There are many states that have requested additional flexibilities in order to focus their resources on slowing down the impact of the coronavirus outbreak and providing the best possible care to Medicaid enrollees in their states. Unfortunately, this is a situation that is still ongoing, and regulations will continue to be updated frequently. Click here to read the current CMMS state-by-state 1135 waiver updates. 

States Approved to Address COVID-19

Currently, there is tracking information on approved Medicaid emergency authorities to address COVID-19 emergencies. This includes the latest healthcare legislative updates and details on Medicaid Disaster Relief State Plan Amendments, other Medicaid and CHIP SPAs, and other state-reported administrative actions; Section 1115 and Section 1135 Waivers; and 1915 © Waiver Appendix K strategies. 

Benefits and Billing Legislation Assignment

Arkansas — AR S 512 – Assignment of benefits to a Healthcare Provider

• Regardless of whether the provider is in-network or out-of-network, enrollees of a healthcare plan may assign, through an assignment of benefits, their right to receive reimbursement for any healthcare service given by a healthcare provider.
• Providers that receive the assignment of benefits can issue a notice to the payer of the assignment of benefits with a claim for payment for the services issued to the enrollee. The notice must be followed by the detailed copy of the assignment of benefits with the enrollee’s signature and date of execution, if the provider is out-of-network,
• Payers who receive proper notice of the assignment of benefits and revoke payment to the enrollee or fail to pay are liable for payment to the healthcare provider and revoke payment to the provider for incorrect payment within 10 days of receiving notice from the provider. Went into effect on March 1, 2020. 

Colorado — CO H 1174 – Out of Network Health Care Services

• Health insurance carriers, health care providers, and health care facilities can supply patients covered by health benefit plans with information concerning the delivery of services by out of network providers, and in-network and out of network facilities. 
• It layouts the disclosure requirements, and the claims and payment process for the provision of out-of-network services. This Act went into effect on January 1, 2020.

Minnesota — MN S 131 – Health Care Facility Fee Disclosures

• Facility fee disclosure before treatment for non-emergency services. This Act took effect on August 1, 2019.

Nevada — NV A 469 – Emergency Services Billing

• Amount a provider of health care may charge a person who has health insurance for certain medically necessary emergency services provided when the provider is out-of-network. 
• Requires an insurer to schedule for the transfer of a person who has health insurance to an in-network facility under certain circumstances. This Act went into effect on January 1, 2020.

New Mexico — NM S 337 – Surprise Billing Protection Act

• Requires insurance to reimburse an out-of-network provider for emergency care necessary to evaluate and stabilize a patient. It also prevents balance billing of an individual at an in-network facility who receives treatment by an out-of-network provider when they do not have the option or ability to choose their provider or treatment by an out-of-network provider is medically necessary. 
• Also sets out reimbursement and overpayment procedures for surprise medical bills. This Act took effect on January 1, 2020.

Tennessee — TN H 1342 – Patient Billing Notices

• Individuals are entitled to benefits under their healthcare policy and have the right to assign their benefits to a healthcare policy and such rights must be clearly stated in the policy. 
• Notice of an assignment must be in writing to the insurer in order to be effective unless otherwise stated in the policy. 
• Out-of-network facility-based physicians may have a right of indemnification or private cause of action against the facility for an insurer’s disregard of an assignment of benefits should they provide detailed notices to the patient.
• Healthcare facilities are also prohibited from collecting out-of-network charges from an insured in excess of cost-sharing amounts unless a detailed written notice is provided prior to treatment. This Act went into effect as of April 30, 2019.

Texas – TX S 1264 – Consumer Protections Against Billing

• Consumer protections against medical and health care billing by out of network providers; provides the procedure for an injunction for balance billing and provides for enforcement by regulatory agencies.
• Provides for balance billing prohibition notices and expands the mandatory coverage of emergency care. Effective September 1, 2019.

Virginia — VA H 2538 – Balance Billing

• Dealing with elective treatment, the facility must post a notice that health care services provided by a provider group will be billed separately from the facility and that some services may not be provided by an in-network provider. 
• The facility must inform the insured person or their representative of the names of the provider groups providing treatment at the facility, that the insured should contact their insurer to determine if the providers are in-network, that the covered person may be financially responsible for services should the provider be out-of-network, and any cost-sharing requirements. This Act went into effect on July 1, 2019.

Washington — WAH 1065 – Health Care Services

• Protects patients from charges for out-of-network health care services. It includes mental health and substance use disorders to the definition of emergency medical conditions and defines balance bill, in-network, and out-of-network. This Act went into effect on January 1, 2020.

Child Health Care Coverage Legislation

Illinois – IL H 2894 – Covering All Kids Health Insurance Program Act

• Amends the Covering All Kids Health Insurance Act and extends the repeal date for the act. Went into effect on August 9, 2019.

Michigan – MI H 4304 – Child Health Care Coverage

• Provisions and enforcement of support, health care, and parenting time orders with respect to divorce, separate maintenance, paternity, child custody and support, and spousal support. Went into effect on June 20, 2019.

