In This Week’s Update:

• Data Sharing for Children Incarcerated Children
• Guidance on Medicaid/CHIP Renewal Requirements
• Enhancing Access to Care for Individuals Following Incarceration
• Funding Opportunity for States to Update Essential Health Benefits Benchmark Plans
• New Resources to Support BAC Recruitment
• State updates: AL, CO, MA, ME, NC, ND, NM, OR & PA

 

Data Sharing for Incarcerated Children
State Health and Value Strategies (SHVS) published an expert perspective which reviews the information sharing considerations for states in implementing the Consolidated Appropriations Act’s (CAA) requirements to provide targeted case management and screening and diagnostic services for children and youth who are incarcerated and enrolled in Medicaid or CHIP. The expert perspective highlights key areas of CAA implementation that require information sharing, which states will need to consider as they work towards coming into full compliance.

 

Guidance on Medicaid/CHIP Renewal Requirements
Also last week, in follow-up to its September guidance on state compliance with federal renewal requirements, CMS issued a supplemental document specifying the “evidence” that states must submit to CMS by December 31 as part of their post-unwinding compliance plans, and a CMCS Informational Bulletin outlining state requirements and flexibilities for verifying financial eligibility (also see the accompanying slide deck). This new guidance is intended to support states in verifying eligibility and conducting renewals in compliance with federal Medicaid and CHIP requirements by December 2026. Updates follow.

 

Enhancing Access to Care for Individuals Following Incarceration
The Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services, announced nearly $52 million in awards for 54 HRSA-funded health centers to increase access to high-quality primary care for people soon to be released from incarceration and reentering the community. The funding enables health centers to implement innovative approaches to support justice-involved individuals before their release to address health risks during reentry, including elevated risk of opioid overdose and the increased risk associated with being disconnected from critical treatment for chronic diseases, including medications. For more information on the opportunity for states to provide certain pre-release healthcare services to justice-involved populations, see the SHVS webinar, Section 1115 Demonstration Opportunity to Support Reentry for Justice-Involved Populations: CMS Guidance.

 

Funding Opportunity for States to Update Essential Health Benefits Benchmark Plans
CMS announced the Essential Health Benefits (EHB)-Benchmark Plan Modernization Grant for States with a Federally-facilitated Exchange (FFE) Notice of Funding Opportunity, available at Grants.gov. The grants would fund states’ efforts to review and potentially modernize their EHB benchmark plans due to enrollees experiencing difficulty accessing needed services, changes in medical evidence or scientific advancement, changes in the health needs of their populations, or other clinical considerations. To be eligible for funding, the state must have an FFE as of January 1, 2026. CMS anticipates awarding at least $250,000 per state to complete this work, with an additional $125,000 award per applicant who decides to establish an advisory board as part of their project.

 

New Resources to Support BAC Recruitment
Under the Ensuring Access to Medicaid Services final rule, state Medicaid agencies will need to create and support a Beneficiary Advisory Council (BAC) and Medicaid Advisory Committee (MAC) by July 2025, with some requirements phased-in over a longer time period. SHVS has published additional template materials designed to support state agencies in recruiting members for the BAC. States can customize the content of the materials, which now include a recruitment flyer, template social media graphics, in addition to core messages, website copy, and newsletter copy.

 

State updates: AL, CO, MA, ME, NC, ND, NM, OR & PA 

• Alabama – The Alabama Department of Public Health Maternal Mortality Review Program is launching the Centers for Disease Control and Prevention’s Hear Her Campaign. The Hear Her Campaign supports efforts to prevent pregnancy-related deaths by sharing resources for people who are pregnant or postpartum, their partners, family, and friends, and the healthcare professionals who interact with them.
• Colorado – The Colorado Division of Insurance, part of the Department of Regulatory Agencies, has prepared a guide on insurance coverage of gender-affirming care medical services for individual and small group health insurance plans, and a guide on insurance coverage of prescription medications to prevent and treat HIV to help Coloradans in choosing a health insurance plan for the coming year.
• Massachusetts – Governor Maura Healey signed legislation to ensure that patients have access to follow-up breast cancer screenings and exams, while also preventing any increase in patient cost-sharing by 2026. Starting in 2026, the legislation will require insurers to cover diagnostic exams for breast cancer, digital breast tomosynthesis screening, and medically necessary and appropriate screening with breast MRIs and ultrasounds. It will also prevent any increase in patient cost-sharing, thus removing cost barriers for patients who need more rigorous screenings due to dense breast tissue or abnormalities seen in their initial preventive screening mammograms.
• Maine – The Maine Department of Health & Human Services issued a survey seeking public input to choose a new name for the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. The goal is to choose a program name that is more memorable and represents the EPSDT program goals of early screening, diagnosis, and access to treatment services for children and youth under age 21.
• New Mexico – Governor Michelle Lujan Grisham announced that four rural healthcare organizations will receive a combined $5.4 million from the Rural Health Care Delivery Fund. This is the first allocation from the $46 million fund championed by the governor and legislature during the 2024 legislative session. The initiative aims to tackle the unique challenges rural health providers face, including geographic isolation and financial barriers. The initial funding will support a range of vital services, including maternal healthcare, behavioral health programs, and primary care expansion.
• North Carolina – North Carolina Medicaid is seeking Medicaid enrollees, family members, or caregivers to serve on two new groups–a Medicaid Advisory Committee (MAC) and a Beneficiary Advisory Council (BAC). The MAC and BAC are designed to center the lived experience of enrollees, their families and caregivers and will provide a more formalized structure for enrollees and interested parties to provide feedback to the state about Medicaid. For template resources states can use to recruit members, see below.
• North Dakota – North Dakota Health and Human Services is seeking public comment on a Medicaid Traditional Individuals with Intellectual Disabilities/Developmental Disabilities (IID/DD) Home and Community-Based Services (HCBS) amendment application to the current Traditional IID/DD waiver dated April 1, 2024. Proposed changes to this waiver amendment include adding remote monitoring as a stand-alone service and also includes adding clarifying language to environmental modification and small group employment and a HCBS ongoing monitoring section. Comments and public input on the proposed changes will be accepted until 8 a.m. CT on December 16, 2024.
• Oregon – The Oregon Health Insurance Marketplace announced a new request for proposals for a State-Based Marketplace (SBM) vendor. Senate Bill 972 (2023) requires the Oregon Health Authority (OHA) to transition the Marketplace using the federal platform to a SBM in time for open enrollment for plan year 2027. Specifically, OHA is required to procure and administer both an information technology platform and call center, to replace the federal platform and call center, and provide electronic access to the health insurance exchange by November 1, 2026. Proposals must be submitted by December 30, 2024.
• Pennsylvania – The Pennsylvania Insurance Department released a network adequacy report which reflects the results of a study of the state’s Marketplace plans regarding provider directory inaccuracies and consumers’ ability to secure a timely appointment with both behavioral health and physical health providers.