State health updates as of February 4, 2022.

As state Medicaid and Children’s Health Insurance Program (CHIP) agencies develop their strategies for unwinding the federal Medicaid continuous coverage requirement under the Families First Coronavirus Response Act, many are looking to text messaging as a mechanism for outreach to their Medicaid and CHIP enrollees and communicating important information. This expert perspective describes states’ authority to send text messages and requirements for obtaining consent. The expert perspective also contains sample consent language to include in the Medicaid/CHIP application as well as template text messages.

To support state efforts, State Health and Value Strategies continues to update the resource Medicaid Managed Care Contract Language: Health Disparities and Health Equity. This compendium provides Medicaid agencies with examples of how different states are leveraging their managed care programs, inclusive of contracts, quality initiatives, and procurement processes, to promote health equity and address health disparities. This expert perspective highlights trends in state Medicaid managed care procurements and model contracts from Michigan, North Carolina, Ohio, Oregon, Virginia, and Washington, as well as new excerpts of relevant language from Pennsylvania and Rhode Island.

State health updates as of January 28, 2022.

When the Families First Coronavirus Response Act Medicaid “continuous coverage” requirement is discontinued states will restart eligibility redeterminations, and millions of Medicaid enrollees will be at risk of losing their coverage. A lack of publicly available data on Medicaid enrollment, renewal, and disenrollment makes it difficult to understand exactly who is losing Medicaid coverage and for what reasons. Publishing timely data in an easy-to-digest, visually appealing way would help improve the transparency, accountability, and equity of the Medicaid program. This expert perspective lays out a set of priority measures that states can incorporate over time into a data dashboard to track Medicaid enrollment following the end of the continuous coverage requirement. For a detailed discussion of the current status of Medicaid enrollment and retention data collection and best practices when developing a data dashboard to display this type of information, SHVS has published a companion issue brief.

State health updates as of January 21, 2022.

On January 15, 2022, health insurers will be subject to new federal requirements to cover and waive cost-sharing for over-the-counter diagnostic tests for COVID-19 for the duration of the federal public health emergency. Past federal guidance required insurers to fully cover COVID-19 tests, but allowed them to require enrollees to first obtain a health professional’s determination that a test is medically necessary. The new requirements, published January 10, enable consumers to obtain the tests directly from pharmacies or online retailers without being seen by a health professional. With case rates surging and the costs of over-the-counter COVID-19 tests ranging from $14 to $34, this new benefit should provide significant financial relief to privately insured individuals. This expert perspective focuses on key provisions of the new coverage requirements as well as health equity considerations and implications for state insurance regulators.

On December 28, 2021, the Centers for Medicare & Medicaid Services (CMS) released a State Health Official letter providing guidance on the scope of and enhanced payments for qualifying community-based mobile crisis intervention services for Medicaid enrollees experiencing a mental health or substance use disorder crisis. The CMS guidance comes as the United States is grappling with staggering need for mental health and SUD services that has grown as a result of the COVID-19 pandemic. This expert perspective provides an overview of the new guidance and reviews the requirements for community mobile crisis services.

State health updates as of January 14, 2022.

On December 28, 2021, the Centers for Medicare & Medicaid Services released its proposed Notice of Benefit & Payment Parameters for plan year 2023. This annual regulation governs core provisions of the Affordable Care Act, including operation of the health insurance marketplaces, standards for insurers, and the risk adjustment program. This expert perspective focuses on provisions of the proposed rule that are of particular import to the state-based marketplaces and state insurance regulators.