New Hampshire – NH S 274 – Newborn Home Visiting Program

• Newborn Home Visiting Program to be available to all Medicaid eligible families. Went into effect on September 17, 2019.

New York – NY A 8053 – Child Health Insurance Plan

• Public Health Law; extends the expiration date for the Child Health Insurance Plan. Went into effect on July 3, 2019.

Texas – TX S 750 – Maternal and Newborn Health Care

• The quality of services provided to women under certain health care programs; provides for the application for funding to implement a model of care for Medicaid recipients; provides for referrals from the Healthy Texas Women Program to the Primary Health Care Services Program; provides for enhanced prenatal and postpartum care services and provides for postpartum depression. Went into effect on June 10, 2019.

Health Insurance Legislation

Arizona — AZ H 2494 – Health Care Service Contracts

• Provides a contract between a health insurer and a health care provider that is issued, amended, or renewed on or after a certain date to provide health care services to the health insurer’s enrollees. 
• Restricts the method of payment from the health insurer to the health care provider in which the only acceptable payment method is a credit card payment or an electronic funds transfer payment. Will take effect on the 91st day after session adjournment.

California – CA S 260 – Automatic Health Care Coverage Enrollment

• Health Care Exchange must enroll an individual in the lowest costs silver plan or another plan upon receiving the individual’s electronic account from a county, or upon receiving information from the State Department of Health Care Services regarding an individual terminated from department-administered health coverage. Went into effect on January 1, 2020.

California – CA A 1802 – Health Care Service Plans: Claim Reimbursement

• Provides that the obligation of a health care service plan to comply with specified portions of the Knox Keene Health Care Service Plan Act reimbursement provisions is not deemed to be waived if the plan requires its medical groups, independent practice associations, or other contracting entities to pay claims for covered services. 
• Updates the information a health care service plan is required to provide. Went into effect on January 1, 2020.

California – CA A 414 – Health Care Coverage

• Office of Statewide Health Planning and Development to annually prepare a report on community benefits.
• Post the report and the community benefit plans submitted by the hospitals on their website. 
• The office to impose fines not to exceed $5,000 on hospitals that fail to adapt, update, or submit community benefit plans. Went into effect on January 1, 2020.

California – CA A 1309 – Health Care Coverage: Enrollment Periods

• For policy, years beginning on or after a certain date, to provide a special enrollment period to allow individuals to enroll in individual health benefit plans through the Health Benefit Exchange in a specified timeframe. Went into effect on January 1, 2020.

Colorado — CO H 1004 – Affordable Health Coverage

• Implementing a competitive state option for affordable health care coverage. 
• The state must seek authorization to use existing federal money for the proposed state option and requires the state to complete studies to determine the feasibility and requirements to implement a state plan. It was enacted on May 17, 2019.

Delaware – DE H 193 – Health Insurance Individual Health Insurance

• Creates the Health Insurance Individual Market Stabilization Reinsurance Program and Fund. Went into effect on June 20, 2019.

Delaware – DE S 35 – Insurance Code

• Amends the Insurance Code relating to health insurance contracts.
• Revises provisions relating to the individual and group health insurance markets to directly incorporate into state law the Patient Protection and Affordable Care Act’s consumer protections, including the prohibition of pre-existing condition provisions, guaranteed asset and availability of coverage, and permissible rating factors. Went into effect on August 6, 2018.

Illinois – IL S 1580 – Healthcare Disability Benefits

• State Employee Article of the Pension Code; allows licensed health care professionals to make certain disability determinations.
• Defines licensed health care professional; requires a licensed health care professional to submit his or her registration number on all reports submitted to the System.
• Eliminates the application deadline for certain disability benefits and makes changes to provisions concerning when a nonoccupational disability benefit begins to accrue. Went into effect July 12, 2019.

Illinois – IL H 2438 – Insurance Code

• Amends the Insurance Code; provides that mental, emotional, nervous, or substance use disorder or condition includes any mental health condition that occurs during pregnancy or during the postpartum period. Went into effect on August 16, 2019.

Illinois – IL H 3487 – State Health Insurance Marketplace

• Each hospital must post, in each facility that has an emergency room, a notice in a conspicuous location in the emergency room with information about how to enroll in health insurance through the State Health Insurance Marketplace. Went into effect on January 1, 2020.

Illinois – IL H 3509 – Donated Breast Milk

• State Employees Group Insurance Act, the Insurance Code, and the Public Aid Code; provides that donated breast milk must be prescribed by a licensed medical practitioner.
• Provides that milk must be obtained from a human milk bank that meets quality guidelines established by the Human Milk Banking Association of North America or is licensed by the Department of Public Health.
• Removes a requirement that the infant must be critically ill. Went into effect on January 1, 2020.

Illinois – IL S 174 – In-Office Membership Care Agreements

• Provides that an in-office membership care agreement provided under the Act is not insurance. Went into effect on August 2, 2019.

