States of Innovation: June 2024
Several recent trends in state health policy were adopted by additional states in June. One such burgeoning trend is states addressing the burden of medical debt, with Minnesota enacting legislation that bans medical providers from withholding medically necessary care due to unpaid debt, among other protections. Other growing trends among states include mitigating the health effects of climate change and preventing gun violence. New York released an Extreme Heat Action Plan and Michigan established a Gun Violence Prevention Task Force and highlighted the availability of free gun locks to protect children from unsecured firearms.
June also saw states taking steps to engage the community and advance health equity. California and North Carolina both hosted webinars on how to more effectively engage Medicaid members, and New Mexico announced Medicaid reimbursement for Community Health Workers and Community Health Representatives. Several states took action on maternal health, including Colorado requiring that health benefit plans and Medicaid provide coverage for doula services. States also continue to increase access to mental and behavioral health, including Hawai’i, Michigan, Montana, North Carolina, and Washington.
In support of reproductive and women’s health, Colorado passed legislation to provide free menstrual products in school bathrooms, and Washington reaffirmed hospitals’ legal requirement to provide emergency abortion services. Several states took steps to strengthen services for children and youth. Maryland launched a program to reduce deaths from suicide among LGBTQIA+ youth, while Illinois established a new Department of Early Childhood.
States continued to implement strategies in support of the unwinding of the Medicaid continuous coverage requirement, such as Colorado which announced it is extending the special enrollment period for individuals no longer eligible for Medicaid to enroll in the Marketplace. June also saw several states seek or receive approval of waiver amendments and requests from the Centers for Medicare & Medicaid Services (CMS).
Community Engagement
California is promoting tools to better engage eligible members in CalAIM. The Department of Health Care Services (DHCS) hosted a webinar, Tools to Better Engage Eligible Members in CalAIM. CalAIM is a multi-year DHCS initiative to improve the quality of life and health outcomes of the eligible population by implementing broad delivery system, program, and payment reform across the Medi-Cal program. The webinar was part of a biannual series of webinars designed to highlight best practices for implementing Enhanced Care Management and Community Supports, increase providers’ successful participation in CalAIM, and improve collaboration with Medi-Cal managed care plans, state and local government agencies, and others.
New Mexico will reimburse Community Health Workers (CHW) and Community Health Representatives (CHR). The New Mexico Human Services Department announced Medicaid reimbursement of CHWs and CHRs. These frontline public health workers serve as a bridge between communities, healthcare systems, and state health departments. CHWs and CHRs help New Mexicans navigate complex medical systems and act as liaisons between the communities where they live and the healthcare system. New Mexico will be the first state to eliminate the need for CHWs and CHRs to obtain an order from a physician or clinician before they see a new Medicaid member.
North Carolina held a Spanish-language webinar to discuss the new Community and Partner Engagement Initiative. The North Carolina Department of Health and Human Services (NCDHHS) hosted a Spanish-language webinar to discuss the new NCDHHS Community and Partner Engagement Initiative with community advocates, partners, leaders and other members of the Hispanic and Latinx community. NCDHHS launched the initiative earlier this year to address ongoing health disparities.
Virginia is hosting community stakeholder meetings. The Virginia Department of Medical Assistance Services will host a series of community stakeholder meetings to learn more about how to collectively support current and eligible Medicaid members.
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
Michigan aims to address racial health disparities with free preventative health screenings. Lieutenant Governor Garlin Gilchrist announced that 22 Neighborhood Wellness Centers are offering free preventive health screenings to help address racial health disparities. Formerly COVID-19 Neighborhood Testing Sites, the Centers are staffed by CHWs who support community members by helping to identify health-related social needs and linking community members to resources. Additionally, CHWs offer health counseling and education services and provide referrals to primary care providers, senior services, and more. Seven of the Neighborhood Wellness Centers are piloting substance-use disorder prevention services, including access to naloxone and prevention education.
SHVS has a resource page that serves as an accessible one-stop source of information on health equity for states. Also see SHVS’ Health Equity Impact Tool, which was designed to benchmark how state health agencies’ work impacts health equity and identify broad strategic equity goals which can be used to generate an action plan.
Maternal Health
Colorado will require health benefit plans and Medicaid to provide coverage for doula services. Governor Jared Polis signed SB24-175 requiring health benefit plans to provide coverage for doula services following the same scope and duration of coverage for doula services that will be included in Medicaid.
New York is facilitating access to doula services and requiring paid break time for breast milk expression. The New York State Department of Health issued a statewide standing order which states that all New Yorkers who are pregnant, birthing, or postpartum would benefit from receiving doula services. The standing order will allow more New Yorkers to access doula care, as a recommendation for doula services is required in order to be eligible for Medicaid coverage. Governor Kathy Hochul announced that a new law requiring employers to provide 30 minutes of paid break time for breast milk expression went into effect June 19. This mandate applies whenever employees have a reasonable need to express breast milk and extends up to three years following childbirth.
For more 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.
Medical Debt
Minnesota is helping to ease the burden of medical debt. Governor Tim Walz signed legislation that bans medical providers from withholding medically necessary care due to unpaid debt and also: prevents medical debt from impacting credit scores; eliminates automatic transfers of medical debt to a patient’s spouse; establishes new protections from unethical medical debt collections practices; requires medical providers to publish their medical debt collection practices; and creates a new process to help people dispute medical coding and billing errors.
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
Hawai’i passed multiple bills related to mental and behavioral health. Governor Josh Green signed into law 22 bills related to the state’s healthcare system and workforce, including bills related to mental and behavioral health. Included among the bills signed into law are SB 3139, which creates a crisis intervention and diversion services program aimed at steering individuals with mental health and substance-use disorders away from the criminal justice system and toward appropriate healthcare services; and SB 3094, which establishes a temporary peer support specialist working group within the Office of Wellness and Resilience to enhance the role and effectiveness of peer support specialists in Hawaiʻi.
Michigan is expanding substance-use treatment through the Recovery Incentives Pilot. The Michigan Department of Health and Human Services (MDHHS) approved eight pre-paid inpatient health plans (PIHPs) to participate in the Recovery Incentives Pilot, which will expand access to evidence-based treatment for Medicaid enrollees who are living with certain substance-use disorders (SUDs). MDHHS, participating PIHPs and providers will collaborate to deliver motivational incentives, such as gift cards, to people living with an SUD who achieve their treatment goals.
Montana announced investments in community-based residential providers and peer support services. Governor Greg Gianforte announced a $15.8 million investment in one-time grants to increase bed capacity for community-based residential providers offering behavioral healthcare or developmental disability services to Montanans. Governor Gianforte also announced an investment of $700,000 to expand peer support services for Montana families and caregivers. Family peer support services are provided by those who have lived experience raising a child with behavioral health issues or special healthcare needs and can provide support and resources to another family who is raising a child with similar needs.
North Carolina created a toolkit to share disaster-specific mental health resources. The North Carolina Department of Health and Human Services launched a new, multilingual Disaster and Behavioral Health Resources Communications Toolkit to provide communities with guidance and resources to support mental and emotional health before, during, and after a disaster.
Washington launched a program to expand access to medications for opioid-use disorder. The Washington State Health Care Authority launched a program that expands access to medications for opioid-use disorder. The program, ScalaNW, equips emergency room clinicians with tools to treat patients for opioid-use disorder and connect them to community-based care.
Mitigating the Health Effects of Climate Change
New York released an Extreme Heat Action Plan. Governor Kathy Hochul announced the release of the state’s Extreme Heat Action Plan, which prioritizes equity in adaptation to extreme heat. The plan includes providing technical assistance to local communities, scaling implementation of nature-based solutions to address inequities and reduce the urban heat island effect and enhancing equitable access to cooling at home and in public spaces.
Preventing Gun Violence
Michigan established a Gun Violence Prevention Task Force and announced the availability of free gun locks. Governor Gretchen Whitmer signed Executive Order 2024-4 establishing the Michigan Gun Violence Prevention Task Force. The task force, housed within MDHHS, will identify root causes of gun violence, compile and report relevant data, maximize existing resources, solicit perspectives from diverse stakeholders, and provide policy recommendations. Also, MDHHS and Michigan State Police are reminding Michigan families about the availability of free gun locks at MDHHS county offices and some local health departments. Cable-style gun locks from Project ChildSafe are being offered as part of an effort to protect children from unsecured firearms and 75,000 gun locks are available while supplies last.
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
Colorado is expanding access to menstrual products for students. Governor Jared Polis signed HB24-1164 to provide menstrual products at no expense to students. The legislation requires schools to provide the products in an increasing percentage of bathrooms each year, with all bathrooms supplied by June 30, 2028.
Washington reaffirmed hospitals’ legal requirement to provide emergency abortion services. Governor Jay Inslee issued a directive requiring the Department of Health to reaffirm that hospitals in Washington state have a legal requirement to provide emergency abortion services. Governor Inslee also directed the Department of Health to take enforcement action, in accordance with applicable law, against hospitals that do not provide such required care.
Services for Children and Youth
Maryland launched a program to reduce deaths from suicide among LGBTQIA+ youth. Governor Wes Moore announced the launch of a pilot program in partnership with the Maryland Department of Health and the Trevor Project to reduce deaths from suicide among LGBTQIA+ youth. The training program will be available to behavioral healthcare workers, mental health providers, law enforcement, suicide prevention leaders, veteran leaders, university faculty, school personnel, and coaches selected by the department’s Office of Suicide Prevention.
Illinois established a new Department of Early Childhood. Governor J.B. Pritzker signed SB1, creating the Department of Early Childhood. The new state agency will focus exclusively on early childhood programs and services for young children. Previously, services for young children were housed in three separate agencies, resulting in service gaps and barriers to services for historically underserved communities. With this new agency, early childhood programs will be unified to improve ease and accessibility for families and providers seeking state resources, including home visiting programs and Early Intervention services.
CMS announced the recipients of the Implementation, Enhancement, and Expansion of Medicaid and CHIP School-Based Services grants. 18 states (AK, DE, KS, KY, MD, MA, MN, NV, NH, NC, OK, OR, PA, RI, VT, WA, WV & WI) will receive grants for the Implementation, Enhancement, and Expansion of Medicaid and CHIP School-Based Services. The states will use these funds to support their efforts to connect millions more children to critical healthcare services, especially mental health services, at school. Made possible by the Bipartisan Safer Communities Act, the states will each receive up to $2.5 million over 3 years.
Unwinding the Medicaid Continuous Coverage Requirement
California automatically enrolled 158,000 individuals in Covered California. Covered California, the state’s official health insurance Marketplace, announced that more than 158,000 Californians remained covered through the Medicaid to Covered California enrollment program over the past year during unwinding of the Medicaid continuous coverage requirement. Under the program, Covered California automatically enrolls individuals in one of its low-cost health plans when they lose Medicaid coverage and gain eligibility for financial help through Covered California.
Colorado is extending a special enrollment period for Marketplace enrollment. The Colorado Division of Insurance has extended the enrollment window for people who are no longer eligible for Medicaid coverage due to unwinding. The deadline is now November 30, 2024 to enroll in health insurance through the Marketplace, extended from the previous deadline of July 31.
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
The District of Columbia is seeking to provide pre-release services to justice-involved individuals. The District of Columbia submitted a demonstration renewal request for the D.C. Behavioral Health Transformation that would include implementing new Medicaid services for justice-involved individuals up to 90-days pre-release and health-related social needs services, specifically housing supports and nutrition supports.
Nevada received approval to offer a limited dental benefit to certain adults. The Centers for Medicare & Medicaid Services approved a new five-year section 1115 demonstration, “Whole Mouth Whole Body Connection for Adults with Diabetes.” Through this demonstration, Nevada will have the authority to offer a limited dental benefit to non-pregnant diabetic adults (21 through 64 years of age) enrolled in Medicaid, through a network of Federally Qualified Health Centers and participating Tribal Health Centers. The limited dental benefit package will include diagnostic and preventative, restorative, endodontic, and periodontic dental services.
New York submitted a demonstration amendment to provide continuous enrollment for children. The amendment to its Medicaid Redesign Team 1115 demonstration would authorize continuous enrollment for Medicaid and CHIP coverage for children during the first six years of their lives and federal Medicaid and CHIP matching funds without regard to whether a child’s family income exceeds eligibility limits.
Rhode Island seeks to address health-related social needs and provide pre-release services. The state submitted an addendum to its extension request for its Medicaid section 1115(a) demonstration, “Rhode Island Comprehensive Demonstration.” If approved, the addendum would allow the state to provide services to address health-related social needs. The addendum also updates the state’s request for pre-release support for incarcerated individuals by requesting 90 days of pre-release coverage and includes additional detail regarding the pre-release services the state would provide. 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.