May 19 Update

In This Week’s Update:

  • Upcoming SHVS webinars: Medicaid Provisions in the House Reconciliation Bill
  • State context: Medicaid cuts
  • CMMI’s new strategic direction
  • State updates: AL, AZ, CA, DE, ID, IN, MD, ME, MI, MN, MO, NC, NJ, OK, OR, RI, VA, VT & WI


Medicaid Provisions in the House Reconciliation Bill
On Thursday, May 22, State Health and Value Strategies (SHVS) will host the first webinar in a two-part series on proposed reconciliation language. During the webinar, experts from Manatt Health will review changes proposed in the House Energy and Commerce (E&C) Committee reconciliation legislation to Medicaid eligibility, payment and financing, and coverage. On Thursday, May 29, SHVS will host the second webinar, during which experts will review proposed changes to policies governing the Affordable Care Act Marketplace and what they might mean for health insurance Marketplace and Division of Insurance officials. Please be sure to register, which is required, for Part 1 and Part 2, and feel free to share the registration information with other interested state colleagues.

Included in the legislative proposals advanced by E&C is a state mandate to impose a work requirement on the Medicaid expansion population. SHVS published an expert perspective which provides an analysis of the E&C proposal to establish work requirements for the Medicaid expansion population and certain other low-income adults. Updates follow.

 

State-Level Context for Federal Medicaid Cuts
The Congressional Budget Office released preliminary estimates of the E&C proposed reconciliation language showing the proposals would reduce federal Medicaid spending by $625 billion. Building on earlier Kaiser Family Foundation (KFF) analysis, KFF has published a new analysis that puts the magnitude of federal funding cuts into context by showing how the cuts relate to states’ budgets and exploring the potential effects on Medicaid enrollment by state. Cuts of $625 billion will force states to make tough choices: maintain current spending on Medicaid by raising taxes or reducing spending on other programs; or cut Medicaid spending by covering fewer people, offering fewer benefits, or paying providers less.

 

CMS Innovation Center 2025 Strategy to Make America Healthy Again
CMS announced the release of a new white paper outlining the CMS Innovation Center’s strategic direction. Building on 15 years of Innovation Center experience and lessons learned, the updated 2025 Innovation Center strategy takes a comprehensive approach to preventive care anchored in the Center for Medicare and Medicaid Innovation’s (CMMI) statutory mandate. The updated CMMI vision is to build healthier lives through evidence-based prevention, patient empowerment, and greater choice and competition. CMMI also highlights its foundational principle of protecting federal taxpayers in all CMS Innovation Center models and other activities. CMMI’s vision will be achieved through three interrelated pillars: promote evidence-based prevention, empower people to achieve their health goals, and drive choice and competition. Together, they will support the varying needs of the populations served by the Innovation Center.

 

Supporting Caregivers and Families Impacted by Substance-Use
Individuals impacted by substance-use who are also caregivers of children need unique supports that are responsive to family context and experience. A new project spotlight brief published by Children’s Hospital of Philadelphia’s PolicyLab shares programs and policies aimed at supporting families with a caregiver experiencing substance-use. The brief highlights three PolicyLab publications and research in three key areas: evaluations of community-based programs that support the wellbeing of families impacted by substance-use; trends in prenatal and postpartum opioid-use, treatment access and retention, and program availability; and policies and practices that enhance equitable access to care, reduce structural barriers, and address intersecting challenges to family wellbeing.

 

State updates: AL, AZ, CA, DE, ID, IN, MD, ME, MI, MN, MO, NC, NJ, OK, OR, RI, VA, VT & WI

