Posted on

TECH (IN)- Breach exposes information of 200,000+ Hoosier Medicaid members

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: The latest casualty in the MOVEit debacle.



Clipped from:


Hoosiers on Medicaid are facing the impacts of a global software breach in late May. (Screenshot from FSSA)

The personal health information of more than 200,000 Hoosiers on Medicaid may have been exposed in a global software breach in late May, the Indiana Family and Social Services Administration (FSSA) announced Friday.

That includes the names, addresses, Social Security numbers, dates of birth, gender, medical conditions, diagnoses, medications, allergies, health conditions, member IDs and plan names of 212,193 Medicaid recipients utilizing Indiana’s services.

Those affected are part of a managed care plan provided by Ohio-based CareSource.

A file transfer software the company was using, called MOVEit, was breached briefly in late May.

CareSource “immediately remediated the breach” and notified FSSA, according to the agency. And the company is contacting those affected with information and credit monitoring options.

It’s part of the same MOVEit hack that, in August, the agency said exposed the names, addresses, case numbers and Medicaid numbers of more than 744,000 Hoosiers on Medicaid. Just four people’s social security numbers were accessed, however.

In that case, the software was being used by Indiana’s health coverage programs enrollment broker, Maximus Health Services.

The breach has impacted an estimated 1,000 organizations and 60 million people worldwide, according to TechCrunch.


Posted on

MCOS (NY)- New York managed Medicaid plan shutting down, prompting layoffs

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: Its not every day you see a MLTC plan close shop. This one could not deal with the “must also have a D-SNP” requirement happening in the NY market in 2024.



Clipped from:

Amherst, N.Y.-based Fallon Health Weinberg is closing a long-term Medicaid managed care plan and laying off 31 employees between Dec. 15 and Jan. 12, 2024, according to a WARN notice filed with the state.

Fallon Health Weinberg was founded in 2014 as a joint partnership between Worcester, Mass.-based Fallon Health and Weinberg Campus, a retirement community in suburban Buffalo, N.Y.

Fallon Health Weinberg offers an all-inclusive managed care plan for the elderly (PACE) and a managed long-term care (MLTC) plan for Medicaid eligible residents.

The MLTC plan is set to close following new state requirements mandating all health plans to offer a D-SNP plan by 2024. Fallon Health Weinberg was unable to meet the Jan. 1 deadline and chose to end the program, Buffalo Business First reported Aug. 15.

A spokesperson for Fallon Health told Becker’s it is one of several plans closing a long-term managed care program because of the new state requirements.

“We are disappointed that we will no longer be able to support these individuals and are focused on helping them transition to other programs, as appropriate,” the spokesperson said. “We anticipate they will receive information from the state in the coming weeks regarding their options. We will support all MLTC employees affected by this decision in the months ahead with severance and with job search and outplacement services.”

Subscribe to the following topics: seoamherstny.warn noticefallon health weinberg

Posted on

MH/BH- HHS Awards $127.7 Million to Expand CCBHC Program

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: Another round of funding for the program started in 2017. The original round got launched 67 clinics in 8 states; the latest awards went to 128 clinics in 40 different states and Puerto Rico.



Clipped from:

The Department of Health and Human Services (HHS), through the Substance Abuse and Mental Health Services Administration (SAMHSA), announced on Thursday that it has designated $127.7 million to expand the Certified Community Behavioral Health Clinics (CCBHCs) program across the US.

Under the Bipartisan Safer Communities Act (BSCA), the awards will enable up to 10 additional states to create state CCBHC programs under Medicaid every 2 years, starting in 2024, providing sustainable funding for CCBHC services to Medicaid beneficiaries.

CCBHCs are required to provide a specified range of behavioral healthcare services, including crisis care 24 hours per day and 7 days a week, as well as routine outpatient care within 10 business days after initial contact.

“CCBHCs serve anyone who asks for help for mental health or substance use, regardless of their ability to pay, and in turn, people being served by CCBHCs experience less homelessness, less illegal substance use, and reduced use of jails, prisons, emergency rooms and hospitals for behavioral health issues,” Miriam Delphin-Rittmon, PhD, HHS assistant secretary for mental health and substance use and the leader of SAMHSA, said in a news release. “This is a model of care that truly works to serve the whole community.”

The first CCBHCs were funded under Medicaid in 2017, with the launch of 67 clinics in an 8-state demonstration program. Currently, there are 500 CCBHCs operating in 46 states, Washington, DC, Guam, and Puerto Rico.

The awarded funds announced on Thursday include 128 grants to health clinics in 40 states and Puerto Rico, with each grantee receiving up to $1 million per year for 4 years. Of the 128 total grants, 63 totaling $62.8 million were designated for assist clinics to establish and implement new CCBHC programs through the CCBHC Planning, Development, and Implementation (CCBHC-PDI) grant. The remaining 65 grants totaling $64.9 million will be used to enhance and support existing CCBHCs through the CCBHC Improvement and Advancement grant program.

The National Council for Mental Wellbeing provides support to stakeholders interested in learning about the CCBHC model or are pursuing implementation. Rebecca Farley David, the National Council’s special advisor of public policy and special initiatives, said the organization was pleased with Thursday’s grant announcement.

