November 11 Update

In This Week’s Update:

  • Enhancing the Enrollment Process and Marketplace Operations
  • Leveraging Medicaid Managed Care to Address Health-Related Social Needs
  • Multiyear Continuous Eligibility in Medicaid and CHIP
  • State updates: AZ, CA, CO, DC, FL, LA, MD, MN, MO, MT, NE, NV, NY, OR, SD, TN & VA

Enhancing the Enrollment Process and Marketplace Operations
Also last week, SHVS published an expert perspective which reviews the proposed Notice of Benefit and Payment Parameters for 2026 released by CMS on October 4. This annual rule governs core provisions of the Affordable Care Act and the expert perspective examines aspects of the proposed rule of interest to state officials.

 

Leveraging Medicaid Managed Care to Address Health-Related Social Needs
On Thursday, November 7, SHVS hosted a webinar highlighting the ways states are addressing enrollees’ health-related social needs (HRSNs) through their Medicaid managed care programs and contracts. During the webinar, experts from Bailit Health showcased recent updates to the SHVS Addressing Health-Related Social Needs Through Medicaid Managed Care toolkit, highlighted state approaches to require and/or incentivize Medicaid plans to address HRSNs, and facilitated a discussion with state Medicaid officials. The slide deck and a recording of the webinar are available.

 

Private Equity in Healthcare: A State-Based Policy Perspective
Private-equity firms’ rapid pace of healthcare acquisitions have prompted discussions about their influence on the U.S. healthcare system. Policymakers, especially at the state level, are exploring ways to regulate private-equity firms’ involvement in physician practices, hospitals, and nursing homes. Debate continues over whether private equity’s role in healthcare is helpful or harmful to patients. A new article for Health Affairs Forefront explains the private-equity investment strategy and its recent growth in healthcare, specifically in physician practices and hospitals. It also analyzes the state-level landscape of laws and regulations surrounding private equity in healthcare and the implications of those laws and regulations. State-based policies are often models for future federal-level policies and provide a valuable perspective for analyzing the policy climate for private equity’s role in healthcare.

 

Multiyear Continuous Eligibility in Medicaid and CHIP
A new policy brief published by Urban Institute identifies actions for state Medicaid programs, managed care plans, and providers aimed at maximizing the positive impacts of continuous eligibility policies on children and their families. Continuous eligibility policies hold promise for reducing insurance gaps, which in turn could offer more peace of mind to parents, increase families’ financial stability, promote receipt of medical care during a critical developmental period of children’s lives, improve kindergarten readiness, and lead to better health and wellbeing in the long term. Ensuring successful implementation of continuous eligibility policies in the pioneering states is important for maximizing positive impacts on children’s health in those states and for laying the groundwork for other states considering the policy.

 

State updates: AZ, CA, CO, DC, FL, LA, MD, MN, MO, MT, NE, NV, NY, OR, SD, TN & VA

  • California
    • As part of Native American Heritage Month, the Department of Health Care Services updated the Indian Health Care Programs Service Locator Tool, which helps users find medical, dental, nutritional, and behavioral health services and Native American healthcare providers near them.
    • Covered California, the state’s official health insurance Marketplace, announced with the start of open enrollment that the state’s cost-sharing reduction program has been bolstered for 2025, increasing the amount of state funds available to $165 million. All Californians with incomes above 200% of the federal poverty level are eligible for an Enhanced Silver 73 plan with no deductibles and reduced out-of-pocket costs.
  • Colorado – Connect for Health Colorado, the state’s official health insurance Marketplace, announced that with the start of open enrollment, the OmniSalud program for undocumented Coloradans is prioritizing continuity of coverage. The program, funded with state dollars up to an enrollment cap, is encouraging current enrollees to claim their spot by November 22. New customers seeking financial assistance will be able to start applying on November 25, 2024.
  • District of Columbia – Mayor Muriel Bowser announced that with the start of open enrollment, Essential Plans on DC Health Link, the District’s official health insurance Marketplace, will offer free care for heart disease. The leading cause of death in the District is heart disease, with the rate of Black residents who die from heart disease two and a half times higher than that of White residents. These standardized plans will charge no copays, deductibles, or coinsurance for residents seeking treatment for cardiovascular and cerebrovascular disease, including doctor visits, and medications. Additionally, these plans will continue to offer free type 2 diabetes care, including free insulin, removing financial barriers to doctor visits and medications.
  • Louisiana – The Louisiana Department of Health is seeking feedback on its upcoming procurement to secure statewide Dental Benefit Program managers for new contracts. The procurement will begin January 1, 2026 with the goals of improving oral health outcomes and coordination of care; increasing the quality of dental care; improving access to essential specialty dental services; and increasing outreach and education to promote dental health.
  • Minnesota – MNsure, the state’s official health insurance Marketplace, announced that with the start of open enrollment, Easy Compare plans will be offered for the first time. Easy Compare plans are standardized plans, making it easier for consumers to evaluate plan options.
  • Oregon – Oregon Health Plan members with specific health conditions may now qualify for new benefits to maintain their current housing and access other housing services. The housing benefits include: rent assistance for up to six months; utility set-up and payments for up to six months; home modifications and upgrades for health or safety reasons (e.g., grab bars, ramp installation, pest control); and rental navigation services.
  • Tennessee – Tennessee requested to amend their Medicaid section 1115 demonstration entitled “TennCare III.” The proposed amendment would expand the scope of services provided under the demonstration to include services for individuals with serious mental illness (SMI) or serious emotional disturbance who are receiving treatment in an Institution for Mental Diseases (IMD); support the implementation of a new quality improvement program for hospitals; and improve the efficiency and transparency of home and community-based services.
  • Virginia – The Virginia Department of Medical Assistance Services is providing notice of intent to submit to CMS in December 2024, a request to amend its section 1115 demonstration, “Building and Transforming Coverage, Services, and Supports for a Healthier Virginia,” to add an SMI program. Virginia is seeking waiver authority for SMI IMD coverage and public comments may be submitted through December 11.
  • Arizona, Colorado, Florida, Maryland, Missouri, Montana, Nebraska, Nevada, New York and South Dakota – Seven states approved ballot initiatives to protect abortion rights and expand access to reproductive healthcare: Arizona, Colorado, Maryland, Missouri, Montana, Nevada and New York; abortion rights measures failed in three states: Florida, Nebraska and South Dakota.