State updates as of January 20, 2023.

State updates as of January 13, 2023.

The Centers for Medicare & Medicaid Services recently released a State Medicaid Director Letter on how states can use “in lieu of” (ILOS) services authority, including to address social drivers of health. The letter establishes the requirements and guardrails states must meet to ensure the use of ILOS are cost effective, medically appropriate, preserve enrollee rights and protections, and fulfill the objectives of the Medicaid program. This expert perspective provides a summary of the guidance.

State updates as of January 6, 2023.

When the federal Medicaid continuous coverage requirement expires, states will be required to redetermine eligibility for over 90 million Medicaid enrollees, threatening the historic coverage gains achieved during the federal public health emergency (PHE). One of the most effective tools for states to mitigate coverage loss for eligible people during “unwinding” and beyond is ex parte redetermination. This Q&A is intended to serve as a resource for states looking to improve their current ex parte processes to support their efforts during unwinding and well beyond.

After weeks of negotiations during the lame duck session, Congress passed the Consolidated Appropriations Act, 2023, an omnibus funding package that includes government appropriations through September 30, 2023 as well as a number of health policy provisions. Among the health policies included in the package, section 5131 of the legislation provides a fixed end date for the Medicaid continuous coverage guarantee (March 31, 2023), a gradual phase down of the Families First Coronavirus Response Act (FFCRA) enhanced federal match rate, and new conditions, reporting requirements, and enforcement mechanisms to prioritize coverage retention and smooth coverage transitions during the “unwinding.” This expert perspective provides an overview of these unwinding provisions and considerations for states.

State updates as of December 23, 2022.

States remained at the center of health policy action again in 2022. This expert perspective profiles ten products published by State Health and Value Strategies in 2022 that highlight three key themes from our work with states this year: helping states prepare for the unwinding of the public health emergency, supporting state innovation and advancing health equity.

On December 12, 2022, the Centers for Medicare & Medicaid Services (CMS) released its proposed Notice of Benefit & Payment Parameters for plan year 2024. This annual regulation governs core provisions of the Affordable Care Act (ACA), 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 would be of interest to state based marketplaces (SBM) and state insurance regulators. Comments on the proposed rule are due on January 30, 2023.

To avoid potential coverage losses when the federal public health emergency (PHE) is declared over and the Medicaid continuous coverage requirement ends, states will need to communicate with enrollees and other stakeholders, including community partners, about the actions they need to take to keep individuals enrolled in Medicaid or transition to another form of health coverage. The first expert perspective in this two-part series on how states are conducting outreach and planning highlighted several states that have promoted transparency through the public release of their unwinding operational plans. This expert perspective reviews examples of states that are collaborating with community partners to support their outreach and engagement efforts.