“We’re very excited to see the announcement of the grants today—thrilled for all the organizations that received grants,” she told Behavioral Healthcare Executive. “I think this is another exciting step towards the future expansion of this program and one that will help bring CCBHC services to a lot more communities.

“The grant funding is an incredibly helpful source of support for clinics that want to go after a CCBHC status as their states are considering putting CCBHCs into place in Medicaid. And in that way, these 2 programs—the demonstration program in Medicaid and the grant program through SAMHSA—are quite complementary.”


Approaching 60th anniversary of Community Mental Health Act of 1963, the Biden-Harris administration awards nearly $130 million to expand Certified Community Behavioral Health Clinics across US. News release. US Department of Health and Human Services. Se

Posted on

MH/BH- Biden-Harris Administration Announces More Than $200 Million To Support Youth Mental Health

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: Lots of new funding for MH/BH and kids announced. 3 major packages out of SAMHSA, ACF and HRSA.



Clipped from:

Builds on unprecedented investment through President Biden’s Unity Agenda to tackle the mental health crisis and support community-based behavioral health care and treatment.

The U.S. Department of Health and Human Services (HHS), through the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (HRSA), and the Administration for Children and Families (ACF), announced $206 million in grant awards towards youth mental health. Also today, Centers for Medicare & Medicaid Services (CMS) will make more Medicaid funding available for school-based health services in Virginia, improving health care access, including mental health services. Combined, these awards will help expand access to mental health services for students in schools, bolster the behavioral health workforce, and improve access to mental health prevention and treatment for children and youth in communities across the country. And they represent a key next step in President Biden’s Unity Agenda, which is making unprecedented investments to tackle the mental health crisis and transform how mental health is understood, accessed, treated, and integrated in and out of health care settings.

The investments include the following:

“The Biden-Harris Administration is deeply committed to tackling the mental health crisis facing America, particularly among our young people. Expanding mental health care services to ensure that everyone who needs help can access care when and where they seek it is a key element of President Biden’s Unity Agenda,” said HHS Secretary Xavier Becerra. “We are transforming mental health and substance use treatment across the country by providing equitable access to services for all Americans. These tools and resources will help families struggling to meet the mental health care needs of their children.”

Recent data confirms that young people need more support to address their mental health and substance use disorder challenges. The most recent Youth Risk Behavior Survey found that nearly three in five U.S. teen girls felt persistently sad or hopeless in 2021 – representing a nearly 60% increase over the past decade. It also found that 22% of high school students seriously considered attempting suicide during the past year.

“These awards reflect the extraordinary commitment of the Biden-Harris Administration to addressing youth mental health,” said Deputy Secretary Andrea Palm. “The tools and resources that we are providing will help children who are struggling by meeting them and their families where they are, and ensuring there is no wrong door to behavioral health care.”

Supporting at Risk Youth and Families

$131.7 Million from SAMHSA to Support At-risk Youth and Families

  • $5.7 million for Planning and Developing Infrastructure to Promote the Mental Health of Children, Youth and Families in American Indian/Alaska Native (AI/AN) Communities,
  • $5.5 million for Cooperative Agreements for School-Based Trauma-Informed Support Services and Mental Health Care for Children and Youth,
  • $2.4 million for Linking Actions for Unmet Needs in Children’s Health (Project LAUNCH), $16.4 million for Healthy Transitions: Improving Life Trajectories for Youth and Young Adults with Serious Mental Disorders Program,
  • $41.2 million for Grants to Expand Substance Abuse Treatment Capacity in Adult and Family Treatment Drug Courts,
  • $48.3 million for Grants for Expansion and Sustainability of the Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances (System of Care SOC Expansion and Sustainability),
  • $1.8 million for Preventing Youth Overdose: Treatment, Recovery, Education, Awareness and Training,
  • $8.7 million for Behavioral Health Partnership for Early Diversion of Adults and Youth, and
  • $1.7 million for Family Counseling and Support for Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex+ Youth and Their Families.

Expanding Access to Youth Mental Health Care

$55 Million from HRSA for Expanding Access to Youth Mental Health Care:

  • $25 million to 77 HRSA-funded health centers to create new and expand existing school-based health centers,
  • $19 million to 25 states and territories to train pediatricians in mental health care and provide real-time teleconsultation for pediatricians to get expert support from psychiatrists and other mental health providers to help them care for their patients’ mental health needs,
  • $11 million to 23 organizations to train more behavioral health providers focused on serving children, adolescents, and young adults in underserved and rural areas.

Center to Support Mental Health Services in Child Welfare

$20 Million from ACF to Launch First National Center to Support Mental Health Services in the Child Welfare System:

  • $20 million to the National Center to Support Mental Health Services in the Child Welfare System to provide technical assistance and evidence-informed training to strengthen coordination and capacity among child welfare and mental health professionals and systems to improve the quality of mental health services they provide to children, young adults, and their families who are involved in the child welfare system and who have experienced adoption.

