Parallon’s eligibility and advocacy team continues to monitor the state of Medicaid eligibility as impacted by COVID-19. Notably, we are keeping a close eye on the Supreme Court decision over Medicaid work requirements. The public health emergency that was due to end January 21st, has now been extended another 90 days ending in April. At the state-level:

  • Georgia’s 1115 and 1332 waivers were approved. Many of those changes could begin July 1, 2021.
  • Missouri and Oklahoma Medicaid expansion will begin July 1, 2021.
  • North Carolina managed Medicaid transition will go into effect July 1, 2021.
  • Tennessee CMS approved the block grant waiver. It is the first state to implement this type of Medicaid funding. It is uncertain when or if it will go into effect based on the controversial nature of this proposal but we are continuing to monitor.

Below we breakdown the latest changes for January 2021, federal Medicaid process updates and state agency closures.*

Here is the January 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.

Florida Medicaid Updates

Florida Medicaid is expecting its largest enrollment year to date of 4.4 million individuals for the 2020-2021 fiscal year. Prior to this year 2016-2017 marked the largest enrollment totals reaching at around 4 million individuals. 2.1 million people signed up or renewed a health exchange plan during this last open enrollment period which ended December 15. This is an increase from the 1.7 million who enrolled in 2019. Despite reports stating premium rates are increasing by 3.1% the Florida ended open enrollment as the state with the largest enrollment totals for all federally facilitated entities (numbers exclude states who run their own healthcare exchange platforms).

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. The 1332 waiver replaces the health exchange platform but allows residents to purchase health insurance with a state facilitated insurance program that is not affiliated with the ACA plans. Considering the controversial nature of these waivers, it is possible the decision will go to the Supreme Court.

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. More to come.

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. The agency is working with the federal government on how to end coverage for people once the federal public health emergency ends. LeBlanc estimated it will take about six months to catch up on all the reviews to determine who is ineligible.

Mississippi Medicaid Updates

The state is preparing for its upcoming legislative session. Mississippi Hospital Association is hoping to have a voice with some of those changes. They are in favor of expanding Medicaid and a possible removal of the managed care plans within the state.

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. Medicaid expansion will face many barriers before fully implementing in the state.

Nevada Medicaid Updates

Effective October 1st the company who owns DXC Technology has been purchased by Gainwell technologies. DXC was the company who processed claims for the state. The state does not expect a huge impact with the change but a memo was sent out to organizations communicating the change.

New Hampshire Medicaid Updates

DHHS announced there could be no Long Term Care placements due to COVID-19 increases.

North Carolina Medicaid Updates

NCDHHS launched a new Beneficiary Portal on the NC Medicaid website to serve as a centralized information resource center for current Medicaid beneficiaries and those wishing to apply for Medicaid benefits. 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.

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. Oklahoma took its first steps on October 16, 2020, seeking to privatize care to most Medicaid recipients. The state is designing a statewide health information exchange to allow health information to flow securely to and from authorized organizations and individuals in Oklahoma with the initial focus on the state’s Medicaid providers.  In addition, Orion Health selected to support Oklahoma Health Information Exchange. OHCA named Dr. Nathan Valentine as the OHCA Chief Quality Officer.

Texas Medicaid Updates

As the legislative sessions begin Senate Joint Resolution 15 is a bill proposing to expand Medicaid within the state. Historically Texas has the largest number of uninsured residents of any state. Even with the increased pressure due to the pandemic, it’s probably unlikely the bill will pass. In addition, Medicaid and Children’s Health Insurance Program (CHIP) flexibilities put in place during the COVID-19 pandemic have been extended.

Utah Medicaid Updates

A new COVID-19 uninsured test coverage is effective beginning June 1, 2020. The new program is designed for patients who do not qualify for regular Medicaid. The programs is retro-active beginning June 1, 2020 but does not cover in-patient stays. Patients must not be eligible for HPE, be a US citizen, Utah resident, and have no health insurance.

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. The state budget may now include dental funds for expanded adults. Currently only pregnant women and children receive dental benefits but it could expand to childless adults if fully approved.