States of Innovation: September 2024

In September, states took action on healthcare affordability to address costs: Colorado published a new tool to promote hospital transparency, while New Jersey released a series of reports on healthcare spending. To expand access to care California awarded nearly $147 million to strengthen community health services for Medicaid members, Minnesota published a report on telehealth access and New Mexico announced investments in rural health. 

States also focused on advancing health equity: Michigan created Healthy Community Zones to reduce racial inequities and North Carolina published a report on health inequities and opportunities for improvements. In terms of Marketplace innovations, two states received federal pass-through funding for section 1332 waivers: Colorado was awarded $361 million, while New York received $10 billion. Illinois was approved  to operate as a State-Based Marketplace on the Federal Platform for this year’s upcoming open enrollment.

States continue to tackle maternal health, including Arkansas, which delivered a report to the governor on policies aimed at improving health outcomes for pregnant people, and Massachusetts where the governor signed legislation to promote access to midwifery care and out-of-hospital birth options. States also took action to address medical debt in September: California banned the inclusion of medical debt in consumer reports, and the District of Columbia relieved $42 million in medical debt for over 62,500 residents.

Throughout the month of September states took action on mental and behavioral health, such as Montana, which announced investments in the behavioral health workforce. Two states, California and Pennsylvania, moved to prevent gun violence. 

Also in September, in an effort to protect reproductive and women’s health, Pennsylvania expanded access to free menstrual products for students. State action to improve services for children and youth included New Jersey expanding its universal home visiting initiative for families with a newborn or who have experienced a stillbirth or neonatal loss.

Lastly, states received approval from the Centers for Medicare & Medicaid Services (CMS) for waiver and state plan amendments and requests. Mississippi received approval to extend its “Healthier Mississippi” section 1115 demonstration, Montana will continue implementation of its reinsurance program, New Hampshire will provide mobile crisis services under its state plan amendment, and New York received approval for an amendment to its section 1332 waiver to provide cost-sharing subsidies for Marketplace enrollees with diabetes, who are pregnant or in their 12-month postpartum period, and all individuals and families with incomes up to 400% of the federal poverty level.

Affordability and Efforts to Address Cost

Colorado published a new tool to promote hospital price transparency. Governor Polis and the Department of Health Care & Policy Financing announced the Hospital Price Transparency Tool, which allows employers, consumers, policymakers, and other payers and state regulators to compare the costs of more than 5,000 procedures at 82 Colorado hospitals. The tool compares hospitals’ gross charges, cash discounted prices, estimated Medicare costs, and commercially negotiated prices. 

New Jersey released a series of reports on healthcare spending. The New Jersey Health Care Affordability, Responsibility and Transparency Program released a trio of reports assessing the quality and affordability of healthcare in New Jersey and the factors contributing to high healthcare costs and cost growth. 

Expanding Access to Care 

California awarded nearly $147 million to strengthen community health services. The California Department of Health Care Services awarded $146.6 million to 133 organizations to support the provision of Enhanced Care Management and Community Supports services to Medi-Cal members. The funding is part of the Providing Access and Transforming Health Capacity and Infrastructure, Transition, Expansion, and Development initiative, designed to help providers strengthen their ability to participate in the Medi-Cal delivery system and provide whole-person care to Californians. 

Minnesota published a report on telehealth recommending its continued availability. The Minnesota Department of Health (MDH) released the final report for the Minnesota Study of Telehealth Expansion and Payment Parity. The report summarizes findings from a wide range of qualitative and quantitative studies conducted by MDH and its partners. A synthesis of study results concludes that, to date, telehealth has expanded access to healthcare without compromising healthcare quality or patient satisfaction. 

Missouri is expanding access to free testing resources for hepatitis C. The Missouri Department of Social Services, MO HealthNet Division announced the ElimiNATION Awareness Tour, part of the ongoing Project HepCure initiative, which aims to eliminate hepatitis C in the state. The ElimiNATION Tour will offer screenings for hepatitis C at no cost, regardless of health insurance status. The tour aims to bring testing resources directly to those in need and, in partnership with local organizations, facilitate linkages to care for individuals who test positive for the virus.

