Policy alerts, briefs, letters & papers

KFF has released an issue brief that describes how state Medicaid programs are implementing arrangements aimed at coordinating Medicare and Medicaid for dual-eligible individuals. Dual-eligible individuals receive their primary health insurance coverage through Medicare and receive additional assistance from their state Medicaid program. The brief reports that nearly all states are leveraging strategies to coordinate care for dual-eligible individuals and many states are using multiple strategies.

The Kaiser Family Foundation has released an issue brief discussing the ramifications of the end of the public health emergency (PHE) for Medicaid Home- and Community-Based Services (HCBS). This brief includes background information on how states supported Medicaid HCBS during the PHE, and highlights important things to watch in Medicaid HCBS as the PHE comes to and end on May 11, 2023.

The National Center for Assisted Living (NCAL) released a white paper as part of its efforts to meet the changing needs of the growing senior population. The document outlines challenges to offering more affordable assisted living for low- and middle-income seniors, as well as solutions that could help improve access to necessary care. NCAL reinforces the need for public-private partnerships to increase affordable assisted living options for low- to moderate-income older adults who can no longer live at home. NCAL also highlights Medicaid as one of the major challenges, as the program is chronically underfunded and limits access to assisted living care.

The AARP Public Policy Institute (PPI) contracted with NORC at the University of Chicago to examine the implications of the Medicaid continuous enrollment unwinding process for older Americans. NORC analyzed Medicaid enrollment trends for the age 50-64 population prior to and during the COVID-19 public health emergency and used this data to model the impact of resuming Medicaid eligibility reassessments, or redeterminations, in this population. This paper discusses these findings as well as their context within the larger health care system. The paper also provides an overview of federal and state actions taken in advance of the ending of Medicaid continuous enrollment and discuss policy options that could help ease the transition.

A new issue brief from Kaiser Family Foundation shares how States can work with Medicaid managed care organizations (MCOs) to prepare beneficiaries for the unwinding process. MCOs deliver to more than two thirds of Medicaid beneficiaries nationally and this article shares insight on the strategic partnerships between states and their MCOs to prepare for the unwinding process.

ADvancing States is pleased to announce the release of a new report, Advancing Equity through MLTSS Programs, co-authored with Impact 120. This report highlights the numerous ways that managed long-term services and supports (MLTSS) programs can enhance state capacity to create more equitable programs for consumers. Research and interviews identified five key themes, which are explored in detail with recommendations for future action.

The Commonwealth Fund has published a compilation of state successes in transforming long-term care as a resource to support policymakers. This policy guide is the result of a nine-month partnership between CSG and the Commonwealth Fund. Subject matter experts and stakeholders from Arizona, Georgia, Hawaii, Indiana, Minnesota, New York, Pennsylvania and Virginia examine the following focus areas in long-term care: Addressing State Regulation of Long-Term Services and Supports Facilities; Optimizing American Rescue Plan Act Spending on Home- and Community-Based Services Under Medicaid; and Revitalizing the Direct Care Workforce and Supporting Family Caregivers.

On January 5, 2023 CMS released a State Medicaid Director’s letter that provides a new reporting and oversight framework for states that permit managed care plans to deliver in-lieu-of services (ILOS) to their enrollees. ILOS are cost-effective substitutes for otherwise covered State plan services that may enhance enrollee’s health and wellbeing (for example, medically-tailored meals that enhance the ability of an enrollee to remain at home rather than in an institutional setting). States using ILOS will be required to limit them to no more than 5% of a managed care program’s total capitation payments and provide evaluative data to CMS about their effectiveness beginning in 2027.

On January 5, 2023 CMS released an Informational Bulletin providing further guidance on the Medicaid eligibility provisions in the recently-enacted Federal budget (Consolidated Appropriations Act of 2023). The CAA permits states to begin terminating Medicaid eligibility for current recipients on April 1, 2023 and provides gradually-decreased FMAP increases through December, 2023. This IB is the first in a series of written guidance from CMS on these provisions, focusing first on revised key due dates for certain state eligibility redetermination deliverables and activities.

The Center for Health Care Strategies, with support from the New York Health Foundation and in partnership with ATW Health Solutions, assisted seven New York-based health care organizations in piloting strategies for engaging patients of color to advance health equity. This CHCS brief outlines considerations for health care organizations in developing patient engagement strategies, including: (1) building trust with patient partners over time; (2) tailoring outreach strategies; (3) using-trauma-informed approaches; (4) engaging patients in data use; and (5) approaching engagement with humility.