American Rescue Plan Act 

May 31st was the enrollment deadline for companies to submit their election notices to those who are eligible for the 100% COBRA subsidies.

Those who are eligible for the COBRA subsidies have 60 days to submit the election notices once received by the employer.

August 2021 Medicaid State of the Union 


Due to the federal government no longer defending the public charge rule, officials expect more California residents to apply for Medi-Cal and Cal-Fresh programs since they no longer have fears of repercussion.  

Additionally, the state passed AB 133 which allows all state residents who are income-eligible to receive Medicaid – no matter their immigration status. The state estimates there will be 235,000 newly eligible recipients. The bill also extends Medicaid postpartum coverage for mothers from 60 days to 12 months. 


The state is proposing a plan that has not been implemented with any other state so far. HB 21-1232 was developed to implement a state-run health insurance option through the marketplace. The new plan is called the Colorado Option. There were several iterations of the law but the final version passed and will begin in January 2023.   


In the beginning of the legislative session large cuts to healthcare companies were creating a lot of trepidation. The state currently closed out the 2021 sessions with no base rate cuts to hospitals.  

Additionally, the state continues to take the lead in new health exchange enrollment due to the extended open enrollment time frame. As the special enrollment period winds down, Florida continues leading the pack with 27% of the total enrollments, more than any other state.    


The state was set to implement partial expansion, which included work requirements for some low-income adults, beginning July 1st but that has since been paused due to push back from CMS. The plan was to pause the implementation until August 1st, but as expected CMS is pushing back and we may not see a final decision until 2022 or it may be rescinded.  


HB 316 passed by the House, and it states that those who are eligible to apply for Medicaid, or to purchase private health insurance, will be ineligible for county indigent or catastrophic healthcare programs. The law took effect July 1st, but it will not be fully implemented until 2023. 


The state posted a memo on August 2nd explaining that all Medicaid beneficiaries who would normally be eligible for HIP (Healthy Indiana Plan) basic will now be eligible for HIP Plus for the duration of the Public Health Emergency.  


Medicaid expansion is once again on the legislative floor and was passed by the House. If it passes the final vote, it will be up to the governor for the final decision.  


The state released a request for proposals for Medicaid Managed Care Organizations, which are to be submitted by September 3rd. The RFP is asking for the MCO to provide sufficient behavioral health integration, delivery system reform, disaster planning and recovery and accountability to name a few. Some Medicaid members will start receiving Medicaid closure notices. The state continues to keep recipients on Medicaid through the public health emergency, but it appears they are beginning the communication campaigns for these members once the PHE is over. 


The state performed Medicaid eligibility audits on a sample of recipients and determined that 5% of the population may actually be ineligible. Most of the discrepancy appears to be the way the state calculates income and does not utilize the IRS for a tax return comparison. Some are hoping to make changes with legislators to tighten the way a recipient’s income is verified.  


Although Missouri voters approved Medicaid expansion through a ballot initiative, the legislation process voted against funding the new program. A lawsuit was filed by three Missouri residents for not funding the program and ultimately was sent to the state’s supreme court who ruled in favor of Medicaid expansion. The judge also ruled to allow the expansion population to begin enrollment effective July 1st. 

New Hampshire 

Federal officials notified the state that Medicaid work requirements have been revoked. They were originally placed on hold before the state even operationalized work requirements. The state does have the ability to appeal the decision.    

North Carolina 

The state transitioned to Managed Medicaid in July. Although it appears the transition will be a low impact for the Medicaid eligibility team it is still a large change for the state. Research also indicates 62% of NC residents are not aware of the transition and might not have switched to Managed Medicaid plans yet.  


Medicaid expansion was effective on July 1st and more than 150,000 Oklahomans have qualified. State health officials say they suspect many more Oklahomans are eligible but have not yet applied.  

Also, the state has an 1115 waiver that was supposed to be effective July 1st, but it has not been approved by CMS. One of the biggest impacts of that approval is not allowing retro Medicaid for the expanded population. So far it is unclear if the current CMS administration will support that change.  

South Carolina 

The South Carolina Department of Health and Human Services (SCDHHS) is adding another managed care organization (MCO) to serve Healthy Connections Medicaid members. Although South Carolina is one of 12 states that has not expanded Medicaid coverage, the governor has expressed that the state will not amend its stance even with the additional dollars in play from the American Rescue Plan. Also, CMS is no longer moving forward with work requirements in the state (which was originally approved by the Trump administration).  


CMS approved Tennessee’s 1115 Waiver to fund Medicaid through a block grant on January 8th, entitled TennCare III. In May, a group of 13 recipients (filed by the Tennessee Justice Center and King and Spalding LLP) filed a complaint in opposition of the new block grant funding. 

The waiver also provides the return of 90 days of retro Medicaid but only for pregnant women and children. This waiver went into effect on July 1st. 

Lastly, the legislative session ended on a good note for postpartum moms. TennCare will extend postpartum coverage for new moms from 60 days to one year. 


Governor Gregg Abbott called for a special session that began July 8th and ended in early August. One bill, which now has over 40 co-sponsors, is designed to allow Medicaid expansion to be passed by local city leaders instead of a state-wide approach. The idea is that if some cities expand, it may provide an incentive for other areas of the state to eventually expand.  

The second special session began August 7th to complete any agenda items from the first session in addition to new topics. The state enacted legislation extending Medicaid postpartum coverage from two to six months. The law also requires the Texas Health and Human Services Commission to ensure Medicaid managed care plans provide continuity of care for individuals in the Healthy Texas Women program to improve maternal health outcomes.  


Legislation and budget season have wrapped up for the state. The budget includes $5 million to increase caseworker salaries at the Utah Division of Child and Family Services. Originally there was a plan to merge the department of health and the department of human services, but that idea was rescinded. Also, CMS is no longer moving forward with work requirements in the state (which was originally approved by the Trump administration). 


Income-eligible pregnant women are now able to obtain Medicaid coverage regardless of their immigration status, and all pregnant women will now have postpartum coverage for 12 months.  

Due changes in the federal landscape, the state has decided to delay the transition of becoming a state-based health exchange by one year.