YEAR-END REPORT - 2021 Published 20-Dec-2021 HPTS Issue Brief 12-20-21.2 Health Policy Tracking Service - Issue Briefs Access to Health Insurance State Children's Health Insurance Program (SCHIP) This Issue Brief was written by a contributing writer. 12/20/2021 Introduction The Medicaid and CHIP Payment and Access Commission (MACPAC) released statistics showing that enrollment in Medicaid and the Children's Health Insurance Program (CHIP) increased by approximately 5.6 percent from July 2019 to July 2020. The federal government approved a plan for the North Carolina Department of Health and Human Services to use Medicaid funding for an evidence-based early childhood program, Reach Out and Read. The Centers for Medicare & Medicaid Services (CMS) issued guidance to state health officials addressing strategies using social determinants of health (SDOH) in Medicaid and the Children's Health Insurance Program (CHIP) to improve the programs. Pennsylvania Department of Human Services (DHS) Secretary Teresa Miller announced enrollment numbers for Medicaid and reminded residents of social safety net programs in the state offering assistance for food and access to health care, including the Children's Health Insurance Program (CHIP). Spending related to the COVID-19 pandemic led to proposed amendments to the Virginia 2020-22 biennial budget while emergency increases in federal money for Medicaid and the Children's Health Insurance Program (CHIP) offset some of those expenses. The Centers for Medicare and Medicaid Services (CMS) recently released guidance for the implementation of value-based payment models for Medicaid and CHIP that address social determinants of health and related costs to the programs. Representative Joaquin Castro, D-Texas, and 93 House Members encouraged President Biden to expand ACA benefits to for Deferred Action for Childhood Arrivals (DACA) recipients, allowing them to access health insurance through federal programs such as the Children's Health Insurance Program (CHIP). Legislation pending in Georgia would automatically enroll children eligible for food stamps in Georgia's Medicaid program. Pending legislation in Utah is focused on increasing enrollment of eligible children in Medicaid and the Children's Health Insurance Program (CHIP). The Utah Senate passed a bill that would significantly expand access to health insurance to children in the state. According to a recent report, the expansion of Medicaid under the Affordable Care Act, which was aimed at increasing access to insurance coverage for uninsured adults who could not afford private health insurance, also helped children to gain access to health insurance coverage. The Organized Dentistry Coalition expressed its support of pending legislation that would extend coverage under the Children's Health Insurance Program (CHIP) to dental care for children and low-income pregnant women. New Jersey Governor Phil Murphy announced a new proposal that would allocate $20 million to pay for children's health insurance for children of unemployed people. Illinois is the first state to extend coverage eligibility for Medicaid to women for one year after giving birth. In Montana, legislation that would have made the state health department review more data when determining eligibility for public assistance programs and would have eliminated continuous eligibility for Medicaid expansion was shelved after a vote in a house committee meeting. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -1- According to a recent analysis by the Kaiser Family Foundation, Medicaid and Children's Health Insurance Program (CHIP) enrollment have increased through November 2020, when compared with declines in enrollment from 2017 through 2019. Rep. Rachel Talbot Ross, D-Portland introduced a bill to that would advance health equity in Maine. The proposed legislation would close gaps in MaineCare and the Children's Health Insurance Program (CHIP). Five new members were appointed recently to the Medicaid and CHIP Payment and Access Commission (MACPAC). The Commission's Chair and Vice Chare were also named and two members were reappointed. The Health Equity and Access under Law (HEAL) for Immigrant Families Act was introduced in both the United States House and the United States Senate. It would extend eligibility to Medicaid and the Children's Health Insurance Program (CHIP) to lawfully present immigrants. The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced that $14.2 million in federal funding under the American Rescue Plan (ARP) would go toward expanding pediatric mental health care access. The Centers for Medicare & Medicaid Services (CMS) released a comprehensive overview of the impact of the COVID-19 Public Health Emergency (PHE) on Medicaid and CHIP beneficiaries. The Centers for Medicare & Medicaid Services (CMS) released data showing that a record number of people had enrolled in coverage through Medicaid and the Children's Health Insurance Program (CHIP) between February 2020 and January 2021. Medical professional and advocacy organizations in Idaho are in favor of the Idaho Kids Covered campaign, aimed at 100% health insurance coverage for children living in the state. Geisinger Health Plan (GHP) expanded its Children's Health Insurance Program (CHIP) coverage to eight additional counties in Pennsylvania. The Maryland Department of Health (MDH) and Governor Larry Hogan announced the launch of a maternal and child healthcare transformation initiative. Health Affairs recently published a study showing that noncitizen children faced an increased risk of health harms due to limited access to health insurance coverage and health care access when compared to their citizen siblings. The Kaiser Family Foundation recently analyzed data regarding the trends in Medicaid and Children's Health Insurance Program (CHIP) enrollment nationwide. The Get Kids Covered Campaign began in Pennsylvania, led by local health advocates in Luzerne County, including United Way of Wyoming Valley, Family Service Association of Northeastern Pennsylvania, and Maternal and Family Health Services. Over five hundred organizations including the American Dental Association wrote a letter to Congress in support of legislation that would make the Children's Health Insurance Program (CHIP) permanent. According to a recent report, the number of children without health insurance in the United States increased in 2020 for the fourth consecutive year. The Centers for Medicare & Medicaid Services (CMS) announced that the Biden-Harris Administration is issuing guidance for states regarding COVID-19 vaccination and testing for people covered under Medicaid and the Children's Health Insurance Program (CHIP). North Carolina Governor Roy Cooper issued an executive order extending deadlines for health assessment documentation and vaccination of children for school and child-care facilities. CareSource announced that it will submit a proposal to serve Iowa residents covered through Medicaid and the Children's Health Insurance Program (CHIP). The Biden administration announced the release of a new resource from the Department of Education aimed at increasing access to mental health care for children. According to a recent study by the Urban Institute, almost one million uninsured children and their parents would gain health insurance coverage if the subsidies under the American Rescue Plan (ARP) became permanent. The Colorado Department of Human Services, Office of Behavioral Health (OHB) and its partners created a program to provide free limited mental health services for children living in the state. The Centers for Medicare & Medicaid Services (CMS) reminded eligible consumers that the COVID-19 vaccine is available at no cost- sharing through Medicaid and the Children's Health Insurance Program (CHIP). Medicaid Initiative to Benefit CHIP Recipients The federal government approved a plan for the North Carolina Department of Health and Human Services to use Medicaid funding for an evidence-based early childhood program, Reach Out and Read. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -2- The focus of the program is on children from low-income families qualifying for Medicaid and the Children's Health Insurance Program (CHIP). According to researchers, children participating in the program have improved literacy and language comprehension. Clinics participating in the program have better relationships between clinicians and patients. Participants also have better attendance for well-child visits. The partnership with Medicaid and Reach Out and Read is one of the first in the country for similar programs. Under the Centers for Medicare & Medicaid Services' Health Services Initiative, states can use federal matching funds for an initiative that improves children's health, particularly the health of low-income children eligible for Medicaid or CHIP. 'Expanding Reach Out and Read recognizes that children's healthy development and early literacy are intertwined,' said NCDHHS Secretary Mandy K. Cohen, M.D. ‘This program meets families where they are and through people they trust.’ The program joins with pediatric primary care locations. It trains medical providers and gives families access to literacy tools. The program encourages healthy routines and relationships through shared stories. Children and families receive a ‘prescription for reading” at every well-child visit. Developmentally appropriate books are provided for each child's home library. Medical providers give families guidance on building resilience and preparing for a healthy development. 'We are proud to work with partners across the state to expand Reach Out and Read in North Carolina,” said Dave Richard, Deputy Secretary for NC Medicaid. ‘We believe this initiative will help strengthen relationships between providers and patients, while improving both health and learning.” The approval will unlock up to $3,013,000 in Medicaid federal matching funds for the program for the next two years. The new initiatives focus on four goals: -Extend Reach Out and Read to begin at birth: Evidence has shown that reading to babies starting at birth improves brain development, and this initiative would provide training to medical providers to begin providing books and literacy tools at birth. -Expand Reach Out and Read to all counties in the state: Reach Out and Read currently operates in 90 counties across North Carolina. These funds will allow Reach Out and Read to establish the intervention in counties where it is not currently available and expand its footprint in counties with limited participation. -Quality improvement: Funds will be used to improve program quality and deepen the impact of participating locations across the state. -Research: To build more evidence of Reach Out and Read's impact, funds will be available to help providers perform research and further professional development. Governor Roy Cooper began the NC Early Childhood Action Plan in February 2019. Over 1,500 North Carolina residents provided input for the program. The program has a framework to measurably improve outcomes for children in the state by 2025. [FN2] The program aims to move ‘the state toward a vision where young children are healthier, safer and thriving.” CHIP Enrollment Increased The Medicaid and CHIP Payment and Access Commission (MACPAC) released statistics showing that enrollment in Medicaid and the Children's Health Insurance Program (CHIP) increased by approximately 5.6 percent from July 2019 to July 2020. The commission pointed to the economic downturn caused by the COVID-19 pandemic as a reason for the increase. Enrollment in the programs increased in every state except for the District of Columbia and Montana. Increases ranged from 0.2 percent in South Carolina to 30.2 percent in Idaho. Idaho adopted Medicaid expansion during that time. MACPAC publishes an annual report, MACStats, that gathers several Medicaid and CHIP statistics, such as eligibility, enrollment, benefits, use of services, access to care, and state and federal spending on the programs. This edition of MACStats utilizes data from the Transformed Medicaid Statistical Information System (T-MSIS), a collection of more recent data and information than available for prior editions. All states now use T-MSIS, improving the timeliness, reliability, and complete nature of the data. Increases in enrollment in Medicaid and CHIP did not cause the spending on the programs to overtake the spending on Medicare or private insurance. Medicaid and CHIP accounted for 9.2 percent of the federal budget, while Medicare accounted for 14.5 percent for fiscal year 2019. 'The COVID-19 pandemic and related unemployment have major implications for Medicaid and CHIP. This publication provides invaluable insights at a critical time for federal and state policymakers, researchers, and anyone who wants to fully understand what's happening with the health care of the more than one-quarter of the U.S. population who are covered by Medicaid or CHIP,” said [FN3] MACPAC Chair Melanie Bella. COVID-19, Federal CHIP Funding Affect Virginia Budget © 2022 Thomson Reuters. No claim to original U.S. Government Works. -3- Spending related to the COVID-19 pandemic led to proposed amendments to the Virginia 2020-22 biennial budget while emergency increases in federal money for Medicaid and the Children's Health Insurance Program (CHIP) offset some of those expenses. The budget is an increase over the 2020 Acts of Assembly, Special Session 1 HB 5005 for 2021 and 2022. The amendments are HB 1800 and SB 1100. Changes include base forecast increases of $1.3 billion and spending reductions of $43 million. Under the proposed budget, Health and Human Resources would receive $177.1 million for discretionary spending. Sixty-seven percent of the spending is related to the pandemic. Major savings from the Department of Medical Services (DMAS) is due to increased emergency funds from the federal government for Medicaid and CHIP. The Medicaid anticipated spending is $245.3 million less than expected because of enhanced federal matching savings during the state of emergency. An additional $59.1 million was available from the Department of Medical Assistance Service's health care fund revenue and cash balance. Virginia will save $14.6 million from the DMAS' Children's Health Insurance Programs. The state gained $208.9 million in savings from the increased federal match rate for Medicaid of 6.2 percent due to the Families First [FN4] Coronavirus Response Act. The act granted enhanced federal Medicaid funds for each quarter of the federal health emergency. Pennsylvania Announces Enrollment Numbers, Reminds Residents of Assistance Programs Pennsylvania Department of Human Services (DHS) Secretary Teresa Miller announced enrollment numbers for Medicaid and reminded residents of social safety net programs in the state offering assistance for food and access to health care, including the Children's Health Insurance Program (CHIP). 