Expanding School-Based Health Services

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat

To learn how to get support for mental health, drug, and alcohol issues, visit

Anyone seeking treatment for mental health or substance use issues should call SAMHSA’s National Helpline at 800-662-HELP (4357) or visit

For more information on ACF’s behavioral health initiatives and resources, please visit:

Reporters with questions for SAMHSA should email, for HRSA should email, for ACF should email, for CMS should email

Posted on

MH/BH- Joe Biden’s taking on insurers to address America’s mental health crisis

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: It’s great to see someone suggest we enforce MH parity laws on the books for years- but I’m not sure fines of $100 a day are going to move the dial on companies making billions a month.



Clipped from:

Health Care

The administration says insurance companies are using loopholes to deny mental health care. Insurers say that’s not the case.


“We always hope for collaboration, but the rule has sticks as well,” Neera Tanden, head of President Joe Biden’s domestic policy council, told POLITICO. “We hope insurers will change their behavior going forward without the sticks, but we will continue to fully enforce the parity law.”

Those sticks include fines of $100 per policyholder per day if insurers don’t close loopholes the administration says they’re using to limit what they pay for mental health care. The administration says those ploys include requirements that doctors seek insurers’ approval before delivering care, lower reimbursement rates for providers who treat mental illness and deliberate efforts to limit the number of in-network physicians available to patients.

Insurance companies say Biden is scapegoating them and that they are already doing their best to lean on technology like telehealth to boost access to care, expand their provider networks and increase what they pay those providers. They’re also trying to better integrate mental health in primary care.

“Nobody has a magic wand to create the number of mental health providers to match the number of physical health providers,” said Craig Smith, partner at law firm Hogan Lovells and former general counsel for Florida’s Agency for Health Care Administration. “You can promulgate regulations. You can pass statutes. No amount of government oversight or enforcement can magically solve the challenge.”

The real issue, the insurance companies argue, is the lack of qualified mental health care providers. Nearly half of the U.S. population lives in an area with a mental health worker shortage, according to health policy research group KFF.

Still, the White House points to a 2022 report to Congress from the Health and Human Services, Labor and Treasury departments, which found that not one of the 156 insurance plans and issuers studied were following rules requiring them to measure their compliance with the 2008 law.

The problem is actually quite simple, advocates of the Biden rules say.

“The insurers are cracking down on mental health reimbursement in order to save money,” said Sen. Chris Murphy (D-Conn.).


Health Care

Biden to crack down on ‘junk’ health insurance

By Adam Cancryn and Robert King | July 06, 2023 01:43 PM

A decadeslong campaign

On Capitol Hill, Democrats and Republicans are alarmed at the state of their constituents’ mental health. Some lawmakers are even opening up about their own struggles.

The Covid-19 pandemic brought the issue to the fore as anxieties about the disease and the social isolation of government lockdowns exacerbated mental health conditions and substance use disorders.

More than a third of adults said they had symptoms of anxiety or depression during the pandemic, and 90 percent of U.S. adults think the nation is in a mental health crisis, according to KFF.

Suicide rates jumped the most they have in decades, up to 14.1 per 100,000 people in 2021, according to the most recent Centers for Disease Control and Prevention data.

Yet access to care has lagged.

Estimates vary, but the latest data from HHS indicates that more than half of adults with mental illness don’t get treatment. Treatment levels may be even lower for substance use conditions like opioid use disorder — just 1 in 5 U.S. adults got medication treatment for it in 2021, according to the latest National Institute on Drug Abuse data.

And while barriers to mental health and substance use disorder treatment vary by condition, stigma is a common throughline, experts say.

The U.S. health care system historically treated mental and physical health care differently. Insurers didn’t typically cover mental health care until after World War II. Insurance coverage was originally fragmented and separated from the broader system, said Colleen Barry, dean of Cornell University’s Brooks School of Public Policy.

“For so long, mental health was a dirty stepchild of health care,” said Maureen Maguire, the American Psychiatric Association associate director of parity implementation and enforcement policy. “There was a lot of shame involved in it. People didn’t want to get help. If you couldn’t find help, you didn’t want to say you couldn’t find help.”

Administrations going back decades have made improving access to care a priority.

John F. Kennedy was the first president to take significant steps to achieve parity for mental health in 1961. He called for the health insurer for federal employees — which offered limited mental health care — to cover it at the same levels of other care.

From then until the 1990s, efforts to expand parity were largely at the state level, according to Barry’s research.

The Mental Health Parity Act of 1996, signed by former President Bill Clinton, required plans to cover mental health equally, but only in terms of annual or lifetime benefit maximums.

In 2008, then-President George W. Bush signed the Mental Health Parity and Addiction Equity Act, whose chief House sponsor, then-Rep. Patrick Kennedy (D-R.I.) used his own struggles with mental illness to convince colleagues to support it.



The law mandated that deductibles and co-pays, as well as treatment limitations, be equivalent to those for physical health care, and enactment was seen as a landmark win.

Since opting not to seek reelection in 2010, Kennedy, the youngest child of former Sen. Ted Kennedy (D-Mass.), has worked to ensure his law is working.

“The more insidious fight over the years, which is why these rules are so important, is around discriminatory medical management practices by payers,” he said. “It’s a lot more challenging to wrap your arms around the myriad ways that insurance companies can limit access.”


White House

White House closely watching McConnell amid health scare

By Jennifer Haberkorn and Jonathan Lemire | July 27, 2023 05:20 PM

Biden’s plan

The new proposed regulations, from HHS and the Treasury and Labor departments, are open for public comment until Oct. 2.