New Mexico is investing in rural health providers to improve access. Governor Michelle Lujan Grisham announced that $46 million is available for rural healthcare providers in the state through the Rural Health Care Delivery Fund (RHCDF) to support vital services in underserved areas. This announcement builds on the initial $80 million investment made through the RHCDF last year, which helped to offset operational costs for rural healthcare providers. The new funding will strengthen primary care, behavioral health, and maternal child health initiatives, increasing access to care in some of the most underserved areas of New Mexico.

New York signed a legislative package to ensure equitable access to essential healthcare services. Governor Kathy Hochul signed a legislative package which includes S.8486-C/A.9102-C, requiring Medicaid reimbursement for ambulance services when treatment in place is administered and/or when transportation is provided to alternative healthcare settings instead of a general hospital.

Health Equity

Massachusetts renamed the agency that supports individuals with disabilities. Governor Maura Healey signed legislation that renames the Massachusetts Rehabilitation Commission to MassAbility, to reflect the administration’s focus on a more inclusive model for disability career services and independent living. The new name directly resulted from feedback from the disability community and was selected following significant research, focus groups, surveys, and conversations with the community, businesses, providers, and advocacy organizations.

Massachusetts Medicaid updated its estate recovery policy. Governor Healey signed into law an Act to Improve Quality and Oversight of Long-Term Care. The Act includes significant changes to MassHealth policies regarding estate recovery, limiting estate recovery to nursing home care and certain other long-term care costs required by the federal government. The Act also removes estate recovery for people with disabilities receiving assistance under MassHealth’s CommonHealth program. To assist state officials in evaluating their estate recovery policies, SHVS published a toolkit states can use to identify where they may have flexibility to make the policies more equitable and less burdensome for affected low-income families. 

Michigan is creating Healthy Community Zones to address racial inequities. The Michigan Department of Health and Human Services announced it will be awarding $9.1 million to organizations to develop Healthy Community Zones in Chippewa and Saginaw counties and the City of Detroit. Healthy Community Zones aim to address racial disparities in health outcomes by supporting communities in implementing community-led initiatives in the focus areas of food security; built environments where people live, work, learn and play; healthy children and youth; and social cohesion. 

New York proposed a rule to improve data collection to address health equity. The New York State Department of Financial Services (DFS) announced a proposed regulation that would require health insurers to include questions about a policyholder’s race, ethnicity, preferred language, sexual orientation and gender identity. Policyholders would have the option to provide this information through a questionnaire administered separately from the application for coverage process. Consistent with best practices in demographic data collection, the proposed regulation promotes the collection of self-reported data while ensuring consumer responses to questions are optional. The demographic data will aid DFS and insurers in identifying and addressing systemic health inequities. SHVS has published issue briefs on the collection of sexual orientation and gender identity data, disability data, and race, ethnicity and language data in Medicaid. For information on the Office of Management and Budget’s recent revisions to the federal standards for race and ethnicity data collection and the implications for health equity, see the SHVS webinar here.

North Carolina published a report assessing health inequities in the state. The North Carolina Department of Health and Human Services published the 2024 Health Disparities Analysis Report. The report offers a comprehensive view of the effects of health disparities on health outcomes across North Carolina and highlights opportunities for improvement and action.

Marketplace Innovations

Colorado received $361 million in pass-through funding for its section 1332 waiver. The U.S. Department of Health and Human Services and the Department of Treasury announced that the Colorado Division of Insurance received $361 million in pass-through funding for its reinsurance and Colorado Option programs under section 1332 of the Affordable Care Act. The funding is an increase from the $245 million the state received in pass-through in 2023.

Illinois received approval to transition to a State-Based Marketplace on the Federal Platform. CMS granted approval to Illinois to operate as a State-Based Marketplace on the Federal Platform for the plan year 2025 open enrollment period.

New York received $10 billion in pass-through funding for its section 1332 waiver. Governor Kathy Hochul announced that the state received $10 billion in pass-through funding from the federal government for the state’s section 1332 waiver program, the Essential Plan. As a reminder, SHVS published a state spotlight highlighting New York’s novel use of section 1332 waiver authority to provide coverage for low-income residents up to 250% of the poverty level, including Deferred Action for Childhood Arrivals recipients, with no premiums and minimal cost-sharing requirements.

