Parallon’s eligibility and advocacy team continues to monitor the state of Medicaid eligibility as impacted by COVID-19. Notably: On January 28, 2021 President Biden signed an executive order to re-open enrollment to the health insurance marketplace from February 15th - May 15, 2021 for the 36 states using Healthcare.gov. California, Colorado, Connecticut, Idaho, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont, Virginia, and Washington are state-based health exchanges and operate individually. From the state based exchanges, the states below have also chosen to open or extend the special enrollment time frames.
Additionally, HHS extends public health emergency until the end of April. This impacts state level flexibilities derived from the 1135 waivers.
Below we breakdown the latest changes for February 2021, federal Medicaid process updates and state agency closures.*
Here is the February 2021 Medicaid State of the Union:
Alaska Medicaid Updates
The state begins the legislative sessions at the end of January 2021 discussing the budget proposals and the governors proposed executive order. Governor Dunleavy is proposing to split the Department of Health and Social Services into two separate agencies. The proposed Department of Health would include public health and Medicaid. The Department of Family and Community Services would be in charge of children services, juvenile justice among other entities. If state lawmakers allow the executive order to stand the change will take place July 2021.
California Medicaid Updates
With the news of presidents Biden's executive order to open up a special enrollment period with healthcare.gov the State of California has also decided to extend open enrollment for Covered California.
Colorado Medicaid Updates
The state is following suit with the federal government and opening up a special enrollment period for the health exchanges from February 8 – May 15th. Colorado Dept. of Health Care Policy and Financing published “PM 21001, Remote Application Assistance” providing guidance to those assisting clients remotely
Florida Medicaid Updates
January 15, 2021 CMS once again approved the MMA 1115 waiver that limits retro-active Medicaid from the traditional 90 days to the month of application. As in the past, this does not include pregnant woman and children.
Georgia Medicaid Updates
In October, CMS approved the 1115 waiver titled Georgia Pathways and the 1332 waiver called Georgia Access. The 1115 waiver partially expands coverage to childless adults along with qualifying activity requirements such as employment, education, or volunteering. This waiver is set to go live July 1, 2021.
Idaho Medicaid Updates
Like many states Idaho, is seeing an increase in Medicaid enrollment and as the 2021 budget season quickly approaches they are looking at ways to control cost. Some of the discussion for cost reduction are around provider rate cuts, higher tax assessments on nursing homes, and benefit reductions.
Indiana Medicaid Updates
CMS conditionally approved Indiana’s request to require some adult Medicaid beneficiaries to work or participate in other “community engagement” activities to remain eligible for coverage, contingent on the Supreme Court legally authorizing the provisions.
Kansas Medicaid Updates
The state decided to part ways with the 3rd party contractor, Maximus who assisted the state with processing Medicaid applications among other duties. Beginning 2021, the duties will not be handled in-house as the state has hired the New Jersey based company Conduent.
Kentucky Medicaid Updates
Effective January 1, 2021, 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.
Louisiana Medicaid Updates
Tara LeBlanc, interim executive director of Medicaid at the state Department of Health, said approximately 160,000 people currently being covered by Medicaid are ineligible. Starting in February’2021, Louisiana Medicaid will send letters to some members asking them to renew their coverage. If no response to the letters, the members may risk losing Medicaid coverage at the end of the public health emergency, even if they are eligible for Medicaid.
Mississippi Medicaid Updates
The state is in the middle of legislative session and Medicaid expansion was on the agenda 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 1 year after giving birth, an increase from the current limit of 60 days.
Missouri Medicaid Updates
Medicaid enrollment numbers have jumped nearly 100,000 people since COVID-19. July 2021 Medicaid expansion will begin and its predicted Medicaid enrollment will increase to about 230,000 people.
Nevada Medicaid Updates
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 2/15 – 5/15.
North Carolina Medicaid Updates
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.
Oklahoma Medicaid Updates
The state announced plans to transition about 21,000 of its Insure Oklahoma members to the Medicaid Expansion program, effective July 1, 2021. Internal work sessions began in January to make sure we are ready for the new influx of recipients. Health Care Authority announced the selection of Blue Cross Blue Shield of Oklahoma, Oklahoma Complete Health, Humana Health Horizons and UnitedHealth care as the four for-profit companies it will use to outsource the care of most of the state’s Medicaid population.
South Carolina Medicaid Updates
The state plans on rolling out a new MMIS system but due to delays will not be rolled out until 2021.The South Carolina Department of Health and Human Services (SCDHHS) is adding an additional managed care organization (MCO) to serve Healthy Connections Medicaid members. Humana will be contracting with SCDHHS beginning July 1, 2021. Providers should expect to receive correspondence from Humana as they begin contracting with providers and continue to develop their provider network.
Tennessee Medicaid Updates
CMS approved Tennessee’s 1115 Waiver to fund Medicaid through a block grant on January 8, 2021 titled TennCare III. The state will continue covering the mandatory populations as stated by federal law but does not need federal approval for additional groups added. 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 and if the state reaches the cap in the future the state would pay for services with 100% state fund.
Texas Medicaid Updates
As the legislative sessions begin Senate Joint Resolution 15 is a bill proposing to expand Medicaid within the state. Even with the increased pressure due to the pandemic, it's unlikely the bill will pass but the initiative is growing in support with groups such as the Texas Medical Association and Bexar County Medical Society. In addition, Medicaid and Children’s Health Insurance Program (CHIP) flexibilities put in place during the COVID-19 pandemic have been extended through February 28, 2021.
Virginia Medicaid Updates
Since January 2019, 452,000 people have gained coverage due to Medicaid expansion. More than 100,000 recipients enrolled since March due to COVID-19. We received a memo from the state late June that the state is allowing verbal consent on traditional Medicaid applications.