In Oregon, Democrats passed a bill in March to establish a basic health program, the details of which are being ironed out by a task force that began meeting this week. In Kentucky, Republicans approved $4.5 million in state funds this spring to set up a basic health program, which was signed into law by the state’s Democratic governor. An estimated 85,000 Oregonians and at least 37,000 Kentuckians will be eligible to enroll in the plans as soon as next year.
Enrollment Assistors Attend YMCA Kids Day Events Throughout the State to Help Consumers Renew or Enroll in Health Coverage
Eligibility Redeterminations will be Resuming for Over 9 Million New Yorkers in Medicaid, Child Health Plus and the Essential Plan
ALBANY, N.Y. (April 27, 2023) – NY State of Health, the state’s official health plan Marketplace, today announced it will participate in the YMCA’s annual Healthy Kids Day, a national initiative featuring free community events with family-friendly activities that promote wellness. Certified enrollment assistors will be available at select YMCAs statewide on April 29, 2023, to provide free help to New Yorkers. They will provide information about upcoming changes to their health insurance, answer questions about renewals, and provide information to uninsured New Yorkers about enrolling in coverage through the Marketplace.
CMS Approves of State of Washington Medicaid Section 1115 Demonstration
April 14: CMS approved an amendment to the State of Washington's Medicaid section 1115(a) demonstration, titled “Medicaid Transformation Project." Approval of this demonstration amendment includes several improvements, like historic continuous eligibility for Medicaid children from the point they become eligible until they reach age six, regardless of income fluctuations or changes that would affect eligibility. The demonstration also expands the definition of transportation so eligible program participants can gain access to benefits, including community services and activities based on their service plan.
So far, so good; that's a pretty big deal, especially as we're in the middle of the Medicaid Unwinding process nationally.
However, there's a rather curious provision at the end of the announcement:
CMS marked another important maternal health milestone by approving Medicaid and Children’s Health Insurance Program (CHIP) postpartum coverage expansion in Rhode Island, an opportunity made possible by the American Rescue Plan. With this approval, 32 states and D.C. have extended postpartum Medicaid/CHIP coverage to a full year.
They include links to the approval letters for both Medicaid and CHIP, but the Medicaid one is oddly both extremely brief ("We received your request; it has been approved") and wonky at the same time, while not being in an easy-to-copy text format.
The House on Wednesday passed a bill that would raise the debt ceiling and slash trillions of dollars in government spending, delivering House Speaker Kevin McCarthy a victory in his efforts to pressure the White House to begin negotiations ahead of a fast-approaching deadline to avoid a default.
The House voted 217 to 215 to pass the Limit, Save, Grow Act of 2023, with all but four Republican members voting in favor. The Republicans who voted against the bill were Reps. Ken Buck of Colorado, Andy Biggs of Arizona, Tim Burchett of Tennessee and Matt Gaetz of Florida. No Democrats supported its passage.
The measure would lift the debt ceiling by $1.5 trillion or until the end of March 2024, whichever comes first, and cut spending to the tune of $4.5 trillion.
Those cuts mean it's dead on arrival in the Democratic-controlled Senate and President Biden has vowed to veto it.
The Affordable Care Act includes a long list of codified instructions about what's required under the law. However, like any major piece of legislation, many of the specific details are left up to the agency responsible for implementing the law.
While the PPACA is itself a lengthy document, it would have to be several times longer yet in order to cover every conceivable detail involved in operating the ACA exchanges, Medicaid expansion and so forth. The major provisions of the ACA fall under the Department of Health & Human Services (HHS), and within that, the Centers for Medicare & Medicaid (CMS)
Every year, CMS issues a long, wonky document called the Notice of Benefit & Payment Parameters (NBPP) for the Affordable Care Act. This is basically a list of proposed tweaks to some of the specifics of how the ACA is actually implemented for the following year.
President Joe Biden is set to announce that his administration is expanding eligibility for Medicaid and the Affordable Care Act’s health insurance exchanges to hundreds of thousands of immigrants brought to the U.S. illegally as children, according to two U.S. officials briefed on the matter.
