Public Charge

On March 9th, Secretary Alejandro N. Mayorkas announced that the federal government will no longer defend the Public Charge rule, which is a law that had the potential to deny someone legal permanent residency status if they are reliant on Medicaid or food assistance.

American Rescue Plan Act

This act was signed into law on March 11th. The key takeaways are as follows:

  • May 31st was the enrollment deadline for companies to submit their election notices to those eligible for 100% COBRA assistance
  • Despite financial incentives to expand Medicaid, it does not appear that any of the remaining non-expansion states are making the change just yet

June 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 Health Exchange enrollment was originally ending on May 15th, but per the Covered California website, enrollment is still open. It does not have an end date published.


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 state is proposing a plan that has not been implemented with any other state so far. HB 21-1232, or the Colorado Option, was developed to implement a state-run health insurance option through the marketplace. Although very controversial and the law continues to change as it goes to each level of the legislative process, the concept is to lower premiums and create a more affordable option for the state’s residents.


Florida closed out the legislative sessions with limited 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. One of the key differences of 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, or lives in a rural area with no access to transportation he/she? They? 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. The law will take effect July 1st, but it will not be fully implemented until 2023.  


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 the $8B in state Medicaid business.  The judge ordered the state to rebid the entire package which would make it the third time the state would have to seek bids from external health insurance companies.


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.


The state is in the middle of a legislative session and Medicaid expansion was on the agenda but unfortunately both proposals to expand the program to childless adults were rejected. In May, a group called the Fairness Project worked on a campaign called “Yes on 76” which would create a ballot initiative for Medicaid expansion. However, it has since been paused due to Mississippi Supreme Court’s decision to overturn another voter approved initiative. The group feels that even if the residents approve expansion, it will still not be supported by law makers.


Although Missouri voters approved Medicaid expansion through a ballot initiative, the legislation process voted against funding the new program. At this time there is no funding to support Medicaid expansion within the state. Lawsuits were filed but the chances of the state implementing this in 2021 are slim.


Nevada is a state-facilitated health exchange and does not utilize the federal platform. They have decided to follow suit and also open up the special enrollment timeframe until August 15th.

North Carolina

Over the past several months, the state has been preparing for the transition to Managed Medicaid for July 2021. Research also indicates 62% of NC residents are not aware of the transition and may not have switched to a Managed Medicaid plans yet.


Medicaid expansion population applications open June 1st to apply for Sooner Care with benefits for those who qualify being effective July 1st. More than 50K Oklahomans have signed up under Medicaid expansion.

The state also has an 1115 waiver pending that if approved would be effective July 1st. One of the biggest impacts of this approval is not allowing retro Medicaid for the expanded population. So far it is unclear if the current CMS administration will support that change.

The Oklahoma Supreme Court ruled Gov. Kevin Stitts’ plan to privatize much of the state’s Medicaid program as unconstitutional. The court determined the Oklahoma Health Care Authority did not have the legislative approval to move forward with the plan, dubbed Sooner Select.

South Carolina

The state plans on rolling out a new MMIS system, but due to delays it will not be rolled out until later in 2021.

The South Carolina Department of Health and Human Services (SCDHHS) is adding an additional managed care organization (MCO) to serve its 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. 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 one year.


Even though the American Rescue Plan offers additional funding to Medicaid this year, State leaders still did not budge on their opposition to expansion. However, in an attempt to reduce the states’ maternal mortality rate, a bill passed that now allows moms to receive Medicaid up to six months postpartum. This is an extra four months of coverage to allow for care for complications or postpartum depression concerns.  


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 five or more 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.