If finalized, they would mandate that insurers analyze their coverage to ensure equivalent access to mental health care based on outcomes.

The companies would have to look at how they respond to requests from doctors to authorize treatments for mental illness, compared with physical ones, as well as audit their provider networks and examine how much they reimburse providers out of network.

“This is something that you would have expected the issuers and plans to be doing as part of their own internal analysis to ensure compliance,” said JoAnn Volk, co-director of the Center on Health Insurance Reforms at Georgetown University.

One major problem Biden’s proposal targets is that of “ghost networks” — inadequate numbers of mental health providers who take insurance — forcing subscribers to go out of network and pay more.

The rule would also establish when health plans can’t require doctors to obtain prior authorization to prescribe a medicine or procedure, or otherwise put up roadblocks for patients seeking mental health, as well as substance use treatment.

Insurers could face fines of up to $100 per day per patient for failing to offer comparable coverage for mental health.

But enforcement could be a challenge, and it’s unclear how aggressive the administration would be. Previous enforcement has largely been collaborative, not punitive.

The Department of Labor has had limited resources to enforce the existing regulations, prompting Murphy to seek more in new legislation.

Insurers’ ally

Insurers say they agree that access to mental health care should be equivalent to that of physical health care.

But AHIP, the lobbying group for insurers, says the situation is more complicated than Biden makes out, and that workforce shortages are what’s behind barriers to care.

“Access to mental health has been, and continues to be, challenging primarily because of a shortage and lack of clinicians, which is why for years, health insurance providers have implemented programs and strategies to expand networks and increase access,” AHIP spokesperson Kristine Grow said in a statement.

The group said those include boosting telehealth coverage and integrating physical and mental health care. And it points to rising mental health care usage since the 2008 law as evidence that the law is working.

The insurers also have a key ally in making their case: the companies that buy insurance plans.

Last month, the ERISA Industry Committee, which represents large employers’ benefit interests and counts among its members some of America’s largest corporations, joined AHIP in writing to administration officials to ask that the comment period on the proposed rules be extended.

The companies and their insurers warned that the rules could create “unnecessary burdens” for providers, insurers and patients, and “unintentionally” impede access to care.

Posted on

REFORM- New CMMI Model Supports Health Equity in States, Shifts Care to the Community

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: CMS invents yet another on-paper “model” to address what it thinks should be done. Cue the next 2 years of analysis, opining and vendors telling us all their 90s’ era “big data” solutions will help docs, plans, and states convert what is designed to be increased accountability into an upside-only deal. You know, value-based care. But this time with an “equity” sticker slapped on it.


Clipped from:

The AHEAD Model will operate for 11 years and aim to shift health care to community-based settings.

CMS has unveiled a new payment model aiming to support health equity in the states by shifting health care to community-based settings. The agency is already addressing health equity in other models, such as Enhancing Oncology Model and ACO REACH.

The States Advancing All-Payer Health Equity Approaches and Development Model (AHEAD Model) aims to better address chronic disease, behavioral health, and other medical conditions by equipping states to promote health equity, increase access to primary care, encourage more sustainable health care spending, and lower costs for patients.

The new AHEAD Model aims to support health equity in states by shifting care to community-based settings, promoting primary care, and increase screening and referrals to resources to address social determinants of health.

Image credit: Bro Vector –


“Primary care is the foundation of a high-performing health system and essential to improving health outcomes for patients and lowering health care costs. For that reason, the CMS Innovation Center has invested significant time and resources over the years testing models to strengthen primary care and improve care coordination and linkages to organizations that address health-related social needs,” Elizabeth Fowler, PhD, JD, deputy CMS administrator and director of the Center for Medicare and Medicaid Innovation (CMMI), said in a statement. “Through AHEAD, more states will have the exciting opportunity to both improve the overall health of their population, support primary care, and transform health care in their communities.”

AHEAD is the next iteration of CMMI multipayer total cost of care models. States that participate will be accountable for quality and health outcomes while reducing avoidable care spending.

Through the model, CMS partners with states to redesign statewide and regionwide health care delivery with the goal of enhancing total population health. The model includes payment models for participating hospitals and primary care practices to achieve the goals of the model.

Through AHEAD, CMS is looking to not only strengthen primary care and improve care coordination, but also increase screening and referrals to resources that help address social determinants of health, such as housing and transportation.

“In our current health care system, fragmented care contributes to persistent, widening health disparities in underserved populations,” said CMS Administrator Chiquita Brooks-LaSure. “The AHEAD Model is a critical step towards addressing disparities in both health care and health equity while improving overall population health.”

Up to 8 states will be selected to participate in the AHEAD Model and each will have the opportunity to receive up to $12 million from the agency.

In late fall 2023, CMS expects to release a Notice of Funding Opportunity followed by an application period in Spring 2024. States interested in participating in the mode will have to apply during these 2 application periods.