The action will allow participants in the Obama-era Deferred Action for Childhood Arrivals program, or DACA, to access government-funded health insurance programs. The officials spoke on the condition of anonymity to discuss the matter before the formal announcement on Thursday.
As Eligibility Redeterminations Resume, New York Gets Ready to Renew Coverage for Over 8 Million Enrollees in Medicaid, Child Health Plus and the Essential Plan
Enrollment Assistors Available at Kinney Drugs, ShopRite and Rite Aid to Educate Consumers About Insurance Through the Marketplace
ALBANY, NY (April 26, 2023) – NY State of Health, the state’s official health plan Marketplace, is teaming up with retail pharmacies across the state to educate New Yorkers enrolled in public health insurance programs about upcoming changes to their coverage. With federal rules now requiring the state to resume eligibility redeterminations for nearly 9 million enrollees in Medicaid, Child Health Plus and the Essential Plan this spring, the Marketplace is increasing outreach to ensure consumers don’t risk a gap in their coverage. Certified enrollment assistors will be available on-site at pharmacies to answer current enrollees’ questions about renewals, as well as provide information to uninsured New Yorkers about enrolling in health insurance through NY State of Health.
This happened last week but I was preoccupied with some personal issues and never got around to posting about it. The news is widespread by now but important enough that I figured I should at least give it a mention anyway.
The Supreme Court issued a decision on Friday evening that maintained the Food and Drug Administration’s approval of a commonly used abortion pill while an appeal moves forward, the latest development in a fast-moving legal battle that followed a lower court’s ruling that ordered the drug pulled off the market.
Justice Samuel A. Alito Jr. had paused the lower court’s ruling on the pill, mifepristone, but that freeze had been set to expire at midnight. The justices issued their decision about five hours before the deadline.
Since March 2020, Aligned with Federal Continuous Coverage Requirements, Enrollment in NY State of Health Programs has Grown by 41 Percent
As the Post-Public Health Emergency Redetermination Process Begins, State Has Deployed Multi-pronged Strategy to Maximize Number of Consumers who Maintain Coverage
ALBANY, N.Y. (April 20, 2023) – NY State of Health, the state’s official health plan Marketplace, today released the 2023 Health Insurance Coverage Update, a detailed summary of NY State of Health enrollment, including demographics, quality measures, and the cost savings realized by millions of New Yorkers who have comprehensive health insurance through the Marketplace. As of January 31, 2023, NY State of Health enrollment is nearly 6.9 million, or more than one in three New Yorkers across the state.
Individuals losing eligibility for MaineCare can enroll in plans on CoverME.gov through July 31, 2024
AUGUSTA— The Maine Department of Health and Human Services (DHHS) announced today the launch of a Special Enrollment Period (SEP) through CoverME.gov, Maine’s Health Insurance Marketplace, to help Maine people transitioning from MaineCare coverage after the COVID-19 pandemic explore affordable health insurance options and avoid gaps in coverage. The Special Enrollment Period began on April 15, 2023, and will continue through July 31, 2024, allowing Maine individuals found no longer eligible for MaineCare to apply for plans through CoverME.gov outside of the annual Open Enrollment Period.
The main distinction between the New Mexico and Minnesota approaches has to do with which existing publicly-funded healthcare program they're based on. While New Mexico went with Medicaid (which half the state's population is already enrolled in anyway), Minnesota is basing theirs on their Basic Health Plan program, MinnesotaCare. I first wrote about this back in February.
...Well, just one day after the Bright Healthcare bombshell news broke, Texas-based health insurance broker Jenny Chumbley Hogue sounded the alarm on another large carrier bailing on Texas next year:
Last night, the Fifth Circuit issued a decision which invalidates the scientific, independent judgment of the FDA about when and how a medicine is available to Americans. The Justice Department has already announced that they are seeking emergency relief from the Supreme Court.
More than 20 years ago, the FDA approved medication abortion as safe and effective for the American people. Last week, a Texas district court ruled to block access to this medication in every state in the country.
