Health Policy News April

Health Policy News’ April edition focuses on a timely issue in health policy- state efforts to eliminate gaps in care for those leaving incarceration, with a focus on a recently approved Section 1115 Medicaid Waiver in California.

As you may have seen, the final Notice of Benefit and Payment Parameters for 2024 was released last week. Among key Exchange and Qualified Health Plan policies finalized are: a new special enrollment period aimed specifically at those losing coverage under Medicaid and the Children’s Health Insurance Program, a requirement for all Qualified Health Plans and most Stand-Alone Dental Plans to comply with network adequacy and Essential Community Provider (ECP) requirements, the introduction of two new ECP categories related to behavioral health (Substance Use Disorder Treatment Centers and Mental Health Facilities), and a limitation on non-standardized plan offerings. As of publication, the final Letter to Issuers in the FFM is yet to be released. HPN subject-matter experts are reviewing the final regulations and we will feature a few updates in our May edition.

California’s Section 1115 Re-Entry Demonstration Waiver: An Indicator for States 

In January 2023, the Centers for Medicare and Medicaid Services (CMS) approved California’s Section 1115 Re-Entry Demonstration Waiver, the first waiver of its kind to receive approval from the agency. The waiver addresses the federal Medicaid Inmate Exclusion Policy, under which states are prohibited from using Medicaid dollars to provide health care services to individuals who are incarcerated even if they would otherwise meet Medicaid eligibility requirements. In practice, states enforce this rule by terminating or suspending Medicaid coverage while individuals are incarcerated and until they reenter their communities. For more on California’s waiver and similar efforts across the nation, click here.

Also, keep an eye out for an upcoming HPN post on a recent CMS State Medicaid Director Letter on these sorts of Demonstration Waivers.

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