Targeted Options for Increasing Medicaid Payments to Providers During COVID-19 Crisis

The COVID-19 pandemic has caused dramatic changes in utilization that threaten the financial stability of providers and may jeopardize access to care during and after the national emergency. With elective cases generally cancelled, hospitals have sharply lower utilization and revenue. Between March and August 2020, a combination of lost revenue related to fewer elective procedures and emergency department/outpatient encounters, and higher costs related to COVID-19 has put many hospitals in a precarious financial position. In addition, many other providers that rely on face-to-face visits have seen large utilization declines due to social distancing requirements: as of July 2020, outpatient visits remain 10 percent below the pre-COVID-19 baseline, even after accounting for the increased use of telemedicine. Most of the Provider Relief Fund dollars have been distributed, yet providers are still experiencing lost revenue and increased costs related to COVID-19. Under any scenario, Medicaid payment strategies—especially for providers serving high numbers of Medicaid patients—remain a critical tool for states to support providers as new COVID-19 hotspots emerge and utilization patterns change.

Analyzing the Fiscal Impact of COVID-19, the Economic Downturn, and Recent Policy Changes: 50-State Databook

As states and Medicaid programs face significant fiscal uncertainty as a result of the COVID-19 public health crisis, the Databook provides projected changes in federal and state Medicaid and CHIP expenditures during calendar years 2020 and 2021 across all fifty states and the District of Columbia for a given scenario and policy response. Taken together, the Databook provides estimates that span across a range of plausible scenarios reflecting increased enrollment and per enrollee spending growth and changes to the duration of the federal Public Health Emergency.

Pathways to Coverage for COVID-19 Testing and Treatment for Adults in Medicaid Expansion and Non- Expansion States

The Pathways to Coverage for COVID-19 Testing and Treatment for Adults toolkit provides an overview for states of various coverage pathways for individuals, including those who are uninsured, in need of COVID-19 testing and treatment. The toolkit provides varying pathways for Medicaid expansion and non-expansion states.

Medicaid COVID-19 Messaging

A toolkit of messages for Medicaid agency staff to outreach to new consumers and current enrollees in light of COVID-19.

Application Template for Section 1332 Reinsurance Waiver

UPDATED 2/19/2019–State Health and Value Strategies, in partnership with health tax expert Jason Levitis, has created a template to help states develop an application for a state innovation waiver under the Affordable Care Act (ACA) section 1332 to implement a state reinsurance program.  Section 1332 gives states flexibility to waive certain ACA provisions and receive federal funding to implement state-based health care policies.  Reinsurance programs are a proven method of reducing premiums and promoting competition and market stability. This template seeks to make application development as simple as possible by adapting language from the successful Oregon application and indicating where elements need to be filled in or otherwise customized.

Messaging to Help Consumers Navigate Skinny Health Plans: A Toolkit for Marketplace Communicators

Recent federal rules on Short-Term Limited-Duration Insurance and Association Health Plans mean that some insurers may now offer products that don’t adhere to previous Affordable Care Act (ACA) requirements.

As “skinny” plans are increasingly marketed and sold across the country, it’s important for Marketplaces and Departments of Insurance to provide consumers with the information they need to make good decisions when buying health insurance. This toolkit contains a variety of communications resources designed to support Marketplaces, state agencies and other partners in these public education efforts.

Value-based Purchasing for Managed Care Procurements: A Toolkit for State Medicaid Agencies

Value Based Purchasing for Managed Care Procurement: A Toolkit for State Medicaid Agencies is designed to assist states interested in implementing value-based purchasing (VBP) approaches with their Medicaid managed care organizations (MCOs). Using a VBP approach can mean significant and ongoing changes for a state Medicaid agency and its MCOs. The Toolkit is designed to guide Medicaid agencies through key action steps and considerations in four phases of the managed care procurement cycle – 1) strategic procurement planning, 2) solicitation development, 3) bidder selection, and 4) contract management.

Future of the Children’s Health Insurance Program: Considerations for States

The expiration of Children’s Health Insurance Program (CHIP) funding on September 30, 2017 raises four critical issues for states: 1) the timing of reauthorization, and what the level of allotment and duration of any extension will be, 2) whether the 23 percent increase to federal matching funds will continue, 3) whether maintenance of effort (MOE) requirements will continue unchanged, and 4) operational considerations for states, including notices to members and budget planning.

Future of the Children’s Health Insurance Program: Considerations for States

The expiration of Children’s Health Insurance Program (CHIP) funding on September 30, 2017 raises four critical issues for states: 1) the timing of reauthorization, and what the level of allotment and duration of any extension will be, 2) whether the 23 percent increase to federal matching funds will continue, 3) whether maintenance of effort (MOE) requirements will continue unchanged, and 4) operational considerations for states, including notices to members and budget planning.