'We all deserve the dignity of having those most essential needs met, especially when we fall on hard times. That's why DHS is here, regardless of the pandemic, to make sure you can get through times like these,” said DHS Secretary Teresa Miller. ‘Our public assistance network can be a lifeline that makes sure people can go to the doctor, have enough to eat, or pay their utilities as other bills and needs arise. This network exists to help you through any change in your circumstances, whether it's a loss of employment or a reduction in income. No one should feel like they have to endure this period and its stress, anxiety, and uncertainty alone. If you or someone you know could use a hand, please let us try to help.” Enrollment in Pennsylvania for Medicaid increased by 300,076 people since February 2020. In November, enrollment has increased by 10.6 percent to 3,131,639. According to DHS, ‘Pennsylvanians who have lost health coverage or are currently uninsured and need coverage for themselves or their children may qualify for coverage through Medicaid or the Children's Health Insurance Program (CHIP). Medicaid and CHIP provide coverage for routine and emergency health services, tests and screenings, and prescriptions, and COVID-19 testing and treatment are covered by Medicaid and CHIP. Medicaid and CHIP enroll individuals throughout the year and do not have a limited or special enrollment time, so people needing health coverage can apply for these programs at any time. There are income limits for Medicaid, but all children qualify for comprehensive health, vision, and dental coverage through CHIP regardless of their parents' [FN5] income. Children who are not income eligible for Medicaid are automatically referred to CHIP for coverage.“ CMS Releases Guidance for States Using Social Determinants of Health for Medicaid, CHIP The Centers for Medicare & Medicaid Services (CMS) issued guidance to state health officials addressing strategies using social determinants of health (SDOH) in Medicaid and the Children's Health Insurance Program (CHIP) to improve the programs. The strategy aims to improve health outcomes, reduce health disparities, and decrease overall costs for Medicaid and CHIP. According to CMS, ‘The new guidance describes how states can leverage existing flexibilities under federal law to tackle adverse health outcomes that can be impacted by SDOH and supports states with designing programs, benefits, and services that can more effectively improve population health and reduce the cost of caring for our nation's most vulnerable and high-risk populations.” CMS indicated that it is committed to accelerating the health care industry shift away from traditional fee-for-service payment models to value-based payment models holding clinicians accountable for cost and quality of care. 'The evidence is clear: social determinants of health, such as access to stable housing or gainful employment, may not be strictly medical, but they nevertheless have a profound impact on people's wellbeing,” said CMS Administrator Seema Verma. ‘Unfortunately, our fee-for-service system inherently limits the doctor-patient relationship to what can be accomplished inside the four walls of a clinician's office. Today's letter to state health officials highlights strategies by which states can promote a value-based system that fosters treatment of the whole person and lowers healthcare costs. Patients are more than a bundle of medical diagnoses, and it's time our healthcare system treated them as such.” The agency favors states' efforts to realign incentives, decrease costs, and advance value-based care throughout the United States [FN6] health care system. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -4- House Members Urge President Biden to Allow DACA Recipients to Access Healthcare Representative Joaquin Castro, D-Texas, and 93 House Members encouraged President Biden to expand ACA benefits to for Deferred Action for Childhood Arrivals (DACA) recipients, allowing them to access health insurance through federal programs such as the Children's Health Insurance Program (CHIP). The letter to President Biden and the Acting Secretary of Health and Human Services (HHS) requested that HHS repeal the rule that excludes DACA recipients from eligibility for many federal programs. 'There are over 200,000 DACA recipients who are currently working as essential workers on the frontline of the pandemic, but who remain excluded from the most basic of health care protections under the Affordable Care Act”, said Congressman Joaquin Castro. ‘In the midst of a deadly pandemic, we need to do everything possible to extend health care for all. I am proud that this letter gathered such strong support in the House of Representatives, and I look forward to working with the Biden-Harris administration to build on the ACA and expand health care coverage.” In the letter, Castro asked that HHS grant access to benefits under the ACA for DACA recipients, particularly considering the ongoing COVID-19 crisis. Many DACA recipients are essential workers at risk of infection. Castro specifically asked that HHS repeal 45 C.F.R. ? 152.2(8), which excludes DACA recipients from the definition of ‘lawfully present” and, consequently from benefits under the ACA. DACA recipients are treated as lawfully present for other federal programs. According to Castro, ‘Fixing this incongruity within the first 100 days of the administration is critical as any additional delay in health care access during the COVID-19 pandemic puts the health of DACA recipients, their families, and the wider community at risk. HHS should then follow up by issuing a State Health Officials letter clarifying their eligibility for Medicaid and CHIP. It is crucial that you both keep your commitment to expanding coverage for undocumented immigrants, including DACA recipients, and rescinding this harmful regulation will help deliver on that promise.” The current regulation and guidance prevent DACA recipients from being eligible for health insurance coverage under Medicaid or CHIP. DACA recipients are also barred from purchasing health insurance coverage through the ACA health insurance exchanges, even at full cost without subsidies. Castro wrote, ‘Making ACA coverage and financial assistance available to all persons granted deferred action, including DACA recipients would advance the goals of the ACA and benefit the American people. Under DACA, immigrant youth with long-term residency in the United States who satisfy a strict set of criminal background and educational criteria are eligible for employment authorization and protection from deportation. Rescission of 45 C.F.R. ? 152.2(8) would grant access to the ACA for the approximately 650,000 current DACA recipients and could ultimately benefit over a million individuals as the DACA program resumes. The regulation excludes a significant pool of young, healthy adults—the exact type of participants that Congress sought to encourage to secure and purchase health insurance under the ACA. Moreover, the regulation potentially leads to worse health outcomes for DACA recipients [FN7] and their families by foreclosing access to health care, including unsubsidized purchases on ACA health insurance marketplace.“ Innovative Payment Models Address Social Determinants of Health that Increase Costs for CHIP The Centers for Medicare and Medicaid Services (CMS) recently released guidance for the implementation of value-based payment models for Medicaid and CHIP that address social determinants of health and related costs to the programs. CMS indicated that these arrangements could help states decrease health disparities and improve health outcomes as well as reduce costs for the programs. Social determinants of health are environmental, social, and economic factors affecting health outcomes. The Centers for Disease Control and Prevention (CDC) points to working, living, and learning environments as significantly related to health risks and outcomes. Lack of resources linked to poor health outcomes can lead to increased costs for payers including Medicaid and CHIP. With the COVID-19 pandemic, these differences have become even more pronounced. According to data, places with higher poverty rates and crowded housing are more likely to be COVID-19 hotspots. One alternative managed care model, the Pay for Success model, includes the Green & Healthy Homes Initiative (GHHI) model. Money in this system is available to address asthma triggers in a beneficiary's home, leading to a decrease in a need for health services. A portion of the savings is spent on the service to the beneficiary's home. The categories of SDOH flexibilities in CMS's guidance document include housing, non-medical transportation, educational services, and employment. Federal money cannot directly cover housing costs for beneficiaries but can cover initiatives for community transitions for beneficiaries moving from homelessness to private housing, covering security deposits, essential household items, and utility activation. Funding can go toward care coordination, case management, non-medical transportation, home delivery of meals, home modifications, job-coaching services, and physical or occupational health services for children. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -5- The guidance does not change the actual regulations. Rather, it assists state officials in to identify ways to use funding under the [FN8] current Medicaid statute to address social determinants of health. Utah Legislation Aims to Enroll More Children in Coverage Pending legislation in Utah is focused on increasing enrollment of eligible children in Medicaid and the Children's Health Insurance Program (CHIP). Senate Minority Whip Luz Escamilla, D-Salt Lake City introduced the legislation to address the increasing number of children without health insurance coverage in Utah. Currently, 87,000 children are uninsured. 'We are a state that deeply cares for kids,” SB158 sponsor Senator Luz Escamilla indicated during a virtual news conference including lawmakers and the nonprofit group Voices for Utah Children. She noted, ‘we have one of the highest rates of uninsurance when it comes to children.” Many children in Utah are eligible for Medicaid and CHIP whose families are unaware of the programs or their eligibility. Some families have trouble with the enrollment process. Escamilla emphasized that the COVID-19 pandemic has further highlighted the need for children to have healthcare coverage. A recent report by Georgetown University Center for Children and Families showed that the rate of uninsured children in Utah in 2019 was 5.7%. The pending legislation, SB158, would implement a Children's Coverage Outreach Pilot Program aimed at underserved populations. The program would also help people with applications, as well as create a media campaign to increase awareness of the coverage programs. The legislation would extend eligibility for the programs to families making up to 200% of the federal poverty level. The estimated cost of the bill is $5.2 million. Escamilla indicated that the investment would save costs in the future. Covered children are less likely to need expensive visits to the emergency room for preventable health issues. Teresa Sanchez of the nonprofit Utah Health Policy Project and Take Care Utah, indicated that her organization was interested in reversing the recent increases in the number of uninsured people in the state, particularly in the Latino community. She cited language barriers and lack of assistance as issues leading to children losing coverage. Another piece of pending legislation in Utah would promote publicly funded insurance for children. The bill, HB262, sponsored by Rep. Doug Welton, R-Payson, aims ‘to find out where the breakdown is and why kids are going uninsured. Why is it that we have these programs, but they're not able to connect to them and get involved in them?” The bill would cost $172,500 in ongoing funds. 'Kids without insurance, it really impacts them in all sorts of ways. And it's a short-term cost for a long-term investment in the hope of [FN9] Utah,” Welton said. Georgia Legislation Pending for Express Enrollment in Medicaid for Eligible Children Legislation pending in Georgia would automatically enroll children eligible for food stamps in Georgia's Medicaid program. Eligible children would not have to separately enroll for Medicaid coverage. The Georgia House of Representatives unanimously passed the legislation in February. House Bill 163 would allow for the automatic enrollment of children in Georgia's Medicaid program if they are from families eligible for food stamps. The bill would allow them to forgo the normal enrollment process for the program. 'For many families, this is difficult,” said state Rep. Sharon Cooper, R-Marietta, chairman of the House Health and Human Services Committee and the bill's chief sponsor. 'They don't have computers, they live in South Georgia where there's no internet, or don't have a car to go to the DFCS [Division of Family and Children Services] office,” Cooper continued. 'We have children today who are eligible for Medicaid but aren't getting it because of this glitch.” The so-called ‘express lane” bill would allow for an estimated 60,000 additional children in Georgia who are eligible for coverage under Medicaid to automatically enroll in the state and federal government program for health insurance. The nonprofit advocacy group Georgians for a Healthy Future collected data on the potential effect of the program. In addition to Rep. Sharon Cooper, R-Marietta, chairman of the House Health and Human Services Committee, Reps. Houston Gaines, R-Athens; Katie Dempsey, R-Rome; Spencer Frye, D-Athens; Eddie Lumsden, R-Armuchee, and Mesha Mainor, D-Atlanta also sponsored the bill. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -6- [FN10] The bill will move to the Georgia Senate for review. Children Benefit from Medicaid Expansion According to a recent report, the expansion of Medicaid under the Affordable Care Act, which was aimed at increasing access to insurance coverage for uninsured adults who could not afford private health insurance, also helped children to gain access to health insurance coverage. The Georgetown University Center for Children and Families released the report. Researchers found that children living in states that chose to expand Medicaid were almost two times as likely to have access to health insurance coverage than children living in states that rejected expansion. Researchers indicated that the findings showed a strong link between health insurance status of parents and their children. 'When parents gain Medicaid coverage, they are more likely to enroll their children in whole family health coverage,” said Adam Searing, research professor at Georgetown University and lead author of the report. ‘With many parents losing their jobs and their health insurance, those living in states that have not expanded Medicaid struggle to find affordable health coverage as the safety net is not there to catch them as it is in other states.” Parents who gain health insurance coverage under Medicaid are more likely to seek health insurance coverage for their children as well. They are more likely to take their children to the doctor and seek medical care for their children. Children living in states that chose not to expand Medicaid have been falling behind on health coverage when compared to children living in states that expanded Medicaid. The uninsured rate of children living in non-expansion states increased at almost three times the rate of children living in Medicaid expansion states from 2016 to 2019. Texas and Florida, both states that did not expand Medicaid, accounted for 41 percent of the coverage losses for children. 'Now is the time for states that have refused Medicaid expansion funding to reexamine that decision given the hardships children and families are facing due to the pandemic and related recession,” said Joan Alker, executive director of the Georgetown University Center for Children and Families. ‘Medicaid expansion will help families get back on their feet and provide parents with help to support their children's health, financial security, and developmental needs.” Researchers also noted that Medicaid expansion correlates with maternal and infant health improvements by increasing access to care [FN11] during pregnancy and before conception leading to a healthier beginning for babies. Utah Legislation Expanding Children's Insurance Coverage Passes Senate The Utah Senate passed a bill that would significantly expand access to health insurance to children in the state. The bill, Sen. Luz Escamilla's Children's Health Coverage Amendments, would remove restrictions on children's access to health coverage and would lead to a large expansion of eligibility for children in Utah for Medicaid and the Children's Health Insurance Program (CHIP). According to Escamilla, the legislation targets barriers to health insurance coverage for children. ‘Currently, in order for you to access Medicaid or CHIP, you have to be a U.S. citizen or a legal permanent resident. We know that there are many multiple statuses that you can be. The Utah way of dealing with this issue — we've done it since 2001 — is that we don't penalize children for decisions and actions that they have no control over. So we are mirroring that same policy with this bill.” Currently, the state is the 46th lowest in the country for health insurance coverage for children. Over 80,000 children in the state are uninsured. Utah also has the largest number of uninsured Latino and Hispanic children. Escamilla called the bill the most important piece of legislation she is sponsoring during this session. The legislation would create a Children's Coverage Outreach Pilot Program. It would undertake outreach programs aimed at underserved populations in the state to educate people about coverage opportunities. It would also assist families in applying for the coverage programs. Under the bill, the Utah Department of Health would fund an expansion of CHIP. Children in families earning at or below 200% of the Federal Poverty Level would be eligible for coverage through CHIP. The expansion and the outreach efforts would cost Utah $5.2 million. Some legislators, including the chair of the Senate Health and Human Services Committee Sen. Michael Kennedy, expressed concern over the cost. Kennedy was the sole committee member to vote against advancing the bill. Escamilla indicated that the bill will save the state money by leading to fewer emergency room visits for uninsured children in the state. More children receiving preventive health care will also save money, according to Escamilla. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -7- 'These are difficult times, and the care and access to care for children should not be a question because it's not their choice. These kids can't change what's happening to them at this point, and I think it just makes sense from an economic perspective to invest in preventive care versus emergency room care.” Supporters of the bill from the community include Voices for Utah Children, United Way of Salt Lake and the Utah Medical Association. [FN12] NJ Governor Proposes Program to Cover Uninsured Children New Jersey Governor Phil Murphy announced a new proposal that would allocate $20 million to pay for children's health insurance for children of unemployed people. The funds are part of the Fiscal Year 2022 budget proposal for Phase 1 of the Cover All Kids campaign. 'No child in New Jersey should be left without the support and security of health care coverage,” said Governor Murphy. ‘The proposed investment toward Cover All Kids in our budget continues the progress we've made toward advancing health care accessibility, while laying the foundation to ensure that more children are able to receive access to quality health care coverage that they deserve.” The Cover All Kids campaign will improve access to health coverage to almost 90,000 uninsured children living in New Jersey. 'As a daughter of immigrants and as someone who grew up with NJ FamilyCare coverage for most of my childhood, I could not be more thankful for the Governor's leadership here and excited about what this campaign will mean for the thousands of uninsured children in New Jersey,” said Shabnam Salih, Executive Director of the Office of Health Care Affordability and Transparency. ‘Through this work we will not only be ensuring better health care for these children, but removing a significant burden in their lives that will help ensure brighter and healthier futures.” Under Phase 1 of the Cover All Kids Campaign, nearly 53,000 children through Fy2022 will receive assistance to access coverage. The proposal will eliminate the 90-day waiting period for coverage to children newly enrolling in the Children's Health Insurance Program (CHIP). It will also eliminate premiums for families with children enrolled in CHIP. It would also create targeted outreach efforts to increase enrollment for currently eligible children who are not enrolled in CHIP. Under Phase 2 of the campaign, coverage options will become available to children of undocumented immigrants and children whose families earn too much to qualify for coverage through NJ FamilyCare. 'Governor Murphy's Cover All Kids initiative is precisely the kind of bold government action we need right now here in Passaic and across this state,” said Congressman Bill Pascrell, Jr. ‘Lack of health care during the pandemic has caused tragedy. Fortunately, our state's local and federal officials are united in our efforts to defeat this virus and strengthen your health care. Thanks to Governor Murphy's leadership and the additional federal resources we have delivered, the state has launched the Cover All Kids initiative to invest in coverage for the 88,000 children who lack health care. This comes on the heels of President Biden's massive American Rescue Plan we passed which makes health care more affordable, makes health services more accessible, and cuts child poverty rates in half. As we look to safely reopen schools and help families recover, we must prioritize the solutions that will keep our neighbors healthy.” 'There's nothing more important than having a kid have access to care. All those families that are here today understand what it means [FN13] when your kids are sick,' said Senator Joseph Vitale. Dental Coalition Supports Bill Extending CHIP Dental Coverage The Organized Dentistry Coalition expressed its support of pending legislation that would extend coverage under the Children's Health Insurance Program (CHIP) to dental care for children and low-income pregnant women. The organizations, along with the American Academy of Pediatric Dentistry, wrote a letter to Sens. Ben Cardin, D-Md., and Debbie Stabenow, D-Mich. thanking them for introducing S 448, the Ensuring Kids Have Access to Medically Necessary Dental Care Act. 'As you know, the Children's Health Insurance Program provides health coverage to nearly 10 million children nationwide, through both Medicaid and separate CHIP programs,” they wrote. If passed, the legislation would extend dental coverage under CHIP. It would eliminate annual and lifetime coverage limits for dental services provided under CHIP. The elimination of this coverage ceiling would apply to children and to low-income pregnant women. The bill would also require the same dental coverage for wraparound dental coverage under CHIP that CHIP enrollees receive. This provision would allow children who are covered for general health insurance otherwise, such as through an employer-sponsored plan or group health plan, to access dental coverage through CHIP. 'Our organizations strongly support this legislation and look forward to working with you to secure its passage,” the letter concluded. ‘Your ongoing leadership and championing of oral health issues, such as improving CHIP, is making a tremendous difference to [FN14] improve the nation's oral health.“ © 2022 Thomson Reuters. No claim to original U.S. Government Works. -8- 'Making sure kids have proper dental care is one of the most fundamentally important things we can do, yet too many children continue to fall through the cracks in our country. This new bill makes sure our safety net for pediatric dental health is both stronger and wider,” said Senator Cardin, a senior member of the Senate Finance Subcommittee on Health Care. ‘Time is of the essence when we're talking about ensuring that kids have access to good dental care, as quality care during childhood can have life-long implications. The changes advanced in our new legislation provide targeted improvements to known shortcomings in our system, and we must address them immediately.” 'Children need good dental care to grow up healthy and happy. But right now, that care is still out of reach for many families. Senator Cardin and I partnered together to make it easier for kids to get the care they need by improving dental coverage under the Children's [FN15] Health Insurance Program,” said Senator Stabenow. Montana Bill to Increase Enrollment Requirements for Public Assistance Programs Shelved In Montana, legislation that would have made the state health department review more data when determining eligibility for public assistance programs and would have eliminated continuous eligibility for Medicaid expansion was shelved after a vote in a house committee meeting. Sen. Cary Smith, R-Billings introduced Senate Bill 100. The legislation had received support from Republican lawmakers and opposition from Democrats. When the bill reached the House Human Services Committee, it was rejected by a 12-7 vote. Five Republicans joined with Democrats to vote against the bill. The Foundation for Government Accountability, a think tank that has worked on proposals for the same in other states, worked to support the legislation. Charlie Brereton, the health care policy adviser for Gov. Greg Gianforte; and the director of the state health department, also worked on the bill. Governor Gianforte, Republican, campaigned on supporting Montana's Medicaid expansion program but with increased checks on eligibility. Smith presented the legislation as a fight against fraud in government programs including Medicaid, Medicaid expansion, the Supplemental Nutrition Assistance Program, the Children's Health Insurance Program and the Temporary Assistance for Needy Families Program. The state health department would have had to verify information in various databases every six months. Information included other state's wage information, arrest and incarceration details, immigration status, public housing assistance payments, databases of substantial lottery winnings. Those opposing the bill asserted that it would lead to a denial of coverage to eligible individuals. A fiscal note predicted that 277 children would lose coverage due to the bill. A report from the George Washington University's Department of Health Policy and Management showed that approximately 22,000 people would lose Medicaid and Children's Health Insurance Program (CHIP) coverage every year due to the legislation. In Montana, about 102,000 children receive coverage through traditional Medicaid. An additional 21,300 receive coverage under CHIP. The legislation would have eliminated continuous eligibility for the state's Medicaid expansion program. Currently, people who qualify for coverage under Medicaid remain qualified for a year. Another bill that was also rejected recently by the Montana legislature would have ended continuous eligibility and would have made significant eligibility changes to CHIP. The legislation, from Rep. Jane Gillette, R-Bozeman, would have eliminated eligibility to CHIP for children in families where the parents are offered ‘affordable” insurance through their employment. The bill defined affordable as employers paying for 80% or more of the cost of premiums. It did not take the family's income level into [FN16] consideration. Illinois First State to Agree to Extend Coverage Eligibility for Postpartum Women Illinois is the first state to extend coverage eligibility for Medicaid to women for one year after giving birth. The Centers for Medicare & Medicaid Services approved the request for a 1115 waiver to increase Medicaid coverage for mothers from 60 days to 12 months after giving birth. The approval is authorized through the end of 2025. Under the recent American Rescue Plan, states are permitted to extend postpartum coverage through Medicaid and the Children's Health Insurance Program. Women will be able to receive coverage for all health issues, not just those related to pregnancy. In Illinois, approximately 2,500 women annually will likely qualify for the coverage due to the waiver. Women with incomes up to 208% of the federal poverty level are eligible. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -9- 'Continuous healthcare coverage reduces healthcare costs and improves outcomes,” said Secretary of Health and Human Services Xavier Becerra. ‘By expanding Medicaid eligibility for a full year after delivery, Illinois is setting an important model for other states across the country to follow.” Postpartum women are especially at risk for disruptions in Medicaid coverage. According to the Assistant Secretary for Planning and Evaluation, approximately 55% of women with Medicaid coverage at delivery lose coverage within six months. Thirty-five percent of women with private insurance lose coverage during the same time. The new policy was driven by the poor maternal outcomes in the United States. In 2019, the rate of maternal mortality increased to 20.1 deaths per 100,000 live births, according to data from the Centers for Disease Prevention and Control. The rate of maternal deaths in the United States was over twice the rate in other countries including the United Kingdom, Australia, and Switzerland, according to a study by The Commonwealth Fund. Black women in the United States face the highest risk after giving birth. The maternal mortality rate was 44 deaths per 100,000 live births, almost 2.5 times the rate for white women, and 3.5 times the rate for Hispanic women. Black women living in Illinois were six times as likely to die of a condition due to pregnancy than white women in the state. Five states have pending 1115 waiver requests to expand government sponsored health insurance coverage to women postpartum, [FN17] including Georgia, Indiana, Missouri, New Jersey and Texas. Maine Bill Aimed at Health Equity Advances Rep. Rachel Talbot Ross, D-Portland introduced a bill to that would advance health equity in Maine. The proposed legislation would close gaps in MaineCare and the Children's Health Insurance Program (CHIP). The Maine Committee on Health and Human Services heard the measure, LD718, and recently advanced the pending legislation. The bill would allow access to the programs without regard to immigration status. 'Last year, Maine made national headlines by having some of the worst racial disparities in the nation when it came to COVID-19,' said Talbot Ross. ‘This is in large part due to the fact that many Mainers are ineligible to receive affordable health care because of their immigration status. Passing this bill, LD 718, is one of the most important things the Legislature can do to advance health equity in Maine. This is a chance to close gaps in MaineCare and CHIP that prevent many immigrants, many Mainers, from accessing the care they need.’ A number of health care organizations support the bill. The Maine Community Action Partnership, Maine Primary Care Association and Northern Light Health all support the legislation. Advocates for immigrants and members of the immigrant community in Maine spoke in support of the bill. Abdulkerim Said, executive director of New Mainers Public Health Initiative, and Crystal Cron, president of Presente Maine, an advocacy organization for the Latinx community in Maine spoke in favor of the legislation. 'At New Mainers Public Health Initiative, we see firsthand how harmful these gaps in coverage are for immigrants in our community,' said Said. ‘We assist people with enrolling in health care coverage like MaineCare or the Marketplace, but too many times we have to tell people that they are not eligible for any coverage because of their immigration status. This causes people to avoid preventive care or conditions that need attention until they become an emergency. This is not a smart way to care for the residents of our state.’ 'Even when they have raked thousands of crates of blueberries, shucked hundreds of thousands of pounds of lobster, harvested broccoli, packed potatoes, washed our dishes, cooked our meals, built our houses and cleaned our toilets, many of my neighbors and friends who are immigrants cannot afford to go to a simple check up at the doctor,' said Cron. ‘People are delaying care that they can't afford to be putting off. Parents agonize over the right moment to take their kids to the doctor. They sacrifice their own health and care, so they can at least afford to take their children.’ The bill continues efforts in the Maine legislature to bring access to health care to low-income families, including immigrants. The Maine legislature exercised its right under federal law to provide health care to low-income Maine residents including immigrants in 1996 with strong bipartisan support. The LePage administration reversed that action in 2011. LD 718 aims to restore eligibility for MaineCare and CHIP to all Maine residents with low incomes. 'Health care is a human right, and it's an investment in Maine's future,' said Talbot Ross. ‘All people in Maine need access to regular, preventive care in order to build their lives and raise their families here, but these discriminatory policies are preventing many from being able to do so. I am proud to be sponsoring legislation to right this wrong, and I'm thankful to the advocates in Maines immigrant [FN18] communities for leading this effort.’ CHIP Enrollment Increases According to a recent analysis by the Kaiser Family Foundation, Medicaid and Children's Health Insurance Program (CHIP) enrollment have increased through November 2020, when compared with declines in enrollment from 2017 through 2019. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -10- The total enrollment grew to 78.9 million in November. Enrollment increased by 7.7 million from actual enrollment in February 2020 (10.8%), just prior to the coronavirus pandemic. Enrollment then began to steadily increase. According to researchers, ‘Increases in enrollment reflect changes in the economy (as more people experience income and job loss and become eligible and enroll in Medicaid and CHIP coverage) and provisions in the Families First Coronavirus Response Act (FFCRA) that require states to ensure continuous coverage to current Medicaid and CHIP enrollees to access a temporary increase in the Medicaid/CHIP match rates.” Researchers based their analysis on the Centers for Medicare and Medicaid Services (CMS) Performance Indicator Project Data. Medicaid state agencies submit enrollment data monthly. Medicaid and CHIP enrollment rates increased after the implementation of the Affordable Care Act (ACA), but then declined two years before the pandemic. After Medicaid expansion in 2014, enrollment in Medicaid and CHIP increased significantly in states that agreed to the expansion. Enrollment began decreasing in 2018 and 2019. By December 2019, enrollment had declined by 2.3 million people or 3.1 percent. Enrollment continued declining to February 2020, due, in part, to a robust economy. Data from some states indicated enrollment losses were due to difficulty with the enrollment or renewal processes. Preliminary data in November 2020 showed that enrollment increased by 10.8% or 7.7 million from February 2020. Changes could be due to the economy and job loss as well as maintenance of eligibility requirements, or eligibility and enrollment requirements, included [FN19] in the Families First Coronavirus Response Act. Bill Would Expand CHIP Eligibility to Include Immigrants The Health Equity and Access under Law (HEAL) for Immigrant Families Act was introduced in both the United States House and the United States Senate. It would extend eligibility to Medicaid and the Children's Health Insurance Program (CHIP) to lawfully present immigrants. Currently, there is a five-year waiting period for lawfully present immigrants to access those programs. Representatives Pramila Jayapal (WA-07) and Nanette Diaz Barrag?n (CA-44) joined Senator Cory Booker (D-N.J.) in introducing the legislation. Over 80 members of Congress co-sponsored the bill. Hundreds of organizations backed the measure. According to Representative Jayapal, ‘[T]he proposal is being introduced amidst a devastating public health crisis in which over two- thirds of the undocumented population are working on the frontlines of the pandemic.” Under the bill, DACA recipients would also become eligible for health insurance coverage under Medicaid and CHIP if otherwise eligible. Additionally, the bill eliminates the current ban on undocumented immigrants purchasing individual health insurance plans through the Affordable Care Act (ACA) marketplace. Undocumented immigrants would be eligible for premium tax credits and cost-sharing reductions for those plans. 'We must finally guarantee health care to everyone as a human right — regardless of immigration status, income, employment, or anything else,” said Congresswoman Jayapal. ‘As a proud immigrant who came to this country alone at the age of 16, I know that the HEAL Act is an urgent, necessary, and just first step to eliminating senseless barriers to health care, making our communities healthier, and ensuring all immigrants get the care they need — during a pandemic and always.” 'For far too long, many immigrant communities have been unfairly denied access to health coverage leading many individuals and families to go without necessary, essential health services, such as preventive care, diagnostic testing, and treatments,” said Senator Booker. ‘The COVID-19 pandemic highlights the urgency of addressing these health coverage gaps as immigrant communities face heightened risks for the disease. Health care is a right, and it shouldn't depend on one's immigration status. I am proud to re-introduce this groundbreaking legislation with Congresswoman Jayapal that will expand access to health care for many immigrant communities and help reduce unfair and unjust barriers that currently exist within our system.” 'No matter your immigration status, you deserve healthcare,” said Congresswoman Barrag?n. ‘If we truly believe that healthcare should be a human right, that means we need to remove the unnecessary barriers that prevent immigrant families from getting the medical care they need to lead healthy, productive lives. By providing immigrants access to affordable health care with the HEAL Act, we can help reduce racial health inequities and level the playing field for everyone.” Immigrants were disproportionately affected by the COVID-19 pandemic. Immigrants are a significant portion of the essential workforce. Approximately 23 million immigrants, including over one million dreamers, participate in the essential workforce, making up one in five essential workers. [FN20] Over two-thirds of the undocumented population are working on the frontlines of the pandemic. MACPAC Appointments Announced © 2022 Thomson Reuters. No claim to original U.S. Government Works. -11- Five new members were appointed recently to the Medicaid and CHIP Payment and Access Commission (MACPAC). The Commission's Chair and Vice Chare were also named and two members were reappointed. Gene L. Dodaro, Comptroller General of the United States and head of the U.S. Government Accountability Office (GAO), announced the appointments. 'Policymakers rely on MACPAC's thoughtful suggestions concerning Medicaid and the Children's Health Insurance Program (CHIP),” Dodaro said. ‘We had a number of excellent candidates interested in serving on the Commission this year, and I'm very pleased to announce today's five new appointments and two reappointments, as well as the naming of a Chair and Vice-Chair.” The newly appointed members are Heidi L. Allen, Robert Duncan, Laura Herrera Scott, and Verlon Johnson. They will serve until April of 2024. Dennis Heaphy was appointed to serve out the remaining term of Thomas Barker, set to expire in April of 2022. Current members Melanie Bella and Katherine Weno have been reappointed. Melanie Bella and current member Kisha Davis have been named the Commission's Chair and Vice Chair. MACPAC reviews Medicaid and CHIP access and payment policies and advises Congress on issues regarding the two programs. The Comptroller General appoints MACPAC's members under the Children's Health Insurance Program Reauthorization Act of 2009. Heidi L. Allen, PhD, MSW, is an associate professor at Columbia University School of Social Work. Robert ‘Bob” Duncan, MBA, is the Executive Vice President of Children's Wisconsin. Dennis Heaphy, MPH, M. Ed., M. Div., has worked to advance whole person-centered care for beneficiaries in Massachusetts and nationally. He is co-founder of Disability Advocates Advancing Our Healthcare Rights (DAAHR), a statewide coalition in Massachusetts. Laura Herrera Scott, MD, MPH, is Vice President of Clinical Strategy and Product at Anthem. Verlon Johnson, MPA, is Senior Vice President, Corporate Strategy at CNSI, a Virginia-based health IT firm that works with state and [FN21] federal agencies to design healthcare technology-driven products and solutions. Impact of COVID-19 on CHIP Recipients The Centers for Medicare & Medicaid Services (CMS) released a comprehensive overview of the impact of the COVID-19 Public Health Emergency (PHE) on Medicaid and CHIP beneficiaries. The agency conducted extensive data analysis using the Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF). The report details the impact of the PHE on service utilization through October 2020 for CHIP and Medicaid beneficiaries. Data includes: COVID-19 treatment, acute care use, and testing, Service use among Medicaid & CHIP beneficiaries age 18 and under, Services delivered via telehealth to Medicaid and CHIP beneficiaries, and Services for mental health and substance use disorders (SUDs) among Medicaid and CHIP beneficiaries. According to CMS, ‘These analyses are essential to increasing our understanding of COVID-19's impacts, as Medicaid and CHIP covered over 100 million Americans for at least one day between January