As the federal government prepares to transition to a new administration, states are entering their legislative sessions, with some navigating Medicaid budget shortfalls and awaiting next steps at the federal level. NASHP is working closely with states to understand their health-related priorities going into the new federal administration and how changes made at the federal level could affect states. This blog summarizes certain state Medicaid policy priorities, highlighting several section 1115 demonstration waivers approved in the final month of the Biden-Harris administration.

In the final days of the Biden-Harris administration, the Centers for Medicare and Medicaid Services (CMS) has continued to approve Section 1115 demonstration waivers¹ with a focus on extending coverage through multi-year continuous eligibility (CE) for children,  care transitions for individuals reentering the community from incarceration, and addressing health-related social needs (HRSN), among others. Arizona, Colorado, Hawaii, Maryland, Michigan, Pennsylvania, Utah, and Vermont are the most recent states to receive new approvals in these areas during the last month of the administration. The chart below summarizes states with approved and pending waivers.

• Continuous Eligibility: Nine states have pursued multi-year continuous eligibility waivers for children, meant to streamline enrollment and minimize coverage interruptions for children (generally between ages 0 to 6). States have pursued these waivers with the goal of reducing health care costs while improving access to health care. To date, data has shown that the longer an individual retains Medicaid/CHIP coverage, the lower their average monthly medical costs. Childhood is a window in which children need consistent health care support, including significant preventive care services. CE supports access to preventive care, especially for children with chronic health issues like diabetes and asthma. CE among children ages 0-6 has additionally been linked to increased school readiness including lower rates of absenteeism and higher academic achievement.
• Supporting Individuals Transitioning from Incarceration: Twenty-six states and the District of Columbia have pursued reentry waivers to test approaches for improving continuity of care for individuals exiting correctional facilities. Formerly incarcerated people experience elevated rates of mortality and morbidity, rearrests, and reincarceration. With the goal of reversing these trends, these Medicaid waivers allow states to provide incarcerated individuals with evidence-based coordinated care such as case management, medication-assisted treatment, a supply of medication upon release, and laboratory and radiology services, among others.
• Health Related Social Needs (HRSN): Twenty-one states and the District of Columbia have pursued HRSN waivers with the goal of providing coverage of clinically appropriate and evidence-based supports that address individuals’ social needs that, when unmet, can drive lapses in coverage and access to care, higher downstream medical costs, and worse health outcomes. For example, North Carolina found $85 in savings per-month per-individual for beneficiaries who received non-medical interventions through their Healthy Opportunities Pilots. The state is now expanding these pilots on a statewide basis. Approved waivers include housing and nutrition supports; case management, outreach, and education; and infrastructure and capacity building funds for community-based organizations.