The Fifth Circuit’s decision—just like the district court’s—second-guesses the agency’s medical experts. If this decision stands, no medication—from chemotherapy drugs, to asthma medicine, to blood pressure pills, to insulin—would be safe from attacks. This decision threatens the rights of Americans across the country, who can look in their medicine cabinets and find medication prescribed by a doctor because the FDA engaged in a process to determine the efficacy and safety of that medication.
...given the slow nature of congressional action, the Biden administration can take some important steps now. For example, HHS could make hundreds of thousands of DACA recipients eligible for ACA coverage through regulatory action. It could also build on its existing investment in outreach and assistance programs to fund more Navigators and other community organizations that are best suited for immigrant-focused enrollment work.
WASHINGTON, D.C. – Doctors for America and the Reproductive Health Coalition have filed a new amicus brief in support of FDA’s approval of the use of mifepristone to end pregnancy through ten weeks gestation.
The brief, filed in the U.S. Court of Appeals for the Fifth Circuit, is in response to the decision made last week by Judge Kacsmaryk in the case of Alliance for Hippocratic Medicine vs. U.S. Food and Drug Administration (FDA), in which Judge Kacsmaryk ordered the FDA to stay the approval of mifepristone. Both Doctors for America (DFA) and the Reproductive Health Coalition (RHC) are deeply concerned that the decision made by Judge Kacsmaryk is not based on medical science, nor the robust data available. Mifepristone is a medication that has been safely used by physicians and patients for over 20 years, with research showing that adverse events and outcomes are exceedingly rare, occurring in less than a fraction of 1% of cases.
Hmmm...this is a bit odd. Every month for years now, the Centers for Medicare & Medicare Services (CMS) has published a monthly press release with a breakout of total Medicare, Medicaid & CHIP enrollment; the most recent one was posted in late February, and ran through November 2022.
For the December update, however, they haven't sent out the normal press release; instead, they included a brief note leading to a Medicaid/CHIP data slideshow which I summarized yesterday, along with another note leading to their new Medicare Monthly Enrollment database.
In any event, according to the spreadsheet I exported, as of December 2022:
Yesterday I noted that the Maryland legislature, which has had an excellent record on healthcare reform policy in recent years, had a rare misstep when they took a pass on allowing undocumented immigrants to enroll in the states ACA exchange. While the lack of federal subsidy eligibility would have severely limited the number of undocumented Maryland residents who would be able to utilize this path towards healthcare, it was still a missed opportunity.
Today, however, I can report that the MD legislature has passed several other bills which move things in the right direction. Via Rob Flaks of WMDT:
With just days left in the General Assembly session, Maryland lawmakers have passed a series of bills aimed at expanding healthcare access and combating costs across the state.
Arizona became the latest state to extend postpartum coverage for individuals enrolled in Medicaid and the Children’s Health Insurance Program, following CMS’ approval of the state’s postpartum coverage extension state plan amendments (SPAs). The opportunity to extend this coverage was made possible by the American Rescue Plan, and this approval marks 31 states and D.C. that have extended postpartum Medicaid/CHIP coverage to a full year.
I have no idea why the administration hasn't put out a formal standalone press release about this...they've done so for every other state to my knowledge (including Oklahoma just two weeks ago), but whatever; it's still good news!
Feds Approve Innovative NJ FamilyCare Projects Addressing Housing, Behavioral & Physical Health, Providing Care & Other Creative Approaches
1115 Demonstration Approval Continues Long-Standing Medicaid Programs and Allows New Innovations
TRENTON – The Centers for Medicare and Medicaid Services (CMS) has approved innovative NJ FamilyCare projects designed to address priorities such as housing, integrating behavioral and physical health services, and new and creative approaches to providing care.
CMS signed off on the projects by approving NJ FamilyCare’s Comprehensive 1115 Demonstration renewal. The 1115 demonstration provides the state with federal authority to operate large parts of the NJ FamilyCare program. The approval is in effect from April 1, 2023 through June 30, 2028.