and October 2020, including children, pregnant women, adults, seniors, and individuals with disabilities, among other groups.” CMS indicated that Medicaid and CHIP covered nearly 43 million children during this time. Many of these children were living in poverty or had special health care needs. Over 1.2 million CHIP and Medicaid beneficiaries received treatment for COVID-19 through October 2020. Almost 124,000 beneficiaries were hospitalized. For children, the largest impact of COVID-19 was a decrease in health services utilization for primary, preventive, dental and mental health services. Utilization rates are rebounding in many areas; however, millions of services need to be utilized to make up for services not used during the PHE. Telehealth delivery of services has increased significantly, peaking in April 2020. Notable gaps in services occurred for mental health conditions and substance use disorders. CMS noted, ‘Taken together, CMS's release of COVID-19 data is a major step toward sharing timely data on some of the nation's largest and most important health coverage programs. These results are essential not only for ensuring robust monitoring and oversight of Medicaid and CHIP, but also for highlighting the distinct impact COVID-19 has had on children's service utilization, telehealth utilization, and services for mental health and SUDs. By using these results, CMS, states, and other key stakeholders can help drive better health outcomes for some of our nation's most vulnerable beneficiaries.” © 2022 Thomson Reuters. No claim to original U.S. Government Works. -12- Medicaid and CHIP paid for over 9.9 million COVID-19 tests or testing services. Service utilization declined among Medicaid & CHIP beneficiaries aged 18 and under: 1.8 million (9%) fewer vaccinations for beneficiaries up to age two, 4.6 million (21%) fewer child screening services, 14 million (34%) fewer mental health services, and 11.4 million (39%) fewer dental services. Almost 68 million services were delivered via telehealth during the PHE, representing an increase of 2,700%. Services for mental health and service use disorders significantly declined in nearly all states. Service utilization rates appear to still be [FN22] declining in most states despite more people reporting mental or behavioral health conditions during the PHE. Government Funds Pediatric Mental Health Services The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced that $14.2 million in federal funding under the American Rescue Plan (ARP) would go toward expanding pediatric mental health care access. Specifically, the funding would help to integrate telehealth services into pediatric primary care. Pediatric Mental Health Care Access (PMHCA) projects will expand into new states and geographic areas nationwide, including tribal areas. The new state and regional networks will include services such as teleconsultations, training, technical assistance and care coordination for pediatric primary care providers to diagnose, treat and refer children and youth with mental health conditions and substance use disorders. Twenty-one PMCHA projects currently exist in the country. 'Children are struggling with a range of emotional and behavioral challenges arising from the COVID-19 pandemic, especially those in families with lower incomes or who face other obstacles to health care,” said HHS Secretary Xavier Becerra. ‘This program harnesses the power of technology to make mental and behavioral health care more accessible and equitable for our nation's children, and links pediatric care providers to children and their families who need that specialized care.” According to research, there is a significant need for pediatric mental and behavioral health care. Approximately 22 percent of children ages 3 to 17 currently have a mental, emotional, developmental, or behavioral condition. Approximately 20% of children with these disorders currently receive care from a specialized provider. 'Now more than ever, families need mental and behavioral health care for their children, but significant disparities in access to this treatment continue to exist,” said Acting HRSA Administrator Diana Espinosa. ‘The expansion of the Pediatric Mental Health Care Access Program paves the way for more children to receive necessary mental health services, especially those in underserved [FN23] communities.“ Idaho Groups Advocate for Universal Health Coverage for Children Medical professional and advocacy organizations in Idaho are in favor of the Idaho Kids Covered campaign, aimed at 100% health insurance coverage for children living in the state. Idaho expanded Medicaid over a year ago, offering coverage to more of the ‘working poor” in the state. Now, some groups in the state are interested in expanding coverage further to include every child in Idaho. Saint Alphonsus Health System is in favor of the efforts. 'Before the pandemic, too many children in Idaho were uninsured. And in 2019, 24,000 children in Idaho did not have health coverage. At a time when we're working to recover from a public health crisis, it's been very clear the importance of health care access,” said Hillarie Hagen, a health policy analyst for Idaho Voices for Children. The group is leading the effort. According to a study from researchers at Georgetown University, 5%, or one in twenty children in Idaho lacked health insurance coverage in 2019. That rate was 12.8% in 2008. It has increased from record lows in 2016 and 2017. In the United States as a whole, 5.7% of children lacked health insurance in 2019. Idaho expanded access to Medicaid after the data was collected. Under current Medicaid qualification standards in the state, 6.1% of children in families making too much to qualify for Medicaid were uninsured. Approximately 92% of currently uninsured Idaho children are eligible for coverage through Medicaid or CHIP. 'Many children who are eligible for Medicaid/CHIP may not be enrolled due to a lack of public outreach or administrative barriers,” stated the Georgetown University's Children's Health Care Report Card for Idaho. ‘The child participation rates show the percentage of eligible children who are enrolled in Medicaid/CHIP.” [FN24] According to Hagan, the Idaho initiative is looking into health care gaps prior to making specific policy recommendations. Record Numbers Enrolled in Medicaid, CHIP © 2022 Thomson Reuters. No claim to original U.S. Government Works. -13- The Centers for Medicare & Medicaid Services (CMS) released data showing that a record number of people had enrolled in coverage through Medicaid and the Children's Health Insurance Program (CHIP) between February 2020 and January 2021. The COVID-19 public health emergency (PHE) was declared in March 2020. The new Enrollment Trends Snapshot report showed that over 80 million individuals accessed health insurance through Medicaid and CHIP. Almost 9.9 million individuals enrolled during that time period, a 13.9% increase. Including all 50 states and the District of Columbia, a total of 80,543,351 people were enrolled and receiving full benefits from the Medicaid and CHIP programs by the end of the year. Fifty states reported total Medicaid child and CHIP enrollment data for January 2021, showing that over 38.3 million children were enrolled in Medicaid and CHIP combined. The enrolled children represented about 50% of the total Medicaid and CHIP enrollment. According to CMS, ‘These numbers highlight the essential role the Medicaid and CHIP programs play in providing quality and needed coverage for millions of vulnerable children and adults. In fact, both programs serve as the largest single source of health coverage in the country.” 'The Biden-Harris administration is using every lever to ensure any American needing access to quality health coverage receives it. Now more than ever, people need the peace of mind of knowing that they have health coverage,” said HHS Secretary Xavier Becerra. ‘This report reminds us what a critical program and rock Medicaid continues to be in giving tens of millions of children and adults access to care. This pandemic taught us that now more than ever, we must work to strengthen Medicaid and make it available whenever and wherever it's needed using the unprecedented investments Congress provided.” The agency attributed the increase in total Medicaid and CHIP enrollment to the impact of the COVID-19 PHE. Under the Families First Coronavirus Response Act (FFCRA), states received a temporary 6.2% payment increase in Federal Medical Assistance Percentage (FMAP) funding. States were able to receive the enhanced funding if they achieved the Maintenance of Effort requirement. Eligible people enrolled in Medicaid had to remain covered throughout the PHE. 'Medicaid and CHIP serve as a much-needed lifeline for millions of people throughout this country. The increase we are seeing is exactly how Medicaid works: the program steps in to support people and their families when times are tough,” said CMS Administrator Chiquita Brooks-Lasure. ‘For the parents that may have lost a job or had another life change during the pandemic, having access to coverage for themselves and their kids is lifechanging. CMS is committed to ensuring our nation's marginalized communities and low- income families have the coverage they need.” CMS created several strategies to support Medicaid and CHIP programs during the PHE to assist states in their response to COVID-19. States received increased flexibility in operating the programs. The data showed a range of indicators linked to key application, eligibility, and enrollment processes within state agencies running the programs. The Centers for Medicare and Medicaid CHIP Services (CMCS) Medicaid and CHIP Coverage Learning Collaborative (MACLC) [FN25] collaborate on the Snapshot to follow Medicaid and CHIP enrollment trends. Maryland Child and Maternal Healthcare Initiative The Maryland Department of Health (MDH) and Governor Larry Hogan announced the launch of a maternal and child healthcare transformation initiative. The $72 million initiative is focused on improving health disparities for Maryland residents. Beginning July 1, and for the next four years, Maryland's Health Services Cost Review Commission (HSCRC) will provide $10 million in annual funding to support the transformation. Two million dollars will go to MDH's Public Health Services annually. Maryland Medicaid will receive $8 million from the fund and will be eligible for matching federal funding. 'Maryland's maternal and child health care transformation is focused on prevention and early intervention,” said Governor Hogan. ‘By investing in access to prenatal care, postpartum care and child health visits, we can improve a wide range of outcomes that potentially impact the health of multiple generations of Marylanders.” Funding will go toward statewide programs and expanding existing healthcare services. The state plans on sustaining the programs after the funding expires in 2025. The programs aim to reduce severe maternal morbidity and pediatric asthma-related emergency department visits for children. In 2021, the Maryland legislature extended Medicaid coverage for comprehensive medical, dental, and other health care services for mothers from two to 12 months postpartum. Under the legislation, an estimated $17 million in additional funding will go toward improving health of mothers eligible for Medicaid coverage. 'All of this new funding represents a significant investment in improving maternal and child health in our state,” said MDH Secretary Dennis R. Schrader. ‘This investment will help us address a long-standing history of health disparities for mothers and children within communities that are underserved and need more support.” Under Maryland's Statewide Integrated Health Improvement Strategy (SIHIS), maternal and child health is a population health priority. The public-private initiative aims to improve health, reduce disparities, and change healthcare delivery. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -14- 'HSCRC is committed to working with other state agencies and private sector partners to transform care delivery,” said Katie Wunderlich, executive director of the HSCRC. ‘Addressing disparities and improving health outcomes for all Marylanders are essential to fulfilling our mission.” HSCRC-funded programs and initiatives include: Home Visiting Services Pilot expansion through Medicaid for high-risk pregnant individuals and children up to age two. Reimbursement for Doula Services. Centering Pregnancy program offering group prenatal care for low-risk pregnancies. HealthySteps promoting positive parenting and health development for babies and toddlers. Maternal Opioid Misuse (MOM) Model Expansion providing extra support for pregnant and postpartum individuals with opioid use disorder. Improving Childhood Asthma Outcomes and Disparities for improving overall childhood asthma outcomes and to address historically poorer asthma outcomes in Black children. Eliminating Disparities in Maternal Health providing funding opportunities for jurisdictions that have elevated maternal morbidity rates to implement or expand programs and initiatives that improve maternal and child health. 'By creating and expanding these programs and services, we'll have increased access to care—especially for chronic conditions —during one of the most critical periods for intervention,” said MDH Deputy Secretary for Public Health Dr. Jinlene Chan. ‘These [FN26] interventions are critical to helping set someone on the path toward a healthier future and may ultimately save lives.“ Health Plan Expands its CHIP Coverage in PA Geisinger Health Plan (GHP) expanded its Children's Health Insurance Program (CHIP) coverage to eight additional counties in Pennsylvania. The coverage, GHP Kids, provides another option for parents with uninsured children. All uninsured children and teens up to age 19 in Bedford, Bucks, Chester, Delaware, Franklin, Fulton, Montgomery and Philadelphia counties can now access health insurance coverage through GHP Kids. Eligibility is not limited by household income. Coverage is low or no cost. 'No one should be without healthcare coverage during this pandemic, especially children,' said Kurt J. Wrobel, GHP president and executive vice president of insurance operations for Geisinger. ‘GHP Kids provides another option in these counties to ensure that no child has to go without health insurance and regular access to care.’ The plan offers complete medical coverage and dental and vision insurance, prescriptions, vaccinations, and other benefits. Currently, 12,000 children and teens in 48 counties receive coverage. The physician network covers over 17,000 primary care and specialty doctors, over 1,800 primary care locations, and 132 clinic and urgent care locations in the state. Members can also access exclusive programs, health coaches and resources as well as case managers, peer support assistants, dietitians and other skilled professionals who work with community organizations, equipment providers, home health agencies, and [FN27] education facilities to better coordinate care and prioritize specific health needs. Recent Trends in Medicaid and CHIP Enrollment The Kaiser Family Foundation recently analyzed data regarding the trends in Medicaid and Children's Health Insurance Program (CHIP) enrollment nationwide. KFF published a data note breaking down enrollment data on a state-by-state basis through February 2021. The period studied includes the early stages of the rollout of the COVID-19 vaccine in the United States. States were experiencing some economic improvements compared with earlier in the pandemic. Total Medicaid/CHIP enrollment was declining from 2017 through 2019. In February 2021, enrollment had grown to 81 million, an increase of 9.8 million compared to February 2020 enrollment numbers. Enrollment increased by 13.8%. Researchers cited, ‘Increases in enrollment reflect changes in the economy (as more people experience income and job loss and become eligible and enroll in Medicaid and CHIP coverage) and provisions in the Families First Coronavirus Response Act (FFCRA) that require states to ensure continuous coverage to current Medicaid enrollees to access a temporary increase in the Medicaid match rates.” © 2022 Thomson Reuters. No claim to original U.S. Government Works. -15- Researchers noted that enrollment has increased for 12 consecutive months. They also indicated that the monthly increases are slowing compared to April through August of last year. Enrollment data for February 2021 was preliminary and is likely to change upward in future reports. The data researchers used was based on KFF analysis of the Centers for Medicare and Medicaid Services (CMS) Performance Indicator Project Data. Medicaid agencies submit Medicaid/CHIP enrollment data monthly and revise it to include retroactive enrollment and to align more fully with reporting criteria. Enrollment in CHIP and Medicaid increased after the implementation of the Affordable Care Act (ACA). It began declining two years prior to the pandemic. In 2014, Medicaid was expanded under the ACA to low-income adults in some states. Large increases in Medicaid and CHIP enrollment occurred in those states. A steady growth in the coverage of children followed. Increased enrollment was due to increased eligibility and due to increased outreach and education for people who were already eligible for the programs. The ACA facilitated enrollment with simpler enrollment procedures. Enrollment began declining in 2018 and 2019. Total enrollment decreased from 73.4 million in December 2017 to 71.2 million in December 2019. Enrollment decreased by 2.2 million people, or 3% of total enrollment. According to researchers, ‘Month-to-month enrollment declines slowed but continued until February 2020. The declines in enrollment, in part, reflected a robust economy, but experiences in some states suggested that they may have also reflected enrollment losses among people who were still eligible for coverage due challenges completing enrollment or renewal processes.” Researchers noted, ‘Recent increases could reflect new enrollment related to changes in the economy and job loss, as well as eligibility and enrollment requirements included in the Families First Coronavirus Response Act (FFCRA), also known as maintenance of eligibility (MOE) requirements.” The FFCRA required states to ensure continuous coverage to people enrolled in Medicaid as of March 18, 2020 in order to receive federal Medicaid matching funds. It also prevented states from making eligibility and enrollment more restrictive to access federal matching funding. During this period, all states saw increases in Medicaid/CHIP enrollment from 8.6% to 27.2%. Most of the growth was in Medicaid, at an increase of 15% between February 2020 to February 2021. CHIP had an increase of 2.2% or 146,000 enrollees. Several states had declines in CHIP enrollment. Researchers noted that many family incomes decreased during this [FN28] time making more children eligible for Medicaid coverage who were previously covered through CHIP. Noncitizen Children Face Higher Health Risks Health Affairs recently published a study showing that noncitizen children faced an increased risk of health harms due to limited access to health insurance coverage and health care access when compared to their citizen siblings. Researchers noted that eligibility restrictions prevent noncitizen children in the United States from accessing publicly funded health insurance programs including CHIP and Medicaid. They found that the lack of access to health care can contribute to poorer health and higher medical costs as adults. Researchers compared citizen and noncitizen siblings living in mixed status families to isolate the impact of the lack of citizenship from other factors, such as socioeconomic status. A noncitizen child has an increased risk of being uninsured. They have a 26 percent less chance of being enrolled in Medicaid or CHIP. According to the study, ‘Noncitizen children had significantly more delays in needed medical care because of cost, primarily mediated by the lack of insurance coverage. The US should reexamine policies that exclude noncitizen children from public health insurance [FN29] programs.“ Letter to Congress: Make CHIP Permanent Over five hundred organizations including the American Dental Association wrote a letter to Congress in support of legislation that would make the Children's Health Insurance Program (CHIP) permanent. The organizations were from all 50 states, the District of Columbia and Puerto Rico. The letter was sent July 22 to House and Senate leaders. The First Focus Campaign for Children led the organizations. They asked for support of the Comprehensive Access to Robust Insurance Now Guaranteed for Kids Act and the Children's Health Insurance Program Permanency Act. 'Both bills would protect the health security and well-being of the 10 million children and pregnant women currently enrolled in CHIP while taking the long overdue and necessary step of finally making CHIP permanent, like every other public health insurance program, including Medicare and Medicaid,” they wrote. ‘Enacting legislation to make CHIP permanent ensures that the children and pregnant women that receive health insurance through the popular and successful Children's Health Insurance Program will never again worry about their coverage expiring mid-year or mid-treatment.” © 2022 Thomson Reuters. No claim to original U.S. Government Works. -16- The organizations indicated, ‘for almost 25 years, CHIP has been an essential source of children's coverage, ensuring access to high- quality, affordable, pediatric-appropriate health care for children in working families whose parents earn too much to qualify for Medicaid but too little to purchase private health insurance on their own.” In addition, they pointed to the progress CHIP has made in reducing the number of uninsured children in the United States by over 68%. In 1997, the uninsured rate of children was almost 15%. In 2016, the uninsured rate of children was less than five percent. During that time, children have gained improved health outcomes and access to care, as have pregnant women. The health care improvements have particularly affected children of color. In 2019, over half of American Indian/Alaska Native, Black, multi-racial, and Hispanic children depended upon Medicaid and CHIP as their source of health insurance coverage. 'To never again wonder about CHIP's future would allow lawmakers, federal and state health departments, advocates, pediatricians, and other providers to be entirely focused and attentive to the emergencies at hand ? ending the COVID-19 pandemic, addressing our nation's shameful maternal and infant mortality crises, and eliminating health disparities and promoting health equity,” the organizations noted. ‘Swift passage of legislation to make CHIP permanent will ensure that never again will we divert any attention away from improving child and maternal health outcomes to prepare for contingency planning for the possible temporary expiration or end of [FN30] CHIP.“ Get Kids Covered Campaign Launches in Pennsylvania The Get Kids Covered Campaign began in Pennsylvania, led by local health advocates in Luzerne County, including United Way of Wyoming Valley, Family Service Association of Northeastern Pennsylvania, and Maternal and Family Health Services. Hundreds of children in the county lack health insurance coverage who might be eligible for coverage through either Medicaid or the Children's Health Insurance Program (CHIP). The program is a regional education program aimed at connecting kids with health insurance coverage. According to United Way of Wyoming Valley President and CEO Bill Jones, ‘Every child in our community should have health (insurance) coverage.” However, almost three percent of children in Luzerne County lack health insurance coverage. 'While it seems like a small percentage, 2.7%, still 1,800 children aren't insured and that's a concern,” Jones said. The organizations decided to focus on the problem with the collaborative educational effort represented by the Get Kids Covered campaign. The coverage is low-cost or free, depending on family income. Enrollment information is available through Pennsylvania's information phone line, 211 Northeast. 'All you have to remember are three little numbers and you're connected right to one of the caseworkers in our offices and they can try and help you out any way they can,” Tom Foley, Director, PA 211 Northeast, indicated. Health insurance coverage is particularly important for children as they return to school during the COVID-19 pandemic. 'If they are insured and do get sick or do have needs, families can help them stay healthier and it's not going to cost them what they think it is,” said Jones. According to Maria Montoro Edwards Ph.D., President and CEO of Maternal and Family Health Services, ‘We know that kids who do have insurance persist in school, have better outcomes and if they're not getting those well visits and checkups and don't have insurance then, unfortunately, they're going to be behind their peers.” Enrollment information is also available through Pennsylvania 211 North Eastern by texting INSUREKIDSNOW to 211-211, or by [FN31] logging onto the Insure Kids website. Testing and Vaccine Coverage for CHIP The Centers for Medicare & Medicaid Services (CMS) announced that the Biden-Harris Administration is issuing guidance for states regarding COVID-19 vaccination and testing for people covered under Medicaid and the Children's Health Insurance Program (CHIP). The guidance also included information about ‘Medicaid program's broader aim of providing much-needed health coverage for millions of eligible individuals.” According to CMS, ‘Testing for COVID-19 is an essential component to keeping the country's schools open, which is why CMS's new guidance highlights Medicaid and CHIP coverage for diagnostic and screening COVID-19 testing in a variety of settings, including schools. The guidance also reinforces that COVID-19 vaccines are available to nearly all Medicaid and Children's Health Insurance Program (CHIP) beneficiaries for free.” Under the American Rescue Plan, 100% federal matching funds are temporarily available for Medicaid and CHIP expenses for COVID-19 vaccine administration. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -17- 'The Biden-Harris Administration continues to remind states that the fight against COVID-19 requires increased efforts to boost testing and vaccination,” U.S. Health and Human Services (HHS) Secretary Xavier Becerra. ‘As families prepare children to return to school, today's guidance reaffirms our commitment to provide free COVID vaccination and testing for all eligible Medicaid and CHIP beneficiaries. I will continue to work with the states to get our communities vaccinated and healthy across the country.” 