All states are now participating in the special open enrollment period for the Health Insurance Exchange, although the dates may vary or change. If a state is not listed then it is federally facilitated and the special enrollment period has been extended to August 15th.
American Rescue Plan Act
This act was signed into law on March 11th. The key takeaways are as follows:
April 2021 Medicaid State of the Union
Due to the federal government no longer defending public charge officials, we expect more California residents to apply for Medi-Cal and Cal-Fresh programs.
The state is following suit with the federal government and opening up a special enrollment period for the health exchanges from February 8th - August 15th. The Colorado Dept. of Health Care Policy and Financing published “PM 21001, Remote Application Assistance” providing guidance to those assisting clients remotely.
Although the federal government is asking the state to not implement the recently approved Georgia Pathways 1115 waiver, it appears the state’s plans are still to go live on July 1st. The state held informational stakeholder sessions and one of the key differences to this waiver compared to other states is that a person will not be eligible until they meet the work requirements and premium payments. There is also no retro eligibility for the newly eligible population. Most patients will not be eligible for a month or potentially longer.
Lastly, the waiver is only for those who have the ability to find work. If a person is chronically homeless, has a disability that has not yet been deemed or those who live in rural areas with no access to transportation will not be eligible to apply until they meet 80 hours a month of employment, volunteer or educational criteria.
The state is a state facilitated health exchange but has also opened up a short special enrollment period from March 1st – March 31st. HB 316 passed by the House regarding anyone who is eligible to apply for Medicaid or purchase private health insurance will be ineligible for county indigent or catastrophic healthcare programs.
Effective January 1st, all Presumptive Eligibility Medicaid members will be enrolled in Managed Care and assigned to United Healthcare Community Plan of Kentucky (UHC). Governor Andy Beshear notified CMS that Kentucky plans to transition back to the Kynect system, with a fully state-run exchange by the fall of 2021.
Bills 55 and 56 were approved by the Senate Health and Welfare committee to remove co-payments and cost-sharing for Medicaid recipients and to limit the number of Managed Care Medicaid contracts to three.
The state’s legislative sessions will convene April 12th. Some of the healthcare related bills surround the pandemic, telemedicine and the cost of Medicaid.
The Department of Health notified its Medicaid members on March 12th that members who received stimulus checks or unemployment benefits during the COVID-19 public health emergency may need to report it to Medicaid as it may impact current eligibility and renewal.
Medicaid expansion was on the agenda during legislative sessions but both proposals to expand the program to childless adults were rejected. In addition, the state is considering longer postpartum Medicaid coverage for new mothers and their babies allowing women enrolled in Medicaid to keep their coverage up to one year after giving birth, an increase from the current limit of 60 days.
Although Missouri voters approved Medicaid expansion through a ballot initiative, some government officials are pushing back on the budget. In an interesting turn of events, House republicans approved a version of the bill that did not include funding for Medicaid expansion. It is now up to the Senate to add expansion funding back into the state budget.
Nevada is a state facilitated health exchange and does not utilize the federal HealthCare.gov platform but they have decided to follow suite and also open up the special enrollment time frame from February 15th- May 15th.
Federal officials notified the state on March 17th 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.
Legislators approved a Medicaid package that increases next year’s funding by over $460M and directs the program begin its long-delayed shift from traditional payments to managed care by July 2021. Internal works sessions began in January for the changes with the director of government payers to make sure we understand the details and the impact of the change on Medicaid eligibility operations.
The state announced plans to transition about 21,000 of its Insure Oklahoma members to the Medicaid Expansion program, effective July 1st. On March 28th, it was announced that Oklahoma will receive $500M in extra federal Medicaid matching funds resulting from the American Rescue Plan Act as an incentive for Medicaid expansion which will become effective July 1st.
The South Carolina Department of Health and Human Services (SCDHHS) is adding an additional managed care organization (MCO) to serve Healthy Connections Medicaid members. Although South Carolina is one of 12 states who 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.
CMS approved Tennessee’s 1115 Waiver to fund Medicaid through a block grant on January 8th, entitled TennCare III. The state will continue covering the mandatory populations as stated by federal law, but it does not need federal approval to add additional groups. There will be no changes to prescription drug coverage in 2021, but there may be in the future. There is a spending cap and per the state it is below current spending. If the state reaches the cap in the future, they would pay for services with 100% state funds. Lieutenant Governor and Senate Speaker Randy McNally is reconsidering his opposition to Medicaid expansion in light of new federal incentives. Governor Bill Lee and House Speaker Cameron Sexton indicated continued opposition to expansion.
State Representative Lyle Larson filed legislation to bring the question of Medicaid expansion directly to voters. The legislation seeks a state constitutional amendment requiring a 2/3 majority in both the Texas House and Senate before voters could decide on it. Expansion has historically received strong opposition in the state. Although we anticipate any bills related to expansion will not be approved, it is still being discussed more this year as the state is receiving more pressure from the number of uninsured residents.
Legislation and budget season 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.
In April, the 40 quarter requirements for LPRs in VA will go away, allowing for LPRs who have been in the US for 5+ years, but not necessarily in 40 quarters, to be enrolled in full, ongoing Medicaid.
Coming in July the state will be adding dental options to adults on Medicaid. Also, in July income-eligible pregnant women will be able to obtain Medicaid coverage regardless of their immigration status and pregnant women will now have postpartum coverage for 12 months.