Michigan – MI H 4397 – Personal Protection Insurance

• Amends insurance laws.
• Requires insurers that offer automobile insurance to file premium rates or personal protection insurance coverage for automobile insurance policies effective after a specified date. Went into effect on June 11, 2019.

Michigan – MI S 1 – No-Fault Auto Insurance

• Makes miscellaneous changes to the Insurance Code related to no-fault automobile insurance coverage and benefit. Went into effect on June 1, 2019.

Michigan – MI S 362 – Healthy Plan Recipients

• Provides general assistance, hospitalization, infirmary, and medical care to poor or unfortunate persons; provides for compliance by this state with the Social Security Act.
• Provides protection, welfare, and services to aged persons, dependent children, the blind, and the permanently and totally disabled.
• Administers programs and services for the prevention and treatment of delinquency, dependency, and neglect of children. Went into effect on September 23, 2019.

Mississippi — MS H 628 – Health Insurance Late Payment Penalties

• Accident and health insurance policies to include additional provisions that penalize the late payment of claims by an insurer to a healthcare provider or insured party. Went into effect on July 1, 2019.

New Mexico — NM H 436 – Health Insurance Law

• Amends the Insurance Code, the Small Group Rate and Renewability Act, the Health Insurance Portability Act, the Health Maintenance Organization Law, and the Nonprofit Health Care Plan Law to align provisions relating to the accessibility of health care coverage to federal law. Went into effect on June 14, 2019.

Rhode Island – RI S 1038 – Insurer Payments on Access to Health Care Study

• Creates a Special Legislative Commission to Study the Impact of Insurer Payments on Access to Health Care. Enacted June 28, 2019.

Vermont – VT H 524 – Health Insurance and the Individual Mandate

• Health insurance and the individual mandate; clarifies who is exempt from the requirement to maintain minimum essential coverage, including certain religious, immigrant, or incarcerated individuals. Went into effect June 17, 2019, July 1, 2019, and January 1, 2020.

The Latest Healthcare Legislative Updates – Liens

Arkansas — AR S 542 – Medical and Hospital Service Liens

• Adds orthotists, prosthetists, and perdorthists as parties that can file a lien. Effective as of July 24, 2019.

Mississippi — MS S 2012 – Lien for Burn Care

• Creates a lien for causes of action accruing to an injured party for unpaid traumatic burn care. Went into effect on July 1, 2019. 

South Dakota — SD S 70 – Hospital Lien Law

• Requires hospitals that receive notification of a third-party payer of healthcare benefits for an injured person to submit to the payer for payment any reasonable and necessary charges for treatment, care, and maintenance before filing a hospital lien. 
• A lien may be filed by a person, association, limited liability company, corporation, county, or other institution, including a Municipal corporation, maintaining a hospital licensed under the laws of the state that furnish care. Effective July 1, 2019.

Utah — UT S 51 – Hospital Lien Law

• Requires that hospitals execute and file, at the expense of the hospital, a release of the lien and mail it to the injured patient, or representative upon receipt of the payment of the lien or the portion recoverable under the lien. Effective May 14, 2019.

Medicaid Programs Legislation

California – CA A 1088 – MediCal: Eligibility

• Requires the State Department of Health Care Services to seek a Medicaid state plan amendment or waiver to implement an income disregard that would allow an aged, blind, or disabled individual who becomes ineligible for MediCal benefits. Effective January 1, 2020. 

California – CA A 1642 – MediCal: Managed Care Plans

• Provide information in a request for alternative access standards and to demonstrate the delivery of MediCal services to enrollees. 
• The information must be compiled by the EQRO to include the extent to which each MediCal managed care plan uses clinically appropriate telecommunications technology to meet established time and distance standards. Effective January 1, 2020.

Connecticut – CT S 1052 – Medicaid Coverage of Telehealth Services

• Expands Medicaid coverage of telehealth services.
• Requires the Commissioner of Social Services to expand Medicaid coverage of telehealth services statewide whenever such coverage meets federal Medicaid requirements for efficiency, economy, and quality of care. Effective July 1, 2019.

Georgia — GA S 106 – Submission of Waiver Requests and Proposals

• Department of Community Health to submit a Section 1115 waiver request, which may include an increase in the income threshold; authorizes the Governor to submit an innovation waiver (Section 1332) proposal with respect to health insurance coverage or health insurance products. Passed on March 27, 2019.

Illinois — IL S 1321 – Child Care Assistance Program

• Amends the Procurement Code; directs the Chief Procurement Officer to work with the Department of Healthcare and Family Services to identify an appropriate method of source selection.
• Revises eligibility for the Children’s Health Insurance Program and other similar programs.
• Establishes a dispute resolution process. Effective August 5, 2019.

Iowa — IA H 625 – Medicaid Integration

• Integrates Medicaid and the Healthy and Well Kids in Iowa program eligibility payment and administrative functions under the Department of Human Services. Effective July 1, 2019.

