Federal Studies and Reports

• A new March of Dimes report revealed over 5.6 million women are living in counties with little to no access to maternity care services, a substantial increase since 2018. According to the report, maternal mortality rates have also increased over the pandemic and the mortality rate racial disparities remain high. The report also notes that about 70 counties have been classified as “maternal care deserts” since 2018, in that they have no hospitals or birth centers with obstetric care services and lack obstetric providers of any kind. States with the highest rates of maternity care deserts are states with more rural populations specifically, Alaska, Nebraska, North Dakota, Oklahoma, and South Dakota (Inside Health Policy, August 11).

Featured Content

New Mexico Care Contracts

• A settlement agreement between New Mexico’s state Ethics Commission and Governor Lujan Grisham requires the state’s Medicaid agency to proceed with implementing Medicaid managed care contracts, effective July 1, 2024, with the four winning bidders as a result of the previous procurement process. The governor had previously decided to redo the managed care procurement which sparked criticism and a complaint to the Ethics Commission. Per the settlement agreement, the winning bidders from the previous procurement process are: Blue Cross and Blue Shield of New Mexico, UnitedHealthcare of New Mexico, Molina Healthcare of New Mexico, Inc., and Presbyterian Health Plan, with Presbyterian additionally awarded the contract to serve the foster care population (Santa Fe New Mexican, August 10; Health Payer Specialist, August 15).

• The New Jersey legislature passed a bill that will let hospitals double the amount of time they can involuntarily commit a person to a psychiatric facility from three days to six days. Individuals can be involuntarily committed if they are mentally ill or pose a danger to themselves or others. The bill is currently on Governor Murphy’s desk pending review. However, more than four dozen advocacy groups and members of the Governor’s administration have urged the Governor to veto the bill claiming it violates individual civil rights. Some hospitals and health systems support the bill arguing that it will give them more time to find proper treatment based on an assessment of the patient’s condition and consideration of insurance coverage (Politico, August 9).
• Voters in Ohio overwhelmingly voted against a ballot measure that would have raised the threshold to pass a constitutional amendment from a simple majority to 60% and make it difficult for citizen-initiated ballot measures to come before voters. The ballot measure was a GOP-led effort to make it more difficult to amend the state’s constitution with a primary focus on making it difficult for abortion protection amendments. 62% of Ohioans voted against the ballot measure (Politico, August 8).
• Vermont’s insurance regulator, Green Mountain Care Board, rejected the 2024 premium hikes proposed by BCBS Vermont and MVP Health Plan, instead offering reduced rate hikes. BCBS Vermont requested a rate increase of 17.5% for its small group plans and an 18% increase for the individual market, however, Green Mountain Care Board granted 13.3% and 14% increases respectively. MVP Health Plan requested a 15.4% rate hike for its small group plans and 15% rate hike for the individual market but were granted 11.5% and 11.4% rate hikes, respectively. The payers requested large rate hikes based on the increase in drug and hospital costs (Health Payer Specialist, August 14).
• The state of New York is beating the odds when it comes to processing Medicaid beneficiary redeterminations. The state has a renewal rate of 72%, compared to the 59% national average. The state has disenrolled an estimated 59,000 individuals, compared to 225,000 disenrollments in California, 408,000 in Florida, and 500,000 in Texas. New York has been engaged in a multimedia campaign called “Keep New Yorkers Covered” and took advantage of CMS’ waivers related to streamlining re-enrollment like matching SNAP data with Medicaid benefits coverage and partnering with multiple community groups and payers to keep residents informed of the importance of the redetermination process (Health Payer Specialist, August 14).
• Kentucky’s attorney general has filed a lawsuit against three pharmacy benefit managers (PBMs) alleging the PBMs “worked in tandem to manipulate and increase insulin prices.” Kentucky joins at least seven other states that have filed similar suits. Representatives of the PBMs deny any wrongdoing (Health Payer Specialist, August 9).
• According to letters to states made public by CMS, seven states (Idaho, Nevada, New Hampshire, South Carolina, Texas, Utah, and Washington) disenrolled more than 40% of their Medicaid beneficiaries from coverage in May. The disenrollments occurred primarily due to administrative reasons like lost paperwork. The letters also revealed that many states failed to process Medicaid applications within 45 days and answer beneficiaries’ calls in less than 10 minutes. Nearly 15 states reported disenrolling 30% of their Medicaid beneficiaries who had renewals due in May because of procedural reasons (Inside Health Policy, August 11).

News

• CVS Health is pledging to pay $6.6 million in grants to improve maternal health outcomes. The funding will be allocated to three organizations: $4.4 million to The March of Dimes, $1 million to the American Health Association, and $1.66 million to Massachusetts General Hospital. The funds will be expended to increase the maternal health workforce of doulas and medical paraprofessionals who help pregnant women during gestation and birth (Health Payer Specialist, August 14).
• As demand for a new class of weight loss drugs grows, patients are increasingly turning to telemedicine to obtain prescriptions. A Trilliant Health analysis found telehealth prescriptions accounted for almost half of the 3.6 million prescriptions for the new weight loss drugs covered in 2022. The same analysis shows that insurers only paid for about half of the claims for these drugs (Health Payer Specialist, August 14).
• The American Hospital Association (AHA) urged CMS to use the FY 2023 uninsurance rate of 9.2% to calculate the funding for Medicare Disproportionate Share Hospital (DSH) payments for FY 2024 to avoid a $957 million pay cut for the fiscal year. AHA criticized CMS for using a lower projected uninsurance rate of 8.3% for FY 2024 citing opaqueness in the agency’s calculations and the projected loss of coverage during the Medicaid beneficiary redetermination process (Inside Health Policy, August 10).
• A think tank (Hoover Institution) based out of Stanford University proposed a new savings account dedicated to healthcare expenses. The new savings account, Individual Health Accounts, is a tax-advantaged savings account that will give consumers more healthcare payment options. Hoover Institution proposed allowing consumers to transfer ACA subsidy balances into these accounts so that consumers do not have to rely on health insurance alone. The authors of the proposal noted that it can lower healthcare costs by promoting price transparency and decreasing reliance on third-party payment. Self-insured health plans have expressed support for this proposed account (Health Payer Specialist, August 14).

• What’s ahead for state budgets in Fiscal Year 2024? Sellers Dorsey leads you through each state’s enacted budget for the year, their Medicaid spending plans, and program changes. See where states are looking to allocate funds to best address their most mission-critical challenges and align with the needs of their communities. Click here to download.
• Don’t miss our NEW (free) webinar, “Nourishing Communities: Addressing Food Insecurity for Better Health,” on Thursday, September 7th from 12 pm – 1 pm (EST). Tune in to hear our panel of experts explore the history of nutrition supports and the challenges faced by states, Medicaid agencies, managed care, and community-based organizations in combatting food insecurity. Click here to learn more and register!
• CMS accepted public comments on the proposed rulemaking “Medicaid Program; Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality,” through July 3, 2023. Sellers Dorsey summarized everything you need to know on comments related to access, state directed payments, medical loss ratios, in-lieu of services, and more. Click here to download the summary.