Applying states will select 1 of 3 cohorts:

  • Cohort 1: 18-month pre-implementation period tentatively starting July 2024 for states ready to apply and implement AHEAD as soon as possible. The first performance year (PY) will tentatively begin January 2026 with 9 PYs.
  • Cohort 2: 30-month pre-implementation period tentatively starting July 2024 for states that need additional time to prepare for implementation. This time may be used for activities such as developing Medicaid components, recruiting providers to participate, and developing data infrastructure. The PY will tentatively begin January 2027 with a total of 8 PYs.
  • Cohort 3: 24-month pre-implementation period tentatively starting January 2025 for states that need additional time to apply to the model. The first PY will tentatively begin January 2027 with a total of 8 PYs.

Overall, the AHEAD Model will operate for 11 years from 2024 through 2034. According to CMS, the model will build upon the work of state-based models from CMMI such as the Maryland Total Cost of Care Model, the Pennsylvania Rural Health Model, and the Vermont All-Payer Accountable Care Organization Model.

Posted on

REFORM (ME)- Maine parents, providers weigh in on proposed ‘Lifespan Waiver’

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: Parents of children with I/DD and other special needs are concerned the plan to create a new program will disrupt the existing group homes systems.




Clipped from:

AUGUSTA, Maine — It’s a huge undertaking—Maine is currently building a new system for children and adults with developmental and intellectual disabilities. 

The “Lifespan Waiver” would provide more comprehensive services at age 14 to help them transition into adulthood.

The program is expected to clear years-long waitlists and provide more opportunities to live independently. However, some families fear a new system will eventually cause much-needed services, like group homes, to disappear.

“Her housemates are her friends; they have been her friends since high school,” Debbie Dionne explained about her daughter Kate. 

Kate lives in a group home in Brunswick. She has cerebral palsy and an intellectual disability following a traumatic birth 43 years ago. Staff help her live independently, which would be difficult for Debbie and her husband to do for their daughter. Another worry, 75 group homes have closed their doors in Maine amid low Medicaid reimbursement rates. 

“If she were to lose this housing, I am 71 and we are aging; my home is not accessible. I do worry,” Debbie said with fear in her voice.

Parents have been raising many concerns since the Maine Department of Health and Human Services announced a new plan last spring, revamping the state’s services system for children and adults with intellectual and developmental disabilities. Families of special needs children must apply for different waivers for home and community services based on their needs, primarily paid for by federal Medicaid dollars. The Lifespan Waiver would enroll children as young as 14, eliminating waivers and wait-for lists across their lifespan.

“Our goal around Lifespan is that a person can stay in one wavier and not have to switch and get the services they need as they age,” Betsy Hopkins, the associate director of the DHHS Office of Aging and Disability Services, said.  

Hopkins said under Lifespan, people can continue to live in group homes and receive services under Section 21 and Section 29.

DHHS officials, who have been gathering comments from the public over the summer, are currently holding listening sessions with parents and providers. Lucinda Turcotte is an adult case manager with Brighter Heights Maine, which provides several services, including case management for special children and adults. Severe shortages of skilled staff to work with this vulnerable population are still a big concern, as is funding.

“We are being told we are developing another waiver that will not have a waitlist. I am not confident that is a guarantee. We all know the funding has to go through the Legislature,”  Turcotte said.

A current rate study could improve pay for direct support workers and agencies. Lifespan still needs approval from the feds and will undergo the rulemaking process in the Legislature next spring. If passed, enrollment could begin in January 2025. 

DHHS is holding a Lifespan Waiver informational tour throughout the state, with sessions planned in Caribou, Bangor, Lewiston, and South Portland next week. People can also register for Zoom sessions.

More NEWS CENTER Maine stories

For the latest breaking news, weather, and traffic alerts, download the NEWS CENTER Maine mobile app.

Posted on

REFORM (WA)- Experts discuss implementation of Medicaid MTP waiver’s component allowing for re-entry coverage for Washingtonians leaving incarceration

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: WA leads the way with one of the first-ever programs that actually gets critical services to incarcerated members BEFORE they are released.



Clipped from:


Shane Ersland | Sep 21, 2023 | Washington

Experts weighed in on Washington’s Section 1115 Medicaid Transformation Project (MTP) waiver and the availability of new services it will offer residents at the Inland Northwest State of Reform Health Policy Conference last week.

The Centers for Medicare & Medicaid Services (CMS) recently approved the Washington State Health Care Authority’s (HCA) request to extend and amend its MTP waiver. The extension will allow the state to implement new programs using federal Medicaid funds to improve Apple Health (Washington’s Medicaid program).



Get information about upcoming events, insight from key stakeholders, and state-specific reporting delivered to your inbox!



“Not everything was approved, but we see it as a success,” HCA MTP Director Chase Napier said. “There are a few programs we’re going to keep talking with CMS about. We are thrilled with what was approved.” 

CMS denied Washington’s request to cover postpartum care for non-citizens. The state therefore cannot use waiver funds to support the initiative, but plans to use other funding resources to provide postpartum care for non-citizens.

The waiver extension will allow for re-entry coverage for individuals who are leaving a jail or prison and re-entering communities. The program will provide pre-release services up to 90 days prior to an individual’s expected date of release from a jail or prison.

“Re-entry is a part of our system that is as fragmented as you can get,” HCA Assistant Director of Medicaid Programs Jason McGill said. “This waiver starts to get at how we can connect that pre-release period with services in the community. It starts to get services in jails for people who need it. It is not a full-coverage benefit. It is a targeted, limited benefit. But it gets at a lot of the gaps in the system that we clearly see today.”