Louisiana – LAH 211 – Medicaid

• Provides relative to Medicaid coverage of certain behavioral health services.
• Limits the number of reimbursable service hours per day for providers of certain behavioral health services.
• Requires release of certain information on claims for payment for behavioral health services. Effective August 1, 2019.

Louisiana – LAH 424 – Medicaid Program

• Revises provisions relating to the Medicaid program.
• Provides for denials of provider claims and prior authorization requests by Medicaid managed care organizations; requires Medicaid managed care organizations and the Department of Health to take certain actions pursuant to the denial of prior authorization requests by healthcare providers; requires publication of information related to prior authorization requirements on certain websites. Effective August 1, 2019.

Maryland — MD H 814 – Easy Enrollment Health Insurance

• Easy Enrollment Health Insurance Program, which allows the state to use tax return forms to identify uninsured residents and refer them to no-cost or low-cost health insurance. Went into effect on June 1, 2019.

Montana — MT H 658 – Healthcare Laws and Medicaid Revisions

• Extends the Medicaid Expansion Program by revising the termination date of the state Health and Economic Livelihood Partnership Act. 
• Establishes community engagement requirements for Help Act participants, ensures Medicaid eligibility verification procedures, and establishes the Help Act Employer Grant Program. Fully effective on January 1, 2020.

New Jersey – NJ A 4744 – Medicaid Medication-Assisted Treatment Benefits

• The Department of Human Services requires medication-assisted treatment benefits under the Medicaid program. Went into effect on October 13, 2019.

New Jersey – NJ S 499 – Medicaid and FamilyCare

• Provides for an improved system for eligibility determination for Medicaid and FamilyCare. 
• Relates to the time between the individual of an application and a request for verification letters sent to an applicant.
• The Department of Human Services must publish certain metrics and performance evaluation results on its website. Went into effect on August 23, 2019.

North Carolina – NC H 656 – Medicaid Transformation

• Laws pertaining to Medicaid and State Health Choice Managed Care Programs are modified as needed for the implementation of the Medicaid transformation.
• Regulations and requirements are established for dis-enrollment from prepaid health plans; revises provisions relating to the appeals process. Full in effect on October 1, 2019.

Nevada – NV S 198 – Medicaid Eligibility

• All provisions relating to Medicaid are revised. 
• The Division of Welfare and Supportive Services must analyze and report certain information concerning the eligibility of children for Medicaid. Went into effect on June 12, 2019.

Nevada – NV S 174 – Autism Spectrum Disorders Services

• Various changes relating to services provided to persons with autism spectrum disorders are modified.
• The Legislative Auditor must conduct an audit of the Medicaid program concerning the delivery of such services. Went into effect on June 7, 2019.

Texas – TX H 72 – Medicaid Benefits for Adopted Children

• Relates to the continuation of Medicaid benefits provided to certain children adopted from the conservatorship of the Department of Family and Protective Services. Went into effect on September 1, 2019.

Benefits and Billing Legislation

Colorado — CO H 1174 – Out of Network Health Care Services

• Health insurance carriers, health care providers, and health care facilities must provide patients covered by health benefit plans with information that is concerning services by out of network providers, and in and out of network facilities. Went into effect on January 1, 2020.

Nevada — NV A 469 – Emergency Services Billing

• The amount a provider of health care can charge a person is limited if they have health insurance that is for a certain necessary medical emergency when the provider is out of network. 
• An insurer must arrange the transfer of an individual who has health insurance to a facility that is in-network when necessary. Went into effect on January 1, 2020.

New Mexico — NM S 337 – Surprise Billing Protection Act

• Insurance is required to reimburse out-of-network providers for emergency services where evaluating and stabilizing a patient is necessary and prior authorization is not required with emergency situations.
• Cost-sharing is limited to the same co-payments, co-insurance, or limitations of benefits to the same extent. 
• Balance billing of an individual at an in-network facility who receives treatment by an out-of-network provider when they do not have the option or ability to choose their provider or treatment by an out-of-network provider is medically necessary is prohibited. Individuals who knowingly select an out-of-network provider may be held responsible for full charges.
• The bill also sets out reimbursement and overpayment procedures for surprise medical bills. Took effect on January 1, 2020.

Tennessee — TN H 1342 – Patient Billing Notices

• Individuals have the right to assign their benefits to a healthcare policy and those rights must be stated clearly in the policy. 
• There must be a notice of an assignment in writing by the insurer, otherwise, it isn’t effective. 
• Prior to treatment, the facility must provide a written notice to the individual or representative that includes required statements in the act.
• If a facility is out-of-network, the physicians may have a right of indemnification against the facility for an insurer’s disregard of an assignment of benefits should they provide detailed notices to the patient.
• Healthcare facilities are not able to collect out-of-network charges from an insured containing large amounts of cost-sharing unless it is in a written notice before treatment. Prior notice is not required when treatment is through an emergency department and the patient is unconscious or incapacitated but must be provided following stabilization. Went into effect on April 30, 2019.