Maternal Health

Arkansas published a report of strategies for improving maternal health in the state. The Strategic Committee for Maternal Health published a report outlining recommended new policies, programs, and approaches aimed at improving health outcomes for pregnant people, new parents, and babies. Stakeholders representing organizations across the state informed the recommendations contained in the report, with focus areas on data, reporting and technology; education and outreach; clinical and practice improvements; and healthcare access and Medicaid.

Massachusetts signed comprehensive legislation to improve maternal health. Governor Maura Healey signed legislation to expand physical and mental healthcare for pregnant individuals. The legislation will require MassHealth to cover doula services up to 12 months postpartum; mandates coverage for postpartum depression screenings; creates a new grant program to address mental and behavioral health or substance-use disorders for perinatal individuals; and establishes a task force to report on maternal health access and birthing safety, among other initiatives.

For information on how states can leverage payment to improve maternal health outcomes, see the SHVS issue brief Maternal Health Providers: Enhancing Health Equity Through Payment Parity.

Medical Debt

California is prohibiting the reporting of medical debt to consumer reporting agencies. Governor Gavin Newsom signed into law a bill that bans the inclusion of medical debt in consumer reports. The bill also prohibits using any medical debt listed on a credit report as a negative factor when making credit decisions, and gives individuals more room to address their medical bills before debt collection and reporting actions can take place.

The District of Columbia is relieving $42 million in medical debt. The District of Columbia is canceling nearly $42 million in medical debt for over 62,500 residents. Approximately $26 million of the total debt relief will go to 36,000 residents who make $25,000 or less per year, and 80% of the recipients live in D.C. ZIP codes that are majority Black or Latino/a. The initiative leverages year-end surplus funds from the fiscal year 2023 budget, of which the District appropriated $900,000 to partner with a non-profit organization for this work. 

For more information on state efforts to prohibit medical debt reporting and eliminate existing debt, see the SHVS expert perspective Mapping State Efforts to Address Medical Debt and a recent Health Affairs Forefront article which examines the burgeoning trend of state efforts to cancel medical debt for just pennies on the dollar.

Mental and Behavioral Health

California unveiled new accountability tools to track progress on the state’s mental health and substance-use initiatives. Governor Gavin Newsom announced updates to mentalhealth.ca.gov to track progress on the implementation of Proposition 1 and other initiatives. The website now features visual thermometers that will be updated to show how many treatment slots are being built for outpatient visits, residential beds for inpatient treatment, permanent supportive housing units, and housing units for veterans. The website also features new maps that show which counties have started Community Assistance, Recovery and Empowerment Court, a program aimed at helping Californians with psychosis and schizophrenia.

Michigan is establishing Adult Crisis Stabilization Units. The Michigan Department of Health and Human Services  is partnering with 10 agencies across the state to create Adult Crisis Stabilization Units (CSUs). A $32 million investment to establish CSUs was included in the state’s fiscal year 2023 budget. Adult CSUs provide immediate crisis support to anyone in a behavioral health crisis for up to 72 hours. These units will also be equipped to manage and treat minor medical conditions so that individuals in a behavioral health crisis aren’t sent to the emergency room for basic medical care.

Montana is supporting the health workforce to improve the behavioral health services system. Governor Greg Gianforte announced a $4 million investment to support startup costs for any Montana institution of higher education launching Physician Assistant and Occupational Therapy doctorate programs. The investment represents the next allocation of $300 million in funding secured by the governor last year to reform and improve Montana’s behavioral health and developmental disabilities services systems.

New Jersey is making naloxone available across school districts. Department of Human Services Commissioner Sarah Adelman and Department of Education Acting Commissioner Kevin Dehmer announced that all New Jersey school districts can now obtain naloxone at no cost through the Naloxone DIRECT program. 

New York awarded funding to support youth struggling with complex mental health issues. Governor Kathy Hochul announced awards amounting to nearly $90 million over five years to establish services that provide critical support to youth struggling with complex mental health issues. Administered by the Office of Mental Health, the critical time transition program will serve youth between the ages of 11 and 17 to help them utilize one-on-one support, provide stability for the child and their family, and help the child avoid extended stays in emergency departments or psychiatric emergency programs.

