.

Artificial Intelligence

Michigan issued guidance on the use of artificial intelligence (AI) in the insurance industry. The Michigan Department of Insurance and Financial Services issued a new bulletin that will ensure consumers are protected when insurance companies use artificial intelligence (AI) technologies to underwrite new policies, make coverage determinations, or decide how much their products will cost. The bulletin details how existing state laws apply to these technologies and outlines the department’s expectations for insurers.

Maternal Health

Arizona distributed funds to improve maternity care in rural areas. The Arizona Health Care Cost Containment System distributed $2.5 million to four community health centers for on-call maternity care services in rural communities which often have little to no maternity care available. The initiative is funded by Senate Bill 1720 which appropriates $7.5 million through June 30, 2026.

Illinois enacted legislation that increases access to maternal care providers. Governor Pritzker signed the Birth Equity Initiative into law, which requires insurers to cover all services for pregnancy, postpartum, and newborn care that are provided by perinatal doulas or licensed certified professional midwives, including home births, home visits, and support during labor, abortion, or miscarriage. The Governor’s larger budget-based birth equity plan also invests $15 million in closing the maternal mortality gap through home visiting expansion, capital dollars for community-birth centers, a diaper pilot program, changes to Medicaid reimbursement rates, and a child tax credit for families in poverty.

Pennsylvania is seeking community input for the development of a maternal health strategic plan. The Pennsylvania Departments of Human Services (DHS), Health (DOH), Drug and Alcohol Programs (DDAP), and the Pennsylvania Insurance Department (PID) launched a planning process to develop a maternal health strategic plan. DHS, DOH, DDAP, and PID will launch an online survey and host community events in September and October to gather input from Pennsylvanians with lived experience in maternal health. The strategic plan will include priorities centering on equity and diversity, with a focus on increasing access to high-quality care, expanding and diversifying the maternal healthcare workforce, and addressing behavioral health and substance-use disorder services and supports.

Texas will distribute funds to improve maternity care in rural areas. Governor Greg Abbott announced the Texas Health and Human Services Commission (HHSC) is awarding $3.3 million in grant funding to improve maternal care in rural hospitals currently not providing labor and delivery services. The HHSC Rural Hospital Maternal Care Operations Grant provides qualifying hospitals a one-time payment of $35,000 to purchase neonatal equipment, supplies, and training for emergency labor and delivery services.

Wyoming is seeking input on its maternal and child health priorities. The Wyoming Department of Health is seeking feedback on priorities for its Maternal and Child Health (MCH) Unit. Community representatives and family members from across the state are invited to participate in focus groups and respond to a survey, which will help determine the final priorities included in Wyoming’s MCH State Action Plan.

For more information on how states can leverage payment to improve maternal health outcomes, see the SHVS issue brief Maternal Health Providers: Enhancing Health Equity Through Payment Parity.

Medical Debt

New Jersey is relieving $100 million in medical debt. Governor Phil Murphy announced that the state is eliminating $100 million in medical debt for approximately 50,000 residents by leveraging over $500,000 in American Rescue Plan Act funds. Eligible residents include those with incomes up to 400% of the federal poverty level or those with medical debt equal to 5% or more of their annual income. This effort is part of the $10 million appropriation included in the 2024 state budget for medical debt cancellation. 

North Carolina announced all eligible hospitals have signed on to the state’s medical debt relief incentive program. Governor Roy Cooper and Health and Human Services Secretary Kody H. Kinsley announced that all 99 eligible hospitals in North Carolina have signed on to the state’s medical debt relief incentive program. Hospitals will now implement programs that will relieve up to $4 billion in past medical debt and put in place forward-looking policies that mitigate the accumulation of debt. It is estimated that nearly 2 million low- and middle-income North Carolinians will have more than a decade of existing medical debt relieved. 

Rhode Island is prohibiting the reporting of medical debt to consumer reporting agencies. Governor Dan McKee signed into law a bill which prohibits hospitals and other medical providers from reporting an individual’s medical debt to consumer reporting agencies and credit bureaus. The legislation also puts in place rules for communicating with consumers and prohibits false and misleading representation by debt collectors as well as collections during insurance appeals.

For more information on state efforts to prohibit medical debt reporting and eliminate existing debt, 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

Colorado is promoting its mental health services. The Colorado Behavioral Health Administration (BHA) and 988 Crisis Hotline Enterprise Board announced the launch of a campaign to increase awareness and utilization of the 988 Colorado Mental Health line. To inform the marketing campaign, BHA conducted research with youth, adults and behavioral health referrers to provide feedback on the proposed messaging, website and creative directions.

Delaware is expanding school-based mental and behavioral health services. Governor John Carney signed two pieces of legislation to support student mental health in schools. The first new law will help establish a mental health services unit for high schools in Delaware, which will lower the ratio of students to counselors to make mental health services more accessible. The second law will expand the reimbursement of school-based behavioral health services through Medicaid. 

Massachusetts is funding community organizations to address the opioid epidemic. The Healey-Driscoll administration announced $3.75 million in grants to 18 grassroots organizations to reduce the harms caused by the opioid epidemic in communities disproportionately impacted by overdose deaths. The grants are the first to be awarded through the Mosaic Opioid Recovery Partnership, a new grantmaking program designed to support communities that have historically experienced a high rate of opioid-related overdose deaths.

Montana is conducting a study of access to affordable housing among Montanans in the behavioral health system. Governor Greg Gianforte announced funding of up to $1 million to conduct a statewide study of how to subsidize housing costs for low-income Montanans served in the state’s behavioral health (BH) system. Individuals served by the state’s BH and Developmental Disabilities systems are increasingly unable to access affordable housing. Through the study, information will be gathered on current rental rates throughout the state to help determine the funding necessary to supplement federal rental assistance.