Texas – TX S 1264 – Consumer Protections Against Billing

• Consumers are protected against medical and health care billing that is out of network.
• The procedure is provided for an injunction for balance billing.
• Enforcement by regulatory agencies is provided.
• Balance billing prohibition notices are provided and mandatory coverage of emergency care is expanded. Went into effect on September 1, 2019.

Washington — WAH 1065 – Health Care Services

• Consumers are protected from charges that are out-of-network health care services.
• Mental health and substance use disorders are added to emergency medical conditions and define balance bills, in-network, and out-of-network. Went into effect fully on June 30, 2019.

Child Health Care Coverage Legislation

Illinois – IL H 2894 – Covering All Kids Health Insurance Program Act

• Amends the Covering All Kids Health Insurance Act. 
• The repeal date for the act is extended. Went into effect on August 9, 2019.

Michigan – MI H 4304 – Child Health Care Coverage

• Provisions and enforcement of support, health care, and parenting time orders dealing with divorce, separate maintenance, paternity, child custody and support, and spousal support are provided.
• Prescribes the powers and duties of the circuit court and friend of the court.
• Prescribes certain duties of certain employers and other sources of income. 
• Provides for penalties and remedies. Went into effect on June 20, 2019.

New Hampshire – NH S 274 – Newborn Home Visiting Program

• Newborn Home Visiting Program shall be available to all Medicaid eligible families. Went into effect on September 17, 2019.

New York – NY A 8053 – Child Health Insurance Plan

• Amends the Public Health Law. 
• The expiration date for the Child Health Insurance Plan is extended. Went into effect on July 3, 2019.

Texas – TX S 750 – Maternal and Newborn Health Care

• Relates to the quality of services provided to women dealing with maternal and newborn health care.
• An application for funding to implement a model of care for Medicaid recipients is provided.
• Provides for referrals from the Healthy Texas Women Program to the Primary Health Care Services Program
• Provides for enhanced prenatal and postpartum care services, including postpartum depression. Went into effect on June 10, 2019.

Health Insurance Legislation

Arizona — AZ H 2494 – Health Care Service Contracts

• A contract between a health insurer and health care provider must be issued, amended, or renewed on or after a specific date to provide health care services to health insurer’s enrollees. 
• Can not restrict the method of payment from a health insurer to health care provider if a credit card payment is the only acceptable method or an electronic funds transfer payment. Will take effect on the 91st day after session adjournment.

California – CA S 260 – Automatic Health Care Coverage Enrollment

• Requires the Health Care Exchange to enroll an individual in the lowest costs silver plan or another plan upon receiving the individual’s electronic account from a county, or upon receiving information from the State Department of Health Care Services regarding an individual terminated from department-administered health coverage. Went into effect on January 1, 2020.

California – CA A 1309 – Health Care Coverage: Enrollment Periods

• A health care service plan and a health insurer are required for a policy beginning on or after a specific date, to provide an enrollment period to allow individuals to enroll in individual health benefit plans through the Health Benefit Exchange in a specified timeframe. Went into effect on January 1, 2020.

Delaware – DE S 35 – Insurance Code

• The Insurance Code relating to health insurance contracts is amended.
• Provisions relating to the individual and group health insurance markets that work directly with the Patient Protection and Affordable Care Act are revised. Went into effect on August 6, 2018.

Illinois – IL H 3487 – State Health Insurance Marketplace

• Amends the University of Illinois Hospital Act and Hospital Licensing Act.
• Each hospital must post in each emergency room, a notice in a location that can be seen easily about how to enroll in health insurance through the State Health Insurance Marketplace. Went into effect on January 1, 2020.

Illinois – IL S 174 – In-Office Membership Care Agreements

• The In-Office Membership Care Act is amended.
• Provides that an in-office membership care agreement provided under the Act is not insurance. Went into effect on August 2, 2019.

Maine — ME S 10 – Consumer Protections for Health Coverage

• The consumer is protected in relation to health insurance coverage included in the federal Patient Protection and Affordable Care Act.
• Individuals and group health plans can not impose any pre-existing condition exclusion on an enrollee and carriers are restricted to enrollment in individual health plans to open enrollment and special enrollment periods established in the rule. Went into effect on March 19, 2019.

Michigan – MI H 4397 – Personal Protection Insurance

• Insurance laws are amended.
• Insurers are required to offer automobile insurance to file premium rates or personal protection insurance coverage for automobile insurance policies effective after a specified date.
• Relates to transportation network companies. Went into effect on June 11, 2019.

Mississippi — MS H 628 – Health Insurance Late Payment Penalties

• Accident and health insurance policies require additional provisions that penalize late payments of claims by an insurer to a healthcare provider or insured party. Went into effect on July 1, 2019.

Nevada — NV A 170 – Health Insurance Coverage

• The insurer must provide information that is related to accessing health care services to the Office of Consumer Health Assistance, the Governors Consumer Health Advocate to submit a report of such information to the Legislature, an insurer to offer a health benefit plan regardless of health status, and an Advocate to take certain actions to assist consumers in accessing health care services. It incorporates ACA protections on a state level. Went into effect on January 1, 2020.

