Special Open Enrollment for the Health Insurance Exchange
American Rescue Plan Act
This act was signed into law on March 11th. The key takeaways are as follows:
May 2021 Medicaid State of the Union
To combat major fiscal challenges, Alaska has reinstated the House Ways and Means Committee. The task of the committee is to limit the growth of government, reduce state spending and find ways to grow new revenue.
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 Department of Health Care Policy and Financing published “PM 21001, Remote Application Assistance” providing guidance to those assisting clients remotely.
Florida closed out the legislative sessions with no base rate cuts to hospitals. Additionally, the state continues to take the lead in new health exchange enrollment (28% since February!) due to the extended open enrollment time frame.
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 period 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 lives in a rural area with no access to transportation will not be eligible to apply until they meet 80 hours a month of employment, volunteer or educational criteria.
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.
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.
Franklin County Judge Phillip Shepherd tossed out contracts awarded to six health insurance companies, citing flaws in the state’s bidding process for $8B in state Medicaid business. The judge ordered the state to rebid the entire package which would make this the third time the state would have to seek bids for the contracts with outside companies to manage healthcare for people covered by Medicaid.
According to Louisiana Healthcare Connections, all inpatient hospital service authorizations will be made within two calendar days of receipt of appropriate medical information required for the review. All concurrent review determinations will be made within one calendar day of receipt of appropriate medical information required for the review.
Although Missouri voters approved Medicaid expansion through a ballot initiative, the Senate voted against funding the new program. Lawsuits are anticipated.
Nevada is a state-facilitated health exchange and does not utilize the federal healthcare.gov platform. They have decided to follow suit and also open up the special enrollment timeframe until August 15th.
Federal officials notified the state on March 17th that Medicaid work requirements have been revoked. 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 to begin its long-delayed shift from traditional payments to managed care by July 2021.
Medicaid expansion population applications open June 1st to apply for SoonerCare with benefits for those who qualify being effective July 1st. On Oct 1st, OHCA will transition to a managed care service delivery model called Sooner Select which will be implemented in partnership with four medical plan organizations (BCBSOK, Humana Healthy Horizons in Oklahoma, Oklahoma Complete Health and United Healthcare) and three dental plan organizations. The American Indian/Alaska Native members are considered voluntary and will have the option to opt-in to a managed care plan.
The South Carolina Department of Health and Human Services (SCDHHS) is adding an additional managed care organization (MCO) to serve Healthy Connections Medicaid members. South Carolina is one of 12 states who has not expanded Medicaid coverage, and 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. 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. Lastly, TennCare will extend postpartum coverage for new mothers from 60 days to 1 year.
The Biden administration rescinded an approved extension of the Medicaid agreement in Texas, which has the nation’s most uninsured residents and for years has refused calls to expand the federal health insurance program.
On April 22nd, Molina Healthcare announced a definitive agreement to acquire Cigna’s Texas Medicaid and Medicare-Medicaid Plan contracts and certain operating assets impacting STAR+PLUS Medicaid beneficiaries in the Hidalgo, Tarrant and Northeast service areas. The deal is expected to close in the 2nd half of 2021 pending regulatory approval.
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.
In April, the 40 quarter requirements for Lawful Permanent Residents (LPRs) in Virginia went away, allowing for LPRs who have been in the US for 5+ years to not be required to have 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 all pregnant women will now have postpartum coverage for 12 months.
Due to the multitude of changes in the federal landscape, the state has decided to delay the transition of becoming a state-based health exchange by one year.