The waiver provides for a mandatory and a secondary set of benefits, McGill said. Some mandatory benefits include pre-release care coordination and medication-assisted treatment (MAT).

“The secondary set of services is really intriguing too, particularly the full set of pharmacy benefits. Not just pharmacy for MAT, but the full pharmacy formulary. Pharmacy formulary has to be the Medicaid formulary. It’s not only the drug, but the treatment.”

— McGill

Caitlin Safford, plan chief of staff at Amerigroup Washington, said the re-entry program will be intense from a managed care organization (MCO) perspective.

“We’ve been working with jails, all the MCOs have,” Safford said. “We work together as MCOs to connect with every jail in our state. We have also been trying to connect with the tribal jails where we’re able to. And that’s our next process. We have a wonderful process with the Department of Corrections.”

The program will represent a major change in the state’s healthcare system, Safford said.

“But this is the missing piece,” Safford said. “Having and being able to do Medicaid [services for individuals] actually in jail is going to be incredible. We’re trying to think about what infrastructure investments we need to make internally to be able to work with jails on a one-to-one basis. We’re looking forward to being able to help guide jails through this process.”

Courtney Smith Jiles, chief strategy officer at the Washington Association for Community Health, discussed the program from the perspective of federally qualified community health centers (FQHCs). The association represents 27 FQHCs in the state.

“Our health centers are some of the most qualified centers to be able to provide services for these folks just coming out of jails. And, frankly, to anyone with a health-related social need. I feel very proud to work on behalf of FQHCs because I have not seen a group of people who take every single opportunity to connect with [their] community in the way that they do.” 

— Smith Jiles

McGill said the state’s initial plan is for prisons and jails to begin offering services in July 2025. They will have to complete a readiness review first, which includes ensuring access to medications and drug prescriptions. 

“All these things have to be done in order to make sure a jail or a prison facility is ready,” McGill said. “We’re planning for a year in advance of that July 2025 timeline to build capacity funding opportunities for our local jails and prisons. And, fortunately, we do have significant funding for that through the waiver to help with those supports.”

The waiver extension will also allow for programs that address health-related social needs (HRSN), including community-based payment through community/Native hubs, rental subsidies for up to six months, and HRSN services for nutrition, housing, medical respite, and transportation. Napier discussed the six-month rental subsidies.

“Of course, we wanted more than six months and are going to continue that conversation with CMS. But we’re thrilled we were able to get six months as a starting point.

— Napier

Safford also spoke about the waiver’s housing component, as Amerigroup serves as a contractor for some related services, including community support services. 

“When we started this program, the housing component started really slow,” Safford said. “That has really shifted, and we have seen, even in just the last year, a significant increase in assessments for supportive housing going up. Which leads to those people being able to access the services. We have a fantastic network of providers. We’re still adding providers to the services network.

When we think about the new components of the waiver, we really see it from a supportive housing standpoint. We’ve had these supportive housing services for five years. And we’ve seen the impact they’ve made. And the legislature added in transition assistance. That transition assistance led to people being able to get into a place to rent. Having first and last month’s rent, having help with utilities, having help with moving costs, that was always identified as a major barrier, even if they had access to supportive housing services themselves.”

Posted on

REFORM (NC)- Medicaid pilot uses groceries to boost health, lower food insecurity

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: Hard to believe the Trump-approved NC Healthy Opportunities program is going on 6 years old. An in-depth report on results is expected to be released soon.



Clipped from:


Elizabeth Jacques and her daughter Elena shop from the Caja Solidaria bicycle delivery. Allison Joyce for STAT

Late last summer, Elizabeth Jacques brought her youngest daughter, Elena, for a medical checkup. At the time, Jacques and her family were experiencing housing instability after a two-year legal battle with their former landlord, who refused to clean up their unsanitary, unlivable conditions.

For Jacques, it was obvious she had to leave a housing situation that was putting her family’s health at risk. Black mold was growing on the walls of the trailer in which Jacques and her family had lived for five years. The mold caused everyone — Jacques, her husband, and her three younger daughters — to get more frequent headaches and stomachaches. It also impacted Jacques’ breathing because she is immune-compromised. “My ability to function as a normal human got worse and worse,” she said. Meanwhile, there were gaping holes in the trailer’s floor; Jacques fell through them in the bathroom twice.


Starting around September 2022, Jacques and her family hopped between three different hotels around Fletcher, in western North Carolina. But choosing to leave their trailer for safer living conditions meant making trade-offs. “In order to make sure we had someplace safe to sleep and to take showers, we chose hotels, and then the food was either given to us [there] or we went to a pantry,” she recalled.

At the physician’s office, the doctor diagnosed Elena, now 7, with ADHD, and said she needed to have her tonsils removed. Knowing that Jacques’ family was unhoused, the doctor also asked a simple question: What else do you need? Without missing a beat, Jacques said: food.

As it turned out, a North Carolina program designed to help families like Jacques’ was well underway.


Sign up for Morning Rounds

Your daily dose of news in health and medicine

Please enter a valid email address.