New Jersey – NJ A 5499 – Health Benefit Plan State-Based Exchange

• The Department of Banking and Insurance is authorized to establish an exchange for certain health benefits in-state.
• The Department of Health Services is required to apply for federal funds for integration of Medicaid eligibility platforms and exchange. Enacted June 28, 2019. 

New Mexico — NM H 285 – Short-Term and Limited Benefit Plan Act

• Establishes guidelines relating to a short-term health and excepted benefit coverage.
• No longer able to sell and issue unlicensed and unapproved health benefits plans.
• Amends sections of the New Mexico insurance code, the health maintenance organization law, and the nonprofit health care plan law to establish direct-service ratio applicability for short-term plans. Went into effect on June 14, 2019.

The Latest Healthcare Liens Legislation

Arkansas — AR S 542 – Medical and Hospital Service Liens

• Orthotists, prosthetists, and perdorthists are added as parties that can now file a lien. Went into effect on July 24, 2019.

Mississippi — MS S 2012 – Lien for Burn Care

• Lien is created for the cause of actions occurring to injured individuals for traumatic burn care that is uncompensated. Went into effect on July 1, 2019.

South Dakota — SD S 70 – Hospital Lien Law

• Amends the hospital lien law. 
• Requires that hospitals receive notification of a third-party payer of healthcare benefits for an injured individual to submit to the payor for payment any reasonable and necessary charges for treatment, care, and maintenance before filing a hospital lien.
• If a lien has already filed, they will then need to submit a request for payment to the payer. If the payer fails to pay, the hospital can file a lien or enforce the existing lien. Went into effect on July 1, 2019.

Utah — UT S 51 – Hospital Lien Law

• At the expense of the hospital, hospitals must execute and file a release of the lien and mail it to the individual that is injured, their heirs, or representative upon receiving the payment of the lien or the portion recoverable under the lien. Went into effect May 14, 2019.

Medicaid Programs Legislation

California – CA S 78 – Health

• Certain health information is allowed to be shared that is related to lead screening for children enrolled in MediCal.
• Minimum Essential Coverage Individual Mandate is created to require individuals to maintain minimum essential coverage.
• Individual Market Assistance is created to be able to provide healthcare coverage assistance.
• Vocational rehabilitation programs are provided for. Enacted June 27, 2019

California – CA A 1088 – MediCal: Eligibility

• The State Department of Health Care Services must seek a Medicaid state plan amendment or waiver to implement income disregard that allows aged, blind, or disabled individuals who become ineligible for MediCal benefits to remain eligible for the MediCal program if their income resources otherwise meet the rest of the eligibility requirements. Went into effect on January 1, 2020.

Connecticut – CT S 1052 – Medicaid Coverage of Telehealth Services

• The Commissioner of Social Services requires Medicaid to expand coverage of telehealth services statewide when coverage meets federal Medicaid requirements. Went into effect on July 1, 2019.

Hawaii – HI H 1453 – Emergency Ambulance Services

• The Department of Health is authorized to establish fees for transportation to medical facilities for emergency medical services.
• Transportation by ambulance to other medical facilities that are not hospitals under emergency circumstances are also authorized.
• Medicaid and private insurances are required to cover ambulance services.
• Medicaid programs and private insurers are required to provide coverage for statewide community paramedicine services rendered by emergency medical technicians or paramedics. Went into effect on June 25, 2019.

Illinois — IL S 1321 – Child Care Assistance Program

• The Procurement Code is amended.
• The Department of Healthcare and Family Services is required to work with the Chief Procurement Officer to identify a method of source selection for the proper techniques required to be able to implement the Integrated Eligibility System.
• Eligibility for the Children’s Health Insurance Program is revised. Went into effect on August 5, 2019.

Iowa — IA H 625 – Medicaid Integration

• Medicaid and the Healthy and Well Kids in Iowa program eligibility payment and administrative functions are integrated. Went into effect on July 1, 2019.

Louisiana – LAH 211 – Medicaid

• Medicaid coverage of specific behavioral health services is provided.
• The number of reimbursable service hours a day is limited for providers with specific behavioral services. 
• Requires inclusion of certain information on claims for payment for behavioral health services. Went into effect on August 1, 2019.

Maryland — MD H 814 – Easy Enrollment Health Insurance

• The Easy Enrollment Health Insurance Program is established. Went into effect on June 1, 2019.

New Jersey – NJ A 4744 – Medicaid Medication-Assisted Treatment Benefits

• The Department of Human Services is required to ensure that medication treatment benefits are provided under Medicaid programs without prior authorization. Went into effect on October 13, 2019.

New Mexico — NM S 41 – Medicaid Providers Due Process

• Preserves access to Medicaid services and Medicaid providers and subcontractors are provided with due process.
• Provides for hearing officers and judicial review of credible allegations towards fraud determination.
• Hearing officers are provided for. Went into effect on January 1, 2020.