'Today's guidance reinforces our commitment to providing low-income adults and children with access to COVID-19 testing and vaccination, and I urge all eligible enrollees to get vaccinated to protect themselves and their families,” said CMS Administrator Chiquita Brooks-LaSure. ‘I also urge states to take advantage of additional federal funds provided by the Biden-Harris Administration and the American Rescue Plan Act by ensuring eligible families have equal access to the essential and comprehensive health care that they need.” Medicaid will cover the cost of diagnostic and screening testing for COVID-19 that meets CDC recommendations. CMS indicated, ‘For families, this coverage will help ensure peace of mind while maintaining access to education.” CMS pointed to the impact of the COVID-19 pandemic on children with disabilities who receive Medicaid services through schools. CMS noted that it is committed to giving children with disabilities. learning remotely access to the same services they receive attending school in person. Almost all Medicaid and CHIP beneficiaries are entitled to COVID-19 vaccines with no cost sharing. CMS released guidance regarding the ARP's temporary 100% federal match for state expenditures for vaccines for CHIP beneficiaries. CMS is also providing matching funding for approved state-funded monetary incentives for beneficiaries to encourage vaccination against COVID-19 and the flu. To Help states build awareness and address vaccine hesitancy, CMS is making federal administrative matching funds available for states' approved expenditures on state-funded monetary incentives for beneficiaries to encourage vaccinations against COVID-19 and [FN32] the Flu. Rate of Children Insured Decreases According to a recent report, the number of children without health insurance in the United States increased in 2020 for the fourth consecutive year. Approximately 5.6% of all children in the United States, or 4.3 million children, lacked health insurance coverage in 2020. The data came from the U.S. Census Bureau. The number represented a seven percent increase in the number of children lacking health insurance from those covered in 2019. The data showed that children of color are most likely to lack health insurance coverage. About 9.5% of Hispanic children lack health insurance coverage. Black children lack health insurance at a rate of 6%. Children living in the south are also more likely to lack coverage, with 7.7% uninsured. In the states that have not chosen to expand Medicaid, the rate of children lacking insurance is over double the rate of uninsured children in other states, 8.5%. The increased numbers of uninsured children are troubling with the surge in pediatric hospitalizations for COVID-19. By September 2021, almost 5.3 million children had tested positive for the virus in the United States. After a decline in child cases in early summer, the cases of COVID-19 in children have increased significantly in recent weeks. Nearly 500,000 cases were added in the two weeks of early September. Congress has an opportunity to reverse the trend of uninsured children. The Democrats in the House Energy and Commerce Committee indicated that making the Children's Health Insurance Program (CHIP) permanent and allowing children 12-month continuous enrollment in Medicaid are priorities for budget legislation. Over 500 local and national organizations recently joined First Focus Campaign for Children in encouraging legislators to make CHIP [FN33] permanent. CareSource to Bid on Iowa CHIP, Medicaid Contract CareSource announced that it will submit a proposal to serve Iowa residents covered through Medicaid and the Children's Health Insurance Program (CHIP). CareSource is a national nonprofit managed care organization. The Iowa Department of Human Services announced in May that it would release a request for proposal (RFP) to managed care organizations (MCOs). The provider would service the programs through the Iowa Health Link Medicaid program. The expected release of the RFP is December 2021. Contracts will be awarded in the fall of 2022. CareSource is not currently approved in Iowa to serve as a managed care organization. It is working with regulators for approval. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -18- CareSource was founded in Ohio. It currently serves over 2 million beneficiaries in Ohio, Indiana, Kentucky, Georgia, and West Virginia. It will begin serving members in Arkansas in 2022. The company will focus on the Medicaid members in Arkansas with complex behavioral health, developmental and intellectual disabilities. According to the organization, it has innovated in the health care field has led the industry in approaching critical issues surrounding social determinants of health. The organization centers its focus on members and aims to transform market-tested programs prioritizing members. 'As a nonprofit organization we focus on our members and the communities we serve instead of shareholders. This makes CareSource unique in Iowa's current managed care environment,” said Erhardt Preitauer, President & CEO, CareSource. ‘Our industry-leading social programs, complex care capabilities and core operations will result in improved quality and health outcomes for Iowa's Medicaid population, while also providing a better experience for both members and the providers who care for them.” Ohio is the current largest market served by CareSource. The organization is ranked the highest quality plan in the state and the lowest cost to taxpayers. Member and provider customer care satisfaction rating exceed 90%. The organization has offered Iowa the CareSource Foundation Grant Challenge, committing $165,000 in grants to Iowa community health care nonprofits. The organization has obtained office space in Des Moines and is planning on hiring leaders to head the Iowa program. CareSource [FN34] also announced its plans to join the health insurance exchange in the state. North Carolina Extends Deadline for Health Care Requirements for Children North Carolina Governor Roy Cooper issued an executive order extending deadlines for health assessment documentation and vaccination of children for school and child-care facilities. The extension was in response to the surge of the Delta variant during the COVID-19 pandemic that prevented many children from obtaining timely physician visits for routine immunizations and health checks. The order was aimed at ensuring that children are not kept out of school because of the increased demands on health care providers during the ongoing COVID-19 pandemic. The order will allow more time for students and their families to obtain the required documentation and immunizations, but it will not waive those requirements to attend schools and child-care facilities. According to the office of the governor, ‘Vaccinations and health assessments are essential to protecting public health and should not be skipped or ignored.” Increases in case rates and the viral transmission by the highly contagious Delta variant have limited the ability of pediatricians to schedule routine health assessment visits. The North Carolina Pediatric Society reported that pediatricians are experiencing record levels of demand. 'One of our top priorities, as we continue to fight the COVID-19 pandemic, is keeping children in classrooms and offering extended time to complete these important health activities will help accomplish that goal,' said NCDHHS Secretary Mandy K. Cohen, M.D. ‘Vaccines and well-check doctor visits help keep kids safe and are important for safeguarding public health in our communities.’ The NC Pediatric Society strongly encouraged the vaccination of everyone 12 and older with the COVID-19 vaccine. 'Remember, anyone under 12 doesn't have the option to get a COVID-19 vaccine right now. They are relying on us to protect them by getting our shots,' Secretary Cohen said. Typically, proof of required immunizations and health assessments are required within 30 days of the first date of school attendance. The Children's Health Insurance Program (CHIP) gives children from lower income families access to immunization and health assessment services. Due to the executive order, the 30-day grace period for all students to provide proof of immunization and health assessment will begin on Nov. 1. 2021. Parents have to provide proof of a scheduled child wellness appointment within the 30-day grace period for children to attend schools [FN35] and child-care facilities. Study: Children Gain Coverage Under American Rescue Plan According to a recent study by the Urban Institute, almost one million uninsured children and their parents would gain health insurance coverage if the subsidies under the American Rescue Plan (ARP) became permanent. The ARP enhanced tax credits are scheduled to end December 32, 2022. Researchers found that the tax credits could benefit nearly one million children and parents in the United States. They used Urban Institute's Health Insurance Policy Simulation Model to study the potential effects of making the subsidy permanent. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -19- The ARP was part of the Biden administration's response to the COVID-19 pandemic. The expanded subsidies help to decrease the cost of health insurance through the ACA Marketplace. People with incomes below 150 percent of the federal poverty level (FPL) were eligible for free premiums. People earning up to 400 percent of the FPL were eligible for reduced premiums. People earning over 400 percent of FPL were eligible for premiums capped at 8.5 percent of their income. Researchers found that making these enhanced subsidies permanent would lead to more children and parents becoming insured. Individual health insurance coverage would increase by 0.5 and 1.2 percent for children and parents. Rates of children lacking health insurance would fall from 4.6 percent to 4.2 percent. Parents without insurance would decrease from 10.8 to 9.8 percent. According to the study, approximately 303,000 children and 686,000 parents would become insured. 67,000 of the children to become covered would be five years old or younger. Most of the families expected to gain coverage have incomes between 200 and 400 percent of FPL. Almost 200,000 children are in this category. Researchers also found that approximately 75,000 children in families earning over 400 percent of FPL would gain coverage. Making the ARP enhanced subsidies permanent would reduce health insurance costs for 4.5 million children and parents who already have private individual health insurance coverage. Taken as a whole, family spending on healthcare could decrease by 18 percent. Families with incomes below 400 percent of FPL would experience the largest decrease in costs for healthcare. In spite of gains through an extension of the ARP subsidies, 3.3 million children and 6.3 million parents would still remain uninsured in 2022. Additional coverage changes, including Medicaid expansion, could reduce those numbers. Over half of uninsured children (57.2 percent) would be eligible for Medicaid or coverage through the Children's Health Insurance Program (CHIP). Less than 20 percent of uninsured people are eligible for tax subsidies through the ACA Marketplace. Approximately 90 percent of children and parents are blocked from publicly subsidized coverage due to one of the following: immigration status, an affordable health plan offering from an employer, or having an income below the required FPL in a state that has not expanded Medicaid. People still must meet immigration requirements for the ARP enhanced subsidies. They also must not be eligible for an employer- sponsored health plan to qualify. Researchers encouraged legislators to expand Medicaid eligibility in the 12 states that have not yet done so, increase outreach efforts [FN36] for 2022 open enrollment, and eliminate the family glitch to reduce the number of uninsured people throughout the United States. White House Focuses on Mental Health Care Access for Children The Biden administration announced the release of a new resource from the Department of Education aimed at increasing access to mental health care for children. The resource, ‘Supporting Child and Student Social, Emotional, Behavioral and Mental Health,” points to challenges in providing mental health supports in schools and makes recommendations to educators and providers. According to the Biden administration, ‘Eliminating these barriers and expanding the full continuum of prevention, treatment, and recovery services, as well as prioritizing integration of these services into settings where young people and their families can access them, are key priorities for the Biden-Harris Administration.” The White House also pointed to its emphasis on mental health in children, including its focus on connecting children to coverage. 'Access to coverage is the first step to improving care for mental health and substance use conditions. Medicaid and the Children's Health Insurance Program (CHIP) serve as critical sources of coverage for children and youth, covering nearly 39 million children nationwide and providing robust coverage for mental health and substance use conditions, including services provided at school. The Biden-Harris Administration is committed to continuing the progress made in children's coverage rates since the enactment of the Affordable Care Act (ACA) by making sure children are connected to coverage.” The White House pointed to the Connecting Kids to Coverage campaign, a national outreach and enrollment initiative. It helps to educate families with children and teens eligible for subsidized health insurance coverage such as Medicaid and CHIP. The campaign focuses particularly on mental health. The Biden administration indicated it is committed to increasing access to affordable health insurance coverage for children and their families. It has quadrupled the number of Navigator associations that assist families in enrolling in health insurance coverage through [FN37] government programs such as CHIP. COVID-19 Vaccine Available at No Cost to Children The Centers for Medicare & Medicaid Services (CMS) reminded eligible consumers that the COVID-19 vaccine is available at no cost- sharing through Medicaid and the Children's Health Insurance Program (CHIP). © 2022 Thomson Reuters. No claim to original U.S. Government Works. -20- The U.S. Food & Drug Administration's (FDA) recently authorized the Pfizer-BioNTech COVID-19 vaccine for use in children ages 5 through 11. The vaccine is also available with no cost-sharing for children with private health insurance coverage. According to CMS, ‘As with all vaccines, the Pfizer-BioNTech COVID-19 Vaccine was tested thoroughly in this age group prior to its authorization for emergency use. While the effects of COVID-19 for a child can last for several months, the most commonly reported side effects of the COVID-19 vaccine in the clinical trial participants were generally mild to moderate in severity, and most went away within one to two days.” 'The COVID-19 vaccine is the best way to keep children safe. The strongest protection against COVID-19, including the Delta variant, is to get vaccinated,” said CMS Administrator Chiquita Brooks-LaSure. ‘I encourage parents everywhere to talk with their pediatrician, school nurse, or other trusted healthcare provider about any questions they may have and to get their children vaccinated as soon as possible.” Under the American Rescue Plan Act of 2021 (ARP), almost all Medicaid and CHIP beneficiaries are eligible to receive coverage of COVID-19 vaccines and their administration without cost-sharing. Health care providers and other entities administering COVID-19 vaccines agreed under the terms of the CDC COVID-19 Vaccination [FN38] Program Provider Agreement not to charge out-of-pocket costs to vaccine recipients, regardless of insurance status. Colorado Creates Free Limited Mental Health Service for Children The Colorado Department of Human Services, Office of Behavioral Health (OHB) and its partners created a program to provide free limited mental health services for children living in the state. The I Matter program will provide up to three free counseling sessions for Colorado residents 18 and under. The services will also be available to people 21 and younger who are receiving special education services. The program was created in response to the growing youth mental health crisis. Children and their parents can access the services through the I Matter website. A confidential online survey about mental health allows residents to schedule sessions with a licensed behavioral health clinician. The services are available primarily through telehealth. Governor Jared Polis created the program through a bipartisan bill. The legislation sets aside $9 million to fund the program. It is part of the Polis administration's Colorado Comeback roadmap. 