States of Innovation: December 2024
In December, states continued to focus on mental and behavioral health with California announcing a new initiative for people with untreated schizophrenia, while Wisconsin launched a program to cover move-in costs for Medicaid members with behavioral health needs. In advance of the transition in federal administrations, multiple states submitted 1115 waiver amendments and requests, including Arizona for continuous enrollment for former foster youth and Utah to provide traditional healing services. CMS also approved waiver requests for ten states, including California, Kentucky, North Carolina and West Virginia.
Other state action in December included New Jersey capping out-of-pocket costs for medication in an effort to address healthcare costs, while Oregon announced policy changes in response to a community engagement effort. Oregon also launched a multi-pronged health equity initiative. On the topic of Marketplace innovations, the District of Columbia is making treatment and management of HIV free for standardized plans.
December also saw several states taking steps to improve maternal health, including Arkansas, New Jersey and New York. Two states took action on medical debt, with Connecticut cancelling $30 million in consumer debt and North Carolina releasing a toolkit to support states interested in the topic.
Affordability and Efforts to Address Cost
New Jersey is capping out-of-pocket costs for certain prescriptions. 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.
Community Engagement
Oregon is implementing policy changes in response to a state-wide listening tour. Following a statewide listening tour, the Oregon Health Authority (OHA) announced it will roll out a series of locally requested policy, regulatory, and administrative changes. These changes seek to boost transparency, accountability, and support for communities. A new report describes 16 efforts state officials are pursuing to respond to the challenges they heard, including reducing administrative burdens for mental health and substance-use providers and supporting community health workers to bill Medicaid for services.
Health Equity
Oregon is launching a multi-pronged health equity initiative. The OHA launched Oregon Health Forward (OHF), an alliance of three major efforts that will advance OHA’s goal to eliminate health inequities by 2030. These initiatives include: OHA’s Strategic Plan, a statewide Call to Action to advance health for all, and an organized effort to strengthen transparency, accountability and belonging within OHA.
Marketplace Innovations
The District of Columbia is making treatment and management of HIV free for standardized plans. 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.
Maternal Health
Arkansas is launching a program to support high-risk pregnancies. The Arkansas Department of Human Services announced that St. Bernards Medical Center will open the first Maternal Life360 HOME in Arkansas. Life360 HOMEs are an innovative program that support individuals with high-risk pregnancies through home-visiting services during pregnancy and for up to two years after birth. The intensive supports available through this program are aimed at improving health outcomes and health-related social needs like food security and housing, and as a result, the long-term health and wellbeing of birthing individuals and babies.
New Jersey is ensuring patients develop a postpartum care plan. 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.
New York launched a campaign to promote a new prenatal leave policy. Governor Kathy Hochul announced a statewide campaign to raise awareness of New York’s paid prenatal leave policy, which went into 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.
Medical Debt
Connecticut is cancelling $30 million in medical debt. Governor Ned Lamont announced that nearly 23,000 Connecticut residents will have $30 million in medical debt erased under the first round of a newly launched partnership with the national nonprofit organization Undue Medical Debt. The state is leveraging approximately $100,000 from American Rescue Plan funds.
North Carolina published a toolkit for other states interested in addressing medical debt. The North Carolina Department of Health and Human Services released a toolkit aimed at assisting other states seeking to tackle the burden of medical debt. The toolkit is informed by North Carolina’s Comprehensive Medical Debt Relief and Reform Incentive Program.
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
California launched a new initiative to meet the needs of people with schizophrenia. The California Department of Health Care Services (DHCS) announced the statewide launch of California’s Community Assistance, Recovery, and Empowerment (CARE) Act, a new pathway to safety and wellbeing for people with untreated or undertreated schizophrenia who are at risk of hospitalization, homelessness, and incarceration. CARE aims to help the system of care meet the needs of people who have fallen through the cracks with robust and comprehensive services, including behavioral health services, stabilization medications, and housing.
California is funding healthcare services at syringe service programs. DHCS awarded $19.3 million to 25 organizations to support low-barrier opioid treatment at syringe services programs (SSP) from September 30, 2024, through September 29, 2027. Awardees include SSPs providing or supporting healthcare services such as assessment, prescription, and management of medication for the treatment of opioid-use disorder.
North Carolina is expanding school-based behavioral health services. The North Carolina Department of Health and Human Services announced a $1.5 million investment to expand behavioral health services in 10 school-based health centers across the state. The funds will enable the centers to expand their services, such as adding telehealth capabilities and implementing evidence-based screening and assessment tools. Some centers will be able to hire licensed behavioral health clinicians to provide behavioral health services directly to students.
Wisconsin is supporting move-in costs for Medicaid members with behavioral health needs. Starting February 1, 2025, the Wisconsin Department of Health Services will launch a new initiative to provide housing support services to Wisconsin Medicaid members experiencing housing insecurity who are also affected by substance-use or mental health conditions. The services available include support with initial setup expenses, like security deposits, pest control, and utility activation.