Privacy Policy

That program, the Healthy Opportunities Pilot (HOP), is the first of its kind in the United States. With $650 million in federal funding secured in 2018, HOP aims to comprehensively test and evaluate how addressing the social determinants of health — access to healthy food, transportation, safe and clean housing, and interpersonal safety — can improve health outcomes, all the while reducing health care utilization rates and emergency services for Medicaid members. Elena was enrolled in Medicaid, which meant Jacques’ family was eligible.


In North Carolina, nearly 13,000 individuals are enrolled in HOP to date, and the food delivery services — which offer fresh produce, grains, and meat on a weekly basis — were the first to launch in earnest. So far, early results from the pilot suggest that food delivery programs associated with HOP are more effective in providing food security than those provided by food subsidies, like food stamps. A more comprehensive report was submitted in March 2023, said Seth A. Berkowitz, the lead evaluator of the HOP program at the University of North Carolina in Chapel Hill, and will be made public soon.

For Jacques and her family, even as they moved from hotel to hotel over a span of 10 months, HOP’s fresh produce deliveries were a constant. Some months, they also got food stamps, or would try pantries — but even some pantries were running out of supplies, Jacques said.

Every Tuesday, Jacques’ daughters would get excited to see the food delivery car pull up in front of their hotel. Elena was like a kid in a candy shop as she helped her mom pick out peaches, oranges, and snap peas during the summer.

Jacques said she lost 30 pounds because of her ability to access fresh fruits and vegetables from the program, even as she was unhoused. Eating well during a turbulent time was just one less thing for her to worry about, even though the rest of her life felt in flux.


A view of Hendersonville, N.C., where the nonprofit Caja Solidaria is based. Allison Joyce for STAT

The promise of produce prescriptions

North Carolina secured funding for the HOP pilot project in 2018 through 1115 Medicaid waivers, which refers to section 1115 of the Social Security Act. Such waivers give the secretary of health and human services the authority to approve pilot projects like HOP that will promote the objectives of the government’s Medicaid program. HOP, as it exists now, will run until 2024.

Impact Health executive director Laurie Stradley, who oversees Western North Carolina’s participation in HOP, said the larger goal is to demonstrate that pilot programs like HOP should be accessible not just to people on Medicaid, but to the general population. “We really believe that this network model that brings together both clinical and social health needs should be available regardless of payer model,” she said.

Since HOP’s approval, many other states, including California, New York, Arizona, Oregon, Massachusetts, and Washington have applied for and received similar 1115 waivers.

These new waivers are unique because they focus not only on food security, but also on nutrition security, noted Dariush Mozaffarian, a cardiologist and a professor of nutrition at Friedman School of Nutrition Science and Policy at Tufts University. And because these waivers are baked into the Social Security Act, they serve as a more sustainable way for states to continue providing such services.

That the food deliveries through HOP are regular constitutes them as produce prescriptions. Such prescriptions are a proven tool to help lower blood sugar levels in low-income individuals with diabetes, decrease obesity, and reduce hypertension. They also have shown to help keep patients out of the hospital, reducing both emergency room visits and hospitalizations in nursing homes, said Mozaffarian.

“We know that when you invest upstream, that our health care dollars go down and our health outcomes go up,” said Stradley. Alongside the food prescriptions, which were the first service that HOP launched in March 2022, the program also helps individuals find stable, long-term housing, have reliable transportation, and get out of unsafe and violent living situations.


People work at Clem’s Organic Gardens, which supplies organic produce to Caja Solidaria. Allison Joyce for STAT


Sonya Jones makes deliveries from the Caja Solidaria SUV. The nonprofit currently serves 150 households. Allison Joyce for STAT

A mobile farmers market

The food delivery services that Jacques and hundreds of other families benefit from in western North Carolina have been spearheaded by a nonprofit called Caja Solidaria based in Hendersonville.

Caja Solidaria, or Caja for short, was founded by Sonya Jones, a former public health professor at the University of South Carolina. Jones left her academic post in the wake of the Covid-19 pandemic and began working for a local mutual aid organization looking to start a food bank in Hendersonville, where she grew up. Eventually, that food bank grew in members and funding.

By the time the pilot program in North Carolina launched, Caja was an obvious partner in western North Carolina. “No [Henderson County] organization was stepping into the shoes of distributing food or healthy food prescription services,” said Jones. “I know how to buy food, I have a nutrition background. It seemed like a really amazing fit.”

Caja Solidaria sources produce, grains, and meat from local farms or distributors, and prioritizes purchasing culturally relevant foods for the families that they serve.

Caja Solidaria sources produce, grains, and meat from local farms or distributors, and prioritizes purchasing culturally relevant foods for the families that they serve. Jacques’ husband, who is Mexican, gets excited over the spice mixes that they have the option of choosing as part of their food deliveries.

The funding from HOP also enables the nonprofit to buy directly from farmers in their communities. The family that Caja Solidaria sources chicken and pork from was struggling to find a customer base in the early days of the pandemic, said Jones, but they have since been able to increase their production every single month to meet Caja’s demand. “We’ve financially stabilized their farm and really helped them get started.”