North Carolina is investing $4.5 million to strengthen behavioral health services for children. The North Carolina Department of Health and Human Services announced a $4.5 million investment in the NC Child Treatment Program, a statewide initiative to train mental health providers in trauma-informed treatment models for children with complex behavioral health needs. The investment is part of the department’s ongoing efforts to strengthen the child behavioral health workforce and build a continuum of services to improve outcomes for children and families.

Preventing Gun Violence

New York awarded nearly $40 million for a youth employment program to reduce gun violence. Governor Kathy Hochul announced nearly $40 million has been awarded for the next phase of the Youth Employment Program, which aims to reduce gun violence by providing job opportunities and training to youth at higher risk of gun violence in communities across the state. The effort is part of New York’s Gun Involved Violence Elimination (GIVE) initiative.

For more information on gun violence prevention, check out this episode of the Princeton Pulse which discusses a public health approach focused on firearm safety and injury prevention.

Reproductive and Women’s Health

New Jersey established a menstrual hygiene program. Governor Phil Murphy signed A2027/S2330 to establish a menstrual hygiene benefit program through Work First New Jersey, the state’s cash assistance program. The program will allow certain eligible adults ages 18 through 50 to purchase menstrual hygiene products using a $14 monthly state benefit.

New York expanded access to menstrual products. Governor Kathy Hochul signed legislation to expand resources for women’s health services. S.5910-B/A.4060-A requires menstrual products in public colleges and universities. S.6146-A/A.5729-A requires commercial health insurers to provide coverage for tattooing performed by a physician as part of breast reconstruction surgery. 

North Carolina is expanding access to free oral contraceptives. Governor Roy Cooper announced that beginning August 1, the oral contraceptive Opill will be available through local and retail pharmacies without a prescription, at no cost for North Carolina Medicaid enrollees.

Services for Children and Youth

New Jersey established a diaper benefit program. Governor Phil Murphy signed A2027/S2330 to establish a diaper benefit program through Work First New Jersey (WFNJ), the state’s cash assistance program. The program will provide individuals participating in WFNJ with a dependent child under 36 months of age with a $30 monthly state benefit for diapers.

New York is expanding the HealthySteps program. Governor Hochul announced more than $24 million to expand HealthySteps, a program that supports young families with children under the age of three. The program pairs pediatric physicians with child development specialists to provide services for children and their families in a pediatric healthcare setting. The funding will support up to 50 new HealthySteps sites. 

Waiver and State Plan Amendments, Requests and Approvals

California seeks to expand behavioral health services. The state submitted an addendum to its pending section 1115 demonstration, with the aim of expanding the care continuum for Medi-Cal members with complex behavioral health issues and risk factors. The state proposes to enable county behavioral health plans to opt into one or both of two new opportunities: (1) community transition in-reach services; and (2) room and board in enriched residential settings.

Colorado seeks to address health-related social needs. Colorado submitted a request to amend its Medicaid section 1115 demonstration to incorporate a health-related social needs program and provide housing and nutrition services for eligible populations. 

Delaware received approval to continue implementation of its reinsurance program. The U.S. Departments of Health and Human Services and Treasury approved Delaware’s application to extend its State Innovation Waiver, known as the Delaware Health Insurance Individual Market Stabilization Reinsurance Program, for an additional five years through 2029. Actuarial analysis submitted as part of the waiver extension application projected that in plan year 2025, statewide premiums will be on average 15.3% lower for individual health insurance coverage when compared to the without-waiver baseline. For more information on state reinsurance programs and considerations for policymakers, see this SHVS expert perspective.

Illinois will provide health-related social needs services, pre-release services, and more for eligible individuals. CMS approved the state’s request to amend and extend its Healthcare Transformation 1115 demonstration waiver. Under the extension the state received authority to provide: (1) services to address health-related social needs, with a focus on housing support, medical respite, and food and nutrition; (2) coverage for pre-release services for individuals leaving carceral settings; (3) services to address community firearm violence; (4) expanded home and community-based services, including non-medical transportation; and (5) substance-use disorder assistance as well as coverage of violence prevention and intervention services for enrollees impacted by violence.

Louisiana seeks to provide pre-release services to justice-involved individuals. The Louisiana Department of Health released for public comment a draft application to CMS for an 1115 demonstration waiver to improve care transitions for Medicaid-eligible individuals who are incarcerated and to provide certain covered services during the 90-day pre-release period. Individuals participating in the demonstration will have access to services including case management, medication-assisted treatment and counseling for substance-use disorders, and a 30-day supply of all prescription medications. Eligible carceral settings will include all state prison facilities and up to 13 parish jails. For more information on the opportunity for states to provide certain pre-release healthcare services to justice-involved populations, see the SHVS webinar, Section 1115 Demonstration Opportunity to Support Reentry for Justice-Involved Populations: CMS Guidance.

Nevada will provide mobile crisis services. CMS approved a state plan amendment (SPA) for mobile crisis services in Nevada. This is the 19th 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.

Tennessee seeks to extend TennCare coverage to additional working individuals with disabilities. Tennessee requested to amend their Medicaid section 1115 demonstration entitled “TennCare III.” The proposed amendment would extend TennCare coverage to additional working individuals with disabilities, with the goal of removing barriers to employment for individuals with disabilities who, but for their income and resources, would otherwise qualify for coverage under the TennCare demonstration. 

Virginia seeks to provide substance-use disorder services. The state submitted an extension request to its section 1115 demonstration to extend the substance-use disorder program and continue coverage for former foster care youth.