North Carolina – NC H 656 – Medicaid Transformation

• Laws pertaining to Medicaid and State Health Choice Managed Care Programs are modified for implementation of Medicaid transformation.
• Regulation and requirements for dis-enrollment from prepaid health plans are established.
• Provisions related to the appeals process are revised. Went into effect fully on October 1, 2019.

New Hampshire – NH S 290 – State Granite Advantage Health Care Program

• Changes to the State Granite Advantage Health Care Program were made including: 
  • Beneficiaries that are subject to the work and community engagement requirements.
  • The number of hours for work and community engagement requirements are reduced.
  • Exemptions for certain individuals are added.
  • Circumstances for the elimination of the requirements are added. Went into effect on July 8, 2019.

Nevada – NV S 198 – Medicaid Eligibility

• Provisions relating to Medicaid are revised.
• The Division of Welfare and Supportive Services are revised to ensure specific information dealing with the eligibility of children for Medicaid. Went into effect on June 12, 2019.

Nevada – NV S 174 – Autism Spectrum Disorders Services

• Changes were made relating to services provided to individuals with autism. 
• The Legislative Auditor requires an audit of Medicaid programs that concern the delivery of services. Went into effect on June 7, 2019.

Texas – TX H 72 – Medicaid Benefits for Adopted Children

• Medicaid benefits are provided to specific children that are adopted from the conservatorship of the Department of Family and Protective Services. Went into effect on September 1, 2019.

What’s Next?

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While most States have chosen to adopt some form of Medicaid expansion, fourteen states have yet to expand Medicaid to individuals and households meeting the new requirements. The main reason? Financial concerns regarding the effectiveness of expansion to improve coverage, access, and economic measures. States which have not adopted Medicaid expansion include Wyoming, South Dakota, Wisconsin, Kansas, Missouri, Oklahoma, Texas, Tennessee, Missouri, Alabama, Georgia, North Carolina, South Carolina, and Florida. 

Unfortunately, the issue that arises in non-expanded states is the problem of having more people in the coverage gap, which results in a slew of other issues. For example, “hospitals in states that enacted the expansion got a wave of newly insured patients, while those in states that rejected it were left with large numbers of uninsured individuals.” In effect, non-expanded states have “suffered a significant increase in hospital closures.” In contrast, states that have decided to take part in Medicaid expansion continue to see improvements in coverage, access, and economic measures. Thus, while expansion is certainly optional, Medicaid expansion carries immense benefits not only for patients and hospitals, but also for states.

What does Medicaid Expansion Entail?

Medicaid expansion aims to reduce the coverage gap by raising the income ceiling for Medicaid up to 138 percent of the federal poverty level. As such, Medicaid expansion covers all families and individuals that fall under this income level. According to the Center for American Progress, this includes “groups who are currently left out of public health coverage such as low-income, able-bodied parents, low-income adults without children, and many low-income individuals with chronic mental illness or disabilities, who struggle to maintain well-paid jobs but don’t currently meet disability standards for Medicaid.” 

At its core, Medicaid expansion seeks to increase healthcare coverage and extend access to healthcare to the poorest and most disadvantaged Americans while also providing economic security for the middle class. Yet, some states worry that the cost of implementing Medicaid expansion will wreak havoc on their state budgets and thus outweigh its perceived benefits. However, Kaiser Family Foundation (KFF) reports that significant research has “indicate[d] that the expansion is linked to gains in coverage; improvements in access, financial security, and some measures of health status/outcomes; and economic benefits for states and providers.” 

How does Medicaid Expansion Benefit Patients?

While Medicaid expansion has not completely closed the coverage gap, expanded states have certainly seen a huge difference. In the fourteen states that did not expand coverage, Medicaid is often limited to 40% of the Federal Poverty Level and only to those with children, with childless adults left out altogether. Yet, most people earning more than the Medicaid threshold but still below the federal poverty level cannot afford insurance, even when subsidized. This means that more than two million people who fall under the coverage gap are left uncovered and unprotected.

If all states were to expand Medicaid, all of these people would be eligible. Furthermore, Medicaid may also offer better coverage than certain plans available in the marketplace. This is especially true for long-term support and behavioral health. Thus, Medicaid expansion benefits patients in providing better access to healthcare.

The purpose of the expansion was to reduce the number of uninsured adults, and it clearly does so. In fact, states that do not adopt the expansion saw a significant increase in the number of uninsured adults between 2017 and 2018. This leads us to our next point: Medicaid expansion can do so much more for low-income individuals and households than merely provide access to healthcare. 

According to Sarah Baron, “Medicaid expansion is much more than access to health insurance. Every dollar a mother doesn’t need to spend on out-of-pocket costs when her child comes down with the flu can go toward food, housing, and other necessities. Medicaid coverage translates into financial flexibility for families and individuals, allowing limited dollars to be spent on basic needs, including breakfast for the majority of the month or a new pair of shoes for a job interview. Medicaid expansion means more than health care coverage; it is an expanded opportunity for success and a pathway to the middle class.”

How does Medicaid Expansion Benefit Hospitals?