Caja started out with a pick-up market and added bike deliveries: The food for the week would get loaded up into pink coolers and put on a wagon, hooked to a black commuter bike. With funding from HOP, the organization was able to buy a four-wheel drive van to drive to families with a mobile farmers market in tow.

Now, Jones and her staff drive two or three routes a day, meeting up to a dozen families on a given route. Families also have the option to pick up their week’s share of produce from their stationary market on Thursdays. Currently, Caja serves 150 households, with 75% of those being families of three or more people.


The Jacques family makes guacamole. Elizabeth and her family were recently helped by the Healthy Opportunities Pilot and relocated to a permanent home. Allison Joyce for STAT

How food deliveries foster community

For DeBorah Ogiste, 65, of Hendersonville, the produce deliveries have not only relieved the financial burden of feeding her family, but also improved her grandson Elian’s health.

Ogiste’s daughter passed away two months after Ogiste retired. Elian, now 8, has a compromised immune system and, as a result, is particularly sensitive to environmental allergies and asthma. He’s been hospitalized several times due to RSV and breathing issues. “If he catches a cold, it’s always more than a cold,” Ogiste said. Having to take Elian out of school for sickness was a common occurrence — at least once or twice a month.

Food stamps, which covered up to $98 a month, were simply not enough for her and a growing boy. “We were definitely food insecure,” Ogiste said. But since they started receiving deliveries from Caja in spring 2022, Elian has been eating healthier, staying in school for longer, and enjoying the avocado tacos from the food deliveries. Fresh fruits and vegetables help regulate her grandson’s allergies and reactions to environmental triggers.

HOP and Caja have also helped Christal Whitmire, 65, of Hendersonville, to wean off her long list of medications. She has long been diagnosed with degenerative disk diseases, spinal stenosis, and fibromyalgia. At one point, Whitmire said that she was prescribed to take dozens of pills each day for her neural conditions, depression, insomnia, migraines, mood stabilizers, high cholesterol, and beyond.

With access to Caja’s food deliveries, she said she’s lost over 100 pounds. “My whole digestive system is better, and then that helps with my sleep. Then, that helps with my headaches,” she said, which in turn reduces her incidence of seizures.

Recently, Whitmire tossed out her prescription for trazodone, a pill meant to help her sleep.

“If there’s going to be a food that’s going to help me rather than a pill, I would do that over a pill every day.”

Christal Whitmire

Beyond the health improvements experienced by many families is a deeper, more emotional benefit of the program: Having someone deliver food to you every single week creates familiarity, trust, and community. Some families list Jones as an emergency contact. The pandemic may have bred loneliness and isolation, but nonprofits like Caja are working to rebuild a community fabric.

“It’s not really [about] the vegetables,” Jones said. “The vegetables open the door to addressing social isolation and community cohesion, which we think are also social determinants of health.”


Elizabeth Jacques and her husband, Luis, eat dinner with their family. Allison Joyce for STAT

The limits of the Healthy Opportunities Pilot

Despite the good intentions of the Healthy Opportunities Pilot, some participants still fall through the cracks. For instance, individuals who turn 65 and roll off of Medicaid and onto Medicare will no longer be registered for HOP, as the program currently serves only Medicaid patients. (However, if someone else in their household is enrolled in Medicaid, they remain eligible.) Stradley, HOP’s executive director, said that the program will be able to offer services to patients who are eligible for Medicaid and Medicare as early as 2024.

Peggy Cummins, who recently turned 65, learned this the hard way. She was food insecure and received deliveries from Caja for the last two years. She also registered for housing help through HOP as her living situation was, in her words, “decrepit and rotten.”

“It’s not fit for humans to live in. But it’s all I’ve got.”

Peggy Cummins

“I can see the ground through the siding. A piece of drywall broke. I had a snake in here and rats,” she said. “It’s not fit for humans to live in. But it’s all I’ve got.” She hoped that HOP could help her, but now that she is no longer a registered member because her health insurance changed, “I don’t have any hope.”

Stradley recognizes other challenges and limitations of HOP’s housing program, especially because vacancy rates across the country for affordable housing are so low. In geographical areas where finding new housing is especially challenging, Stradley said that HOP is able to allocate funds to help families improve their current homes.

Jacques, who also expressed a need for housing when her family got enrolled in HOP, had a long-awaited but happy ending to her saga. In July, she finally received a call from a local nonprofit: They found a new, safe place for her and her family to rent.

The transformative power of social health care

Tracking the results of the pilot program could help change health policy in the U.S., especially “if the interventions are shown to improve health and do so in a way that’s cost saving or cost equivalent to other medical interventions,” said Mozzafarian of Tufts University.

“We are aware that many eyes are on us,” said Stradley. “We are working hard to generate the evidence that could persuade other payer groups to invest in social and clinical health care, including Medicare, private payers, and more.”

The Biden administration is also pushing to strengthen Medicaid and the Affordable Care Act. An executive order in January 2021 emphasized that states should utilize waivers like the 1115 that expand Medicaid coverage and access to care.

Jacques, who has seen how a pilot program like HOP can help her family’s physical health and psychological safety, believes that programs like this should eventually become a permanent fixture in our health systems. “Some people get stuck and they don’t know how to get out of whatever the situation may be,” she said. “This program is so important, not just to me, but to many. It’s a lifeline.”

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.