'From our first day in office, behavioral health has been a priority for the Polis-Primavera administration. We recognize that the pandemic has amplified the need for mental health services, particularly for young people,” said Lieutenant Governor Primavera. ‘This program is the first of its kind in the nation and meets the urgency of the moment. By bringing mental health support directly to Colorado youth, we can help them take charge of their healing, build resilience, and help our state build back stronger.” Analysis by the National Conference of State Legislatures showed that Colorado is the only state with a program that provides free therapy sessions to children and youth. The state expects to serve over 10,000 youth with the government funding for the program. 'By launching the I Matter program today, Colorado is making historic progress in our fight against the mental health crisis affecting our kids,” said Representative Dafna Michaelson Jenet, D-Commerce City. ‘Providing free mental health counseling to students is an innovative and transformational way to meet young people where they are and get them the support they need. I'm excited to see this program become a reality after so much hard work, and I hope to soon see other states follow Colorado's lead.” Colorado is facing a youth behavioral health crisis that began prior to the COVID-19 pandemic. According to the 2019 Healthy Kids Colorado Survey, over one third of Colorado high school students felt too sad or hopeless for at least two weeks that they halted their usual activities. Throughout the nation, the pandemic detrimentally affected the mental health of children. The Centers for Disease Control conducted research that showed the proportion of mental health-related emergency department visits increased 31% among children ages 12 to 17 from 2019 to 2020. The I Matter program is recruiting counselors from diverse cultural backgrounds to better serve all children in Colorado. They are seeking people from Black, Indigenous, Latinx and LGBTQIA+ communities. The I Matter marketing and outreach campaign will encourage youth to access the counseling services. The ad campaign will use youth feedback to reach out to all Colorado youth, including people of color and LGBTQIA+ people. Advertising will include platforms such as TikTok and Snapchat. It will also reach out to schools and youth organizations. Campaign materials including posters and rack cards are free upon request. Under Colorado state law, children 12 and older can consent to counseling without their parent or guardian's consent. Children 12 and [FN39] older will be able to access the I Matter program independently. Children younger than 12 will need permission from a guardian. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -21- © Copyright Thomson/West - NETSCAN's Health Policy Tracking Service [FN2] . Press release, “NCDHHS to Expand Reach Out and Read to All North Carolina Counties Through New Medicaid Initiative,” NCDHHS, December 23, 2020, available at https://www.ncdhhs.gov/news/press-releases/ncdhhs-expand-reach-out-and-read-all-north-carolina- counties-through-new. [FN3] . Press release, “MACPAC Releases 2020 Edition of MACStats: Medicaid and CHIP Data Book,” MACPAC, December 15, 2020, available at https://www.macpac.gov/news/macpac-releases-2020-edition-of-macstats-medicaid-and-chip-data-book/. [FN4] . De La Rosa, Shawna, “Pandemic expenses drive budget increase amendments,” State of Reform, January 15, 2021, available at https://stateofreform.com/featured/2021/01/pandemic-expenses-drive-budget-increase-amendments/. [FN5] . Press release, “Enrollment Data, Announces Recent Changes To SNAP Benefits And Eligibility,” Pennsylvania Pressroom, January 6, 2021, available at https://www.media.pa.gov/pages/dhs_details.aspx?newsid=643. [FN6] . Press release, “CMS Issues New Roadmap for States to Address the Social Determinants of Health to Improve Outcomes, Lower Costs, Support State Value-Based Care Strategies,” CMS Newsroom, January 7, 2021, available at https://www.cms.gov/newsroom/ press-releases/cms-issues-new-roadmap-states-address-social-determinants-health-improve-outcomes-lower-costs. [FN7] . Press release, “REP. CASTRO AND OVER 90 COLLEAGUES URGE BIDEN ADMINISTRATION TO EXTEND ACA BENEFITS TO DACA RECIPIENTS,” Joaquin Castro Media Center, January 27, 2021, available at https://castro.house.gov/media-center/press- releases/rep-castro-and-over-90-colleagues-urge-biden-administration-to-extend-aca-benefits-to-daca-recipients. [FN8] . DeSantis, Regina, “CMS Issues New Guidance for States to Address Social Determinants of Health,” JD Supra, January 22, 2021, available at https://www.jdsupra.com/legalnews/cms-issues-new-guidance-for-states-to-2771306/. [FN9] . Imlay, Ashley, “With tens of thousands of kids without insurance, Utah lawmakers want state to step up,” Deseret News, February 9, 2021, available at https://www.deseret.com/utah/2021/2/9/22274566/2021-legislature-helping-uninsured-kids-medicaid-chip-programs- availability-pandemic-funding. [FN10] . Williams, Dave, Bureau Chief Capital Beat News Service, “?Express lane' children's Medicaid bill clears Georgia State House,” February 16, 2021, available at https://www.gwinnettdailypost.com/features/health/express-lane-children-s-medicaid-bill-clears-georgia- state-house/article_8ae79208-709f-11eb-b5b4-5332fe35cb50.html. [FN11] . Press release, “Report Finds Medicaid Expansion Associated with Lower Child Uninsured Rate,” Georgetown University Health Policy Institute Center for Children and Families, February 17, 2021, available at https://ccf.georgetown.edu/wp-content/uploads/2021/02/ MedExKidsRelease2021.pdf. [FN12] . Kirshbaum, Eli, “Utah Senate greenlights children's health care expansion bill,” State of Reform, February 26, 2021, available at https://stateofreform.com/featured/2021/02/utah-senate-greenlights-childrens-health-care-expansion-bill/. [FN13] . Press release, “Governor Murphy Highlights Cover All Kids Initiative to Provide All New Jersey Kids with Health Insurance,” Governor Phil Murphy, March 30, 2021, available at https://nj.gov/governor/news/news/562021/approved/20210330b.shtml. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -22- [FN14] . Garvin, Jennifer, “Organized dentistry thanks lawmakers for bill calling for CHIP improvements,” American Dental Association, March 29, 2021, available at https://www.ada.org/en/publications/ada-news/2021-archive/march/organized-dentistry-thanks-lawmakers-for-bill- calling-for-chip-improvements. [FN15] . Press release, “Cardin, Stabenow Seek to Close Important Gaps in Kids' Dental Care,” Cardin for Maryland, February 25, 2021, available at https://www.cardin.senate.gov/newsroom/press/release/cardin-stabenow-seek-to-close-important-gaps-in-kids-dental-care. [FN16] . Michels, Holly, “Montana House committee tables bill tightening eligibility verification on assistance programs,” Independent Record, April 13, 2021, available at https://helenair.com/news/state-and-regional/govt-and-politics/montana-senate-tables-bill-tightening- eligibility-verification-on-assistance-programs/article_5d596af4-8234-5f74-b232-c6d9ca9630db.html. [FN17] . Vadya, Anuja, “Illinois first state to offer full Medicaid benefits to women one year postpartum,” Med City News, April 15, 2016, available at https://medcitynews.com/2021/04/illinois-first-state-to-offer-full-medicaid-benefits-to-women-one-year-postpartum/?rf=1. [FN18] . Press release, “Talbot Ross introduces bill to advance health equity,” Maine House Democrats, April 15, 2021, available at https:// www.maine.gov/tools/whatsnew/index.php?topic=HouseDems+News&id=4482102&v=Article. [FN19] . Corallo, Bradley, and Robin Rudowitz, “Analysis of Recent National Trends in Medicaid and CHIP Enrollment,” KFF, April 8, 2021, available at https://www.kff.org/coronavirus-covid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment/. [FN20] . Press release, “Jayapal, Booker, and Barrag?n Introduce Legislation to Expand Health Care to Immigrants,” Pramila Jayapal Congresswoman for WA-07, May 12, 2021, available at https://jayapal.house.gov/2021/05/12/heal-act/. [FN21] . Press release, “GAO Makes MACPAC Appointments, Designates Chair and Vice Chair,” GAO Press Center, May 3, 2021, available at https://www.gao.gov/press-release/gao-makes-macpac-appointments#-designates-chair-and-vice-chair-0. [FN22] . Press release, “Fact Sheet: Medicaid & CHIP and the COVID-19 Public Health Emergency,” CMS Newsroom, May 14, 2021, available at https://www.cms.gov/newsroom/fact-sheets/fact-sheet-medicaid-chip-and-covid-19-public-health-emergency. [FN23] . Press release, “HHS Announces $14.2 Million from American Rescue Plan to Expand Pediatric Mental Health Care Access,” HHS.gov, May 20, 2021, available at https://www.hhs.gov/about/news/2021/05/20/hhs-announces-142-million-american-rescue-plan- expand-pediatric-mental-health-care-access.html. [FN24] . Pfannenstiel, Kyle, “Idaho groups push for universal child health insurance access,” Post Register, June 14, 2021, available at https://www.postregister.com/news/government/idaho-groups-push-for-universal-child-health-insurance-access/article_a166bb7f- ab90-583a-8596-0021a943c9d8.html. [FN25] . Press release, “New Medicaid and CHIP Enrollment Snapshot Shows Almost 10 million Americans Enrolled in Coverage During the COVID-19 Public Health Emergency,” HHS.gov, June 21, 2021, available at https://www.hhs.gov/about/news/2021/06/21/new- medicaid-and-chip-enrollment-snapshot-shows-almost-10-million-americans-enrolled.html. [FN26] . Press release, “Governor Hogan Announces Launch of $72 Million Maternal and Child Health Care Initiative,” Maryland.gov, available at https://governor.maryland.gov/2021/07/06/governor-hogan-announces-launch-of-72-million-maternal-and-child-health-care-initiative/. [FN27] © 2022 Thomson Reuters. No claim to original U.S. Government Works. -23- . Press release, “Geisinger expands Children's Health Insurance Program coverage to 8 more counties,” The Progress, June 30, 2021, available at http://www.theprogressnews.com/news/state/geisinger-expands-childrens-health-insurance-program-coverage-to-8-more- counties/article_cb9c5cec-7e60-513e-a127-e1c4ecf7a3a6.html. [FN28] . Corallo, Bradley, and Robin Rudowitz, “Analysis of Recent National Trends in Medicaid and CHIP Enrollment,” KFF, July 20, 2021, available at https://www.kff.org/coronavirus-covid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment/. [FN29] . Jewers, Mariellen, and Leighton Ku, “Noncitizen Children Face Higher Health Harms Compared With Their Siblings Who Have US Citizen Status,” Health Affairs, July 2021, available at https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2021.00065? journalCode=hlthaff. [FN30] . Garvin, Jennifer, “Groups urge Congress to make CHIP permanent,” ADA News, July 30, 2021, available at https://www.ada.org/en/ publications/ada-news/2021-archive/july/groups-urge-congress-to-make-chip-permanent. [FN31] . Hiller, Mark, “Wilkes-Barre services announce ?Get Kids Covered' campaign for children's health insurance,” PA Homepage, August 17, 2021, available at https://www.pahomepage.com/news/joint-wilkes-barre-services-announce-get-kids-covered-campaign-for- childrens-health-insurance/. [FN32] . Press release, “Biden-Harris Administration Releases Medicaid and CHIP Guidance Targeting Vaccination and Testing for COVID-19,” CMS Newsroom, August 30, 2021, available at https://www.cms.gov/newsroom/press-releases/biden-harris-administration- releases-medicaid-and-chip-guidance-targeting-vaccination-and-testing. [FN33] . Kayal, Michele, “Health insurance for children drops for fourth year in a row,” First Focus, September 14, 2021, available at https:// firstfocus.org/news/press-release/health-insurance-for-children-drops-for-fourth-year-in-a-row. [FN34] . Press release, “CareSource Announces Plans to Bid to Serve Iowa's Medicaid Population,” Yahoo Finance, September 29, 2021, available at https://finance.yahoo.com/news/caresource-announces-plans-bid-serve-145900143.html. [FN35] . Press release, “Executive Order Extends School Immunization, Health Assessment Deadlines to Provide NC Families and Schools Flexibility Amid Ongoing COVID-19 Pandemic,” NCDHHS, September 24. 2021, available at https://www.ncdhhs.gov/news/press- releases/2021/09/24/executive-order-extends-school-immunization-health-assessment-deadlines-provide-nc-families-and. [FN36] . Bailey, Victoria, “Impact of Fixed American Rescue Plan Act Subsidies on Families,” HealthPayer Intelligence, October 18, 2021, available at https://healthpayerintelligence.com/news/impact-of-fixed-american-rescue-plan-act-subsidies-on-families. [FN37] . Press release, “FACT SHEET: Improving Access and Care for Youth Mental Health and Substance Use Conditions,” The White House Briefing Room, October 19, 2021, available at https://www.whitehouse.gov/briefing-room/statements-releases/2021/10/19/fact- sheet-improving-access-and-care-for-youth-mental-health-and-substance-use-conditions/. [FN38] . Press release, “Coverage is Available for COVID-19 Vaccinations for Eligible Children Ages 5 through 11,” CMS Newsroom, November 3, 2021, available at https://www.cms.gov/newsroom/press-releases/coverage-available-covid-19-vaccinations-eligible- children-ages-5-through-11. [FN39] . Press release, “Polis-Primavera Administration Launches Historic Program to Connect Youth to Free Counseling Sessions,” October 27, 2021, available at https://cdhs.colorado.gov/press-release/polis-primavera-administration-launches-historic-program-to-connect- youth-to-free. © 2022 Thomson Reuters. No claim to original U.S. Government Works. -24- Produced by Thomson Reuters Accelus Regulatory Intelligence 22-Jan-2022 © 2022 Thomson Reuters. No claim to original U.S. Government Works. -25-