As expected, Medicaid expansion greatly benefits hospitals all over the country. If a patient comes in uninsured and unable to pay, chances are the hospital may never be able to collect on the bill. No matter how efficient the hospital’s billing processes may be, a hospital will very rarely receive reimbursement from people who don’t have money to pay in the first place. While payment plans may help, enrolling people in those plans still lengthens the reimbursement process. As a result, hospitals may increase their medical charges so that people who can pay more might cover the gap of lost revenue. All of this takes time, effort, and resources, none of which guarantees a win-win solution to offset bad debt effectively.

In addition, rural hospitals in non-expanded states, specifically those in the Midwest and Texas, have also seen a higher rate of closure than rural hospitals in expanded states. Not only that, the loss of rural hospitals is directly associated with a higher rate of mortality and reduced patient satisfaction. Why? Loss of rural hospitals mean that patients in smaller towns have longer distances to the nearest medical facility. In effect, they are more likely to delay care or avoid medical attention, which may lead to worsened symptoms. All in all, this affects not just the hospitals, but the health of small towns in general.

On the other hand, low-income patients who do have Medicaid allow hospitals to be reimbursed, albeit at lower levels than from private insurers. Still, some reimbursement is always better than no reimbursement. Hospitals in expanded states often have healthier revenue cycle processes and are more likely to overcome the threats of closure. This is why in most cases, hospitals are eager to have every eligible patient enrolled on Medicaid. That being said, while patient advocates increase the chances of eligible patients receiving Medicaid, only states have the power to widen eligibility so that more people qualify.

To Expand or Not to Expand Medicaid

The main argument that governors and state legislatures have used to opt-out of Medicaid expansion is typically financial: they claim the state can’t afford such high financial risk. At first glance, this concern makes sense because Medicaid often takes up the largest share of most state budgets. What’s more, states can’t borrow money the way the Federal government can. This results in governors and state legislatures being concerned that adopting Medicaid expansion means they have to redistribute the budget and take away from other currently-funded programs.

As a result, the common stance between non-expanded states is that Medicaid expansion does not benefit states. According to numerous studies and research, however, this is not the case. 

How does Medicaid Expansion Benefit States?

To address the main financial concern of non-expanded states, let’s first talk about the financial benefits that come with adopting Medicaid expansion.

The Federal share of Medicaid expansion costs is currently set at 90%, much higher than what it was under pre-ACA criteria. According to the Commonwealth Fund, “This leaves states on the hook for at most 10 percent of the total cost of enrollees in the new eligibility category — considerably less than the roughly 25 percent to 50 percent of the cost that states pay for enrollees eligible for Medicaid [before ACA].”

In addition, states that cover hospitals’ uncompensated care costs may also benefit financially. Arkansas, one such state that also took up Medicaid expansion in 2014, estimates that it will produce “net state savings each year through fiscal year 2021, and $444 million total from 2018-2021” through Medicaid expansion. The reason? Expanded states often “pay less to hospitals to cover uncompensated care costs” because hospitals typically see higher reimbursement rates after Medicaid expansion. What’s more, some states have also seen that taxes on managed care organizations serving Medicaid beneficiaries can significantly offset the cost of expansion. 

Other states have also found that they saved money from lower costs for mental health care programs designed to fill the gap in various marketplace plans. In fact, Virginia anticipates that Medicaid expansion will save $421 million over two years as it claims “the enhanced matching rate for some populations it previously covered at its regular Medicaid match (50 percent) and generates savings in its corrections system and elsewhere.”

Other Ways Medicaid Expansion Benefits States

In addition to the significant financial savings of Medicaid expansion, there are less obvious benefits to adopt expansion. This includes:

1. Low-income individuals getting access to more preventive care. Not only is this a huge benefit for patients, this also eliminates further costs to hospitals and states, as would be the case if preventable illnesses were left untreated.
2. A reduction in people using the ER as their primary care physician.
3. An increased incentive for low-income individuals and households to work. With the lower income requirement of non-expanded states, people might decide to postpone work because they worry they will lose their Medicaid coverage if their incomes were to increase into the coverage gap range. 
4. Reduction in mortality. A study found that expanded states see a 6.1% decrease in mortality rates compared to similar non-expanded states.
5. Improved health and economy. According to several studies, people who have access to Medicaid or other health coverage have better health and lower rates of depression. In effect, healthier individuals result in a significant reduction in workplace absenteeism, which in turn contributes to the good of the overall economy.

About Midland

The Midland Group is a trusted patient advocacy firm. Having worked with different facilities across the country, we have seen firsthand the incredible benefits that accompany Medicaid expansion: for the patients, hospitals, and states. Since 1989, our goal has always been to increase people’s access to healthcare and protect the financial health of our partner hospitals. With over 30 years of experience, our team stands by ready to assist patients in our partner hospitals to qualify for various public benefits programs. Our trained patient advocates are familiar with all the tools and ever-changing rules and regulations revolving around all forms of health-related public benefits. Contact us today for more information regarding our suite of services.

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