Policy alerts, briefs, letters & papers

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.

This new KFF brief finds that only 45% of all nursing facility residents and 22% of staff are up to date with their COVID-19 vaccinations. That is a sharp drop from the 87 percent of nursing facility residents and staff who completed their primary vaccination series. The U.S. Centers for Disease Control and Prevention (CDC) currently defines having up to date vaccines as “having received a bivalent booster or having received a final shot of the original vaccines less than two months ago.” The share of residents who are up to date ranged from 73 percent in South Dakota to 24 percent in Arizona. Among nursing home staff, the share ranged from 48 percent in California to 10 percent in Alabama.

This new KFF brief finds that only 45% of all nursing facility residents and 22% of staff are up to date with their COVID-19 vaccinations. That is a sharp drop from the 87 percent of nursing facility residents and staff who completed their primary vaccination series. The U.S. Centers for Disease Control and Prevention (CDC) currently defines having up to date vaccines as “having received a bivalent booster or having received a final shot of the original vaccines less than two months ago.” The share of residents who are up to date ranged from 73 percent in South Dakota to 24 percent in Arizona. Among nursing home staff, the share ranged from 48 percent in California to 10 percent in Alabama.

This blog post reviews considerations to strengthen provider networks in California to ensure that older adults and people with disabilities receive services that meet their needs. The post focuses on strategies for partnering with three key provider types: (1) community-based organizations; (2) institutional long-term care facilities; and (3) Medicare providers. Lessons from California can help inform other states and Medicaid managed care organizations across the country.

This brief highlights Part D plan (PDP) availability. In 2023, the average number of PDPs available to beneficiaries is 24, up one from 2022. A total of 801 PDPs will be offered in the U.S., ranging from 19 in New York to 28 in Arizona.