Michigan, New York, Oklahoma, and South Carolina were selected to participate in a new behavioral health model. The Centers for Medicare & Medicaid Services (CMS) announced that state Medicaid agencies in Michigan, New York, Oklahoma, and South Carolina were selected to participate in the Innovation in Behavioral Health (IBH) Model. The IBH Model is focused on improving the quality of care and behavioral and physical health outcomes for adults enrolled in Medicaid and Medicare with moderate to severe mental health conditions and substance-use disorder.
Waiver and State Plan Amendments, Requests and Approvals
Arizona is requesting continuous enrollment for former foster care youth and received approval for reentry services for justice-involved individuals. 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. Arizona received approval for an amendment to its 1115 waiver to provide certain services to incarcerated individuals as they prepare for release and reentry.
Colorado is requesting to extend its waiver to provide continuous enrollment for children zero to three. Colorado submitted a request to extend its section 1115 demonstration and continue providing approved components of the waiver, such as continuous eligibility for children ages zero to three, as well as continued authority for pending amendment requests such as reentry services for justice-involved individuals.
California received approval to provide additional benefits and services to people with behavioral health needs. DHCS announced CMS’ approval of California’s section 1115 demonstration, the Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) demonstration. The demonstration will establish a robust continuum of evidence-based community services for people with significant behavioral health needs, including providing up to six months of transitional rent for qualified members, supporting the health of children and youth involved in the child welfare system, and providing transitional care management services to support individuals with significant behavioral health needs who are returning to the community. CMS also approved an amendment to California’s Advancing and Innovating Medi-Cal (CalAIM) section 1115 demonstration, to provide Consolidated Appropriations Act, 2023 waiver authority related to the approved reentry demonstration initiative and expenditure authority for health-related social needs.
Kentucky’s 1115 waiver was extended for five years with three amendments. CMS approved a five-year extension of Kentucky’s section 1115 demonstration, “TEAMKY.” This extension continues previously approved authorities and includes two amendments that allow Kentucky to provide (1) medically necessary short-term inpatient treatment services for Medicaid eligible adults with serious mental illness residing in settings that qualify as institutions for mental diseases, (2) episodic housing interventions under a health-related social needs (HRSN) initiative, and (3) recovery residence support services, which are non-clinical activities necessary to support enrollees recovering from substance-use disorder (SUD).
Massachusetts requested an amendment to its 1115 waiver. 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.
Michigan receives approval to provide reentry services. CMS approved a new section 1115 demonstration which will allow the state to provide limited pre-release demonstration coverage to certain incarcerated individuals under Medicaid, as well as for applicable youth and children who are or would be eligible for CHIP if not for their incarceration status, for up to 90 days. Michigan will provide pre-release services in state prisons, county jails, tribal correctional facilities, and juvenile facilities.
North Carolina received a five-year extension of its 1115 waiver. CMS approved a five-year extension of North Carolina’s section 1115 demonstration, “North Carolina Medicaid Reform Demonstration.” This extension continues previously approved authorities and also provides new authority for continuous eligibility for children, an enhanced home and community-based benefit, health information technology incentive-based programs, workforce initiatives, coverage for foster care youth who turned 18 years old from other states, designated state health programs, and a reentry demonstration initiative.
Pennsylvania was approved to provide re-entry services and health-related social needs to certain enrollees. CMS approved a new section 1115 demonstration, “Keystones of Health.” Approval of the demonstration gives Pennsylvania authority to provide limited pre-release Medicaid coverage to certain incarcerated individuals who are in state prisons and county jails up to 90 days prior to release. The demonstration also allows Pennsylvania to provide some housing and nutrition-related services to certain Medicaid enrollees based on a set of clinical and social risk criteria.
Utah submitted a waiver amendment to provide traditional healing services. 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.
Vermont received approval from CMS to provide health-related social needs. CMS approved an amendment to Vermont’s section 1115 demonstration which grants the state authority to provide health-related social needs services and infrastructure support, and expand eligibility for the Substance Used Disorder Community Intervention and Treatment for eligible enrollees up to and including 225 percent of the federal poverty level.
West Virginia’s 1115 waiver was extended for another five years. CMS approved a five-year extension of West Virginia’s section 1115 demonstration, “Evolving West Virginia Medicaid’s Behavioral Health Continuum of Care.” The extension continues previously approved authorities and provides new authorities, such as certain housing supports under the HRSN framework, post-overdose response teams called Quick Response Teams, recovery-related support services to help individuals with SUD manage their symptoms that interfere with employment, and a reentry demonstration initiative.
Wisconsin submitted an amendment request to expand reimbursement for stays in institutions for mental disease. The state submitted a request to CMS to amend the BadgerCare Reform 1115 waiver. Under the amendment, the state would expand reimbursement for acute inpatient stays in hospital IMDs to include individuals diagnosed with serious mental illness or serious emotional disturbance.