North Carolina published a report on improving behavioral health and received federal funding to expand services in rural North Carolina. The North Carolina Department of Health and Human Services announced the release of a new report, Transforming North Carolina’s Behavioral Health System: Investing in a System That Delivers Whole-Person Care When and Where People Need It. The report outlines the state’s efforts to transform the public behavioral health system to deliver high-quality, equitable, accessible care that meets people where they are in their communities. Additionally, the Health Resources and Services Administration announced nearly $9 million to support healthcare services in rural North Carolina. The funding will launch new opioid treatment and recovery services in rural communities.

Preventing Gun Violence

California is strengthening gun safety laws. Governor Newsom signed into law a bipartisan legislative package to bolster California’s gun safety laws. The package includes new measures to safeguard victims of domestic violence by providing training and tools for child welfare caseworkers and law enforcement officers to determine whether perpetrators have access to guns as well as strengthening safe storage requirements.

Pennsylvania will award grants to combat gun violence. The Shapiro-Davis administration announced $56.5 million in grant funding to combat gun violence and create more afterschool and out-of-school opportunities for kids. The funding comes after Governor Shaprio signed an executive order re-establishing the Office of Gun Violence Prevention.

For more information on gun violence prevention, check out this episode of the Princeton Pulse which discusses a public health approach focused on firearm safety and injury prevention.

Reproductive and Women’s Health

California is expanding access to coverage for IVF. Governor Gavin Newsom announced he has signed SB 729 which requires large group healthcare service plan contracts and disability insurance policies to provide coverage for the diagnosis and treatment of infertility and fertility service, including in vitro fertilization (IVF).

Pennsylvania expanded access to menstrual products. The Shapiro Administration announced that all school districts, career and technical centers, and charter schools will receive funding to provide free period products to students. 

Services for Children and Youth

California is investing $56 million in early childhood mental health services. The Department of Health Care Services awarded $56 million to expand early childhood mental health and wellness services. The 54 organizations awarded funding will expand access to early childhood mental health and wellness services, including services focused on prevention, early intervention, and resiliency/recovery for children and youth, with a specific focus on children and youth who are from the following groups: Black, Indigenous, and people of color and the LGBTQIA+ community.

Kentucky is protecting LGBTQIA+ youth. Governor Andy Beshear signed an executive order officially banning the practice of conversion therapy on minors in the state. The executive order makes it illegal to use state or federal funds to subject minors to conversion therapy and gives licensing boards the authority to take disciplinary action against licensees found to have practiced conversion therapy on minors.

New Jersey is expanding its universal home visiting initiative. As part of the state’s effort to expand Family Connects NJ, the state’s universal nurse home visitation program, the Department of Children and Families has awarded contracts to two partner agencies to make free visits from a nurse available to every family with a newborn, as well as families that have experienced the tragedy of stillbirth or neonatal loss, in an additional six counties. 

Waiver and State Plan Amendments, Requests and Approvals

Mississippi received approval for an extension of its section 1115 demonstration. CMS approved a five-year extension of Mississippi’s “Healthier Mississippi” section 1115 demonstration. The demonstration covers individuals who are aged, blind, and disabled with income at or below 135% of the federal poverty level who are not eligible for Medicare and are not eligible under the Medicaid state plan. 

Montana received approval to continue implementation of its reinsurance program. The Department of Health and Human Services approved Montana’s application to extend its section 1332 state innovation waiver to operate the state reinsurance program for an additional five years through December 31, 2029. For more information on state reinsurance programs and considerations for policymakers, see this SHVS expert perspective.

New Hampshire received approval to provide mobile crisis services. CMS approved a state plan amendment (SPA) for mobile crisis services in New Hampshire. This is the 20th mobile crisis SPA approved. As a reminder, SHVS published an expert perspective on the enhanced payment available through the American Rescue Plan Act for community-based mobile crisis services. 

New York received approval to expand cost-sharing subsidies to Marketplace enrollees. New York State of Health, the state’s official health insurance Marketplace, announced CMS approval of an amendment to the state’s section 1332 waiver. The amendment provides cost-sharing subsidies for enrollees with diabetes, who are pregnant or in their 12-month postpartum period, and all individuals and families with incomes up to 400% of the federal poverty level.