Coronavirus (COVID-19) Unwinding Federal Medicaid Flexibilities: Issues and Considerations for States
States quickly mobilized to implement emergency federal authorities (e.g., Section 1135 waivers, 1915(c) Waiver Appendix K, emergency Section 1115 waivers) and state-level regulatory flexibilities to respond to the COVID-19 pandemic; now they must determine which flexibilities to scale back or sustain, taking into account fiscal implications. The interaction of the stimulus package dates, the Public Health Emergency, and the President’s National Emergency Declaration, among other factors, are complex, and states are actively grappling with decision making regarding which flexibilities they need and want to keep, and how. This Excel workbook is intended to serve as a tool for states as they strategize and plan for the next phase of the COVID-19 pandemic. Specifically, states can utilize this template to conduct both a primary analysis as they determine which flexibilities to unwind or maintain and a secondary analysis to plan for operational and implementation implications. The workbook has been updated to reflect the renewal of the Public Health Emergency as of October 2, 2020.
Federal Declarations and Flexibilities Supporting Medicaid and CHIP COVID-19 Response Efforts Effective and Expiration Dates
To help states respond to the ongoing coronavirus (COVID-19) pandemic, the White House, the U.S. Department of Health and Human Services (HHS), and the Centers for Medicare and Medicaid Services (CMS) have invoked their emergency powers to authorize temporary flexibilities in Medicaid and the Children’s Health Insurance Program (CHIP). Congress’s legislative relief packages have provided additional federal support for state Medicaid programs, subject to certain conditions. The timeframes for these emergency measures are summarized in the chart below, including the effective dates and expiration timelines dictated by law or agency guidance. The chart also includes current end dates, which are subject to change as federal and state officials take actions to renew or terminate particular authorities.
On April 30, 2020, New Hampshire received approval from the Centers for Medicare & Medicaid Services (CMS) to require its managed care organizations (MCOs) to make a directed payment to six types of essential Medicaid providers in order to help them keep their doors open during the COVID-19 pandemic. Numerous states across the country share New Hampshire’s interest in directing MCOs to use some of their capitation funds to support providers facing sharp declines in utilization due to COVID-19. This regulatory analysis provides an overview of New Hampshire’s directed payment and the documents used in the New Hampshire approval.
On August 14, 2019, the Department of Homeland Security (DHS) published a final rule, Inadmissibility on Public Charge Grounds. The rule makes significant changes to the standards DHS will use to determine whether an immigrant is likely to become a “public charge”—a person dependent on the government for support—which will make it more difficult for certain immigrants to obtain lawful permanent residence (a green card) in the US. State
State Health and Value Strategies, in partnership with Manatt Health, has developed a variety of resources for states regarding the revised public charge rule and implications for states.
Materials and slides that were shared at the Small Group Convening that was held on September 12, 2018 in Philadelphia, PA.
Recent guidance issued by the Centers for Medicare and Medicaid Services (CMS) expanded the circumstances under which states can receive full federal funding for services received through the Indian Health Service (IHS) and tribal health facilities. This webinar, presented by the State Network team at Manatt Health, provided an overview of the CMS guidance, as well as the financial implications for states and tribes.
Webinar: Final 2017 Notice of Benefit and Payment Parameters and Letter to Federal Marketplace Issuers
The Department of Health and Human Services (HHS) recently published its final Notice of Benefit and Payment Parameters for 2017, as well as the final version of its 2017 letter to Qualified Health Plan (QHP) issuers participating in the federally-facilitated marketplace (FFM). The State Network team at Manatt Health led a webinar explaining this final rule and what it will mean for states.
In March of 2012, the U.S. Department of Health and Human Services issued a regulation defining student health plans as individual health insurance under federal law. As a result, they are now subject to the same consumer protections afforded to all those covered by individual health insurance set forth in the Public Health Service Act, as amended by the Affordable Care Act. This issue brief, prepared by the Center on Health Insurance Reforms at the Georgetown University Health Policy Institute, examines student health plans, which cover over 1 million students, and investigates the interplay between federal and state regulation with regard to these plans.
Final HHS Notice of Benefit and Payment Parameters for 2016: Brief Summary of Key Provisions for the 2016 Plan Year
On February 27, 2015, the federal Department of Health and Human Services published the Notice of Benefit and Payment Parameters for 2016 Final Rule, which included several provisions pertaining to form review. This analysis, prepared by the Georgetown University Health Policy Institute’s Center on Health Insurance Reforms, provides a brief summary of the key provisions specific to form review and other notable provisions specific to the 2016 plan year.
Federal regulations state that in order to be certified as a Qualified Health Plan in a Federally-facilitated marketplace, plans must be considered “meaningfully different” from all other plans in their subgroup. This document, prepared by the Georgetown Health Policy Institute’s Center on Health Insurance Reforms, is intended to help insurance regulators to understand meaningful difference standards and the ways in which they are applied by CMS.