  • Alabama – Alabama Medicaid issued a request for public comment on the proposed renewals for the Intellectual Disabilities and Living at Home Waivers. These waivers provide home and community-based services to individuals who, but for the provision of such services, would require Intermediate Care Facility for Individuals with Intellectual Disabilities level of care.
  • Arizona
  • California – Governor Gavin Newsom announced $3.3 billion in grant funding to create over 5,000 residential treatment beds and more than 21,800 outpatient treatment slots for behavioral healthcare services. Administered by the California Department of Health Care Services, the Proposition 1 Bond Behavioral Health Continuum Infrastructure Program Round 1: Launch Ready awards will expand access to care for Californians experiencing mental health conditions and substance-use disorders, including those experiencing homelessness.
  • Delaware – Governor Matt Meyer announced the establishment of the Delaware Food is Medicine Committee, a statewide initiative to improve health outcomes, lower healthcare costs, and strengthen local food systems. Lieutenant Governor Kyle Evans Gay will chair the committee, leading a diverse team of leaders from healthcare, agriculture, research, and community organizations to develop Delaware’s first statewide Food is Medicine framework. The committee will draw on proven models implemented in other states.
  • Kansas – Governor Laura Kelly announced that she has sent a letter to the Kansas Congressional delegation, requesting that they “protect Kansas from the looming federal Medicaid cuts that threaten quality, affordable healthcare access for the most vulnerable Kansans.” Under the latest plan proposed by Congress, the Kansas Medicaid program could lose up to $1 billion in federal funding within the first year alone.
  • Idaho – CMS approved an amendment to the “Idaho Behavioral Health Transformation Section 1115 Demonstration.”  This amendment allows the state to end the authority that currently permits legally responsible individuals to provide 1905(a) personal care services (PCS). CMS’ approval of this amendment allows the state to revert to how it operated its 1905(a) PCS program prior to the COVID-19 public health emergency and is in compliance with Medicaid state plan requirements for 1905(a) PCS.
  • Indiana – Governor Mike Braun, through Executive Order 25-31, established Indiana’s Working Group on Applied Behavior Analysis (ABA) Therapy. This initiative aims to develop evidence-based recommendations to contain the increasing Medicaid costs associated with ABA therapy while ensuring continued high-quality care for thousands of Hoosier children and young adults.
  • Maryland
  • Maine – The Department of Health and Human Services released a blog post highlighting the impact of federal Medicaid proposals on the state as well as a more detailed analysis on the potential impacts to Maine.
  • Michigan –
  • Minnesota – The state is taking steps to increase oversight of autism services providers and some housing services providers. The state will re-categorize both types of services as “high risk.”
  • Missouri – MO HealthNet, the state’s Medicaid program, is hosting a series of in-person networking opportunities across the state for providers and community partners to learn about benefits, incentives, and resources available to pregnant individuals and their families, including individualized case management, doula coverage, non-emergency medical transportation, and more.
  • New Jersey – Department of Banking and Insurance Commissioner Justin Zimmerman sent a letter to New Jersey’s congressional delegation urging them to extend the expiring federal enhanced premium tax credits. New Jersey would lose more than half a billion dollars in enhanced premium tax credits, and 454,016 New Jerseyans–88% of Marketplace consumers–would see their premiums increase if the tax credits were allowed to lapse. The state has created fact sheets on the impacts by congressional district and the impact on the overall state.
  • North Carolina – The North Carolina Department of Health and Human Services is expanding student loan repayment for rural healthcare providers through the North Carolina Primary Care Physician Incentive program. North Carolina’s rural population is the second largest in the country, with more than 4.6 million people living in rural counties. The program is open to primary care physicians in independent private practices located in Tier one and Tier two counties based on North Carolina’s County Distress Rankings.
  • Oklahoma – The Oklahoma Health Care Authority announced the appointment of a new chief operating officer and the promotion of two long-standing leaders to executive roles. Sherri White is the new chief operating officer, while Carolyn Reconnu-Shoffner was promoted to chief clinical officer and Christina Foss as state Medicaid director, in addition to her role as chief of staff.
  • Oregon – Governor Tina Kotek has selected Sean O’Day as acting director of the Oregon Department of Consumer and Business Services (DCBS). He will replace Andrew R. Stolfi, who was recently confirmed by the Oregon State Senate to be the director of the Oregon Employment Department. TK Keen, the deputy insurance commissioner and administrator of DCBS’ Division of Financial Regulation, will take on the duties as acting insurance commissioner.
  • Rhode Island
    • General Treasurer James A. Diossa announced that an additional $3.5 million in medical debt, held by over 3,200 Rhode Islanders, has been forgiven through the state’s Medical Debt Relief Program. To date, the program has relieved more than $10 million in medical debt, helping more than 6,000 Rhode Islanders. As a reminder, SHVS has an expert perspective which tracks state efforts to cancel medical debt and prohibit medical debt reporting to credit agencies.
    • According to a new report released by the Office of the Health Insurance Commissioner, hospital and drug costs–including GLP-1s–were the primary drivers of the 7.8% increase in statewide healthcare spending in 2023, leading the state to exceed its 6% cost growth target. While the benchmark was nearly doubled in 2023—from 3.2% to 6%—to account for the effect of the highest inflation in over 40 years, spending still exceeded the target due to fast-rising prices, increased use of medical services, and the expanded use of expensive weight-loss drugs.
  • Vermont – Governor Phil Scott signed legislation that appropriates $1 million to the state treasurer for the purpose of creating a medical debt relief program and prohibiting a credit reporting agency from reporting medical debt. While signing the bill, Governor Scott sent a letter to the general assembly stating, “with a looming healthcare crisis and our growing crisis of affordability in Vermont, we should anticipate this debt financing program to grow which raises significant concerns about future appropriations…we will need to manage this program effectively and pair it with real reforms.”
  • Virginia – Governor Youngkin signed House Bill 1609, which requires the Health Insurance Reform Commission to consider coverage for the diagnosis and treatment of infertility and for standard fertility preservation procedures in its 2025 review of the essential health benefits benchmark plan.
  • Wisconsin