...The proposal at issue would allow undocumented immigrants to buy health insurance through the state exchange, a policy change that state analysts predict would lead to coverage for about one-third of the state’s undocumented population, or 82,500 people. The move would add Maryland to a small number of states targeting the group in an effort to shore up gaps in health care access — a goal that has faced head winds in Congress.
Supporters say the proposal dovetails with Gov. Wes Moore’s goal of eliminating child poverty and would reduce overall premiums and care provided by hospitals free of charge to the uninsured. But instead of passing a bill that would open the insurance marketplace, which would require a federal waiver, lawmakers instead approved legislation that calls for the Maryland Health Department and the Maryland Health Benefit Exchange to study options for undocumented immigrants’ health care needs to guide their work moving forward.
Attorney General Bonta Announces $2.1 Million Settlement Against Companies Over Sham Health Insurance Plans
OAKLAND — California Attorney General Rob Bonta today announced a $2.1 million settlement against two companies, Shared Health Alliance, Inc. (SHA) and Alliance for Shared Health (ASH), to resolve allegations that they offered and deceptively advertised sham health insurance and violated insurance regulations that protect consumers. ASH, a nonprofit corporation that purported to be a healthcare sharing ministry (HCSM), created, operated, and sold unauthorized health insurance through its for-profit administrative vendor, SHA.
In December 2022, 92,340,585 individuals were enrolled in Medicaid and CHIP.
85,280,085 individuals were enrolled in Medicaid in December 2022, an increase of 425,110
7,060,500 individuals were enrolled in CHIP in December 2022, an increase of 87,296 individuals from November 2022.
Since February 2020, enrollment in Medicaid and CHIP has increased by 21,690,345 individuals (30.7%).
Medicaid enrollment has increased by 21,474,995 individuals (33.7%).
CHIP enrollment has increased by 215,350 individuals (3.1%).
The Medicaid enrollment increases are likely driven by COVID-19 and the continuous enrollment condition in the Families First Coronavirus Response Act (FFCRA).
In December 2022, 2,360,820 applications for Medicaid and CHIP were submitted directly to states.
DENVER— In its tenth year of enrollment operations, Connect for Health Colorado, the state’s official health insurance marketplace, is providing more financial help for health insurance, offering more local enrollment assistance and enrolling more people into coverage than ever before.
In a report published today, Connect for Health Colorado provides a comprehensive look at the Open Enrollment Period data and outcomes. (Connect for Health Colorado released preliminary enrollment totals from the Open Enrollment Period at the end of January.) This new report includes information such as average costs and enrollments by county and the significance of Broker and Assister enrollment assistance. Here are the highlights:
I was out of town for much of last week (my son's robotics team made it to the state championship) so I'm afraid I'm playing a bit of catch up today, so I kind of missed out on writing about this development which, while expected, is both depressing and enraging. Via the NY Times:
A federal judge in Texas issued a preliminary ruling invalidating the Food and Drug Administration’s 23-year-old approval of the abortion pill mifepristone, an unprecedented order that — if it stands through court challenges — could make it harder for patients to get abortions in states where abortion is legal, not just in those trying to restrict it.
The drug will continue to be available at least in the short-term since the judge, Matthew J. Kacsmaryk, stayed his own order for seven days to give the F.D.A. time to ask an appeals court to intervene.
Less than an hour after Judge Kacsmaryk’s ruling, a judge in Washington state issued a ruling in another case, which contradicted the Texas decision, ordering the F.D.A. to make no changes to the availability of mifepristone in the 18 states that filed that lawsuit.
Consumer Advisory: Maryland-issued health insurance policies are not impacted by Braidwood Management, Inc. v. Becerra; preventative services, including PrEP, are still required to be covered
BALTIMORE – Health insurance policies (including HMO plans) issued in Maryland are not impacted by a recent ruling by a federal judge in Texas that health plans do not have to cover certain preventive services.
...Well, just one day after the Bright Healthcare bombshell news broke, Texas-based health insurance broker Jenny Chumbley Hogue sounded the alarm on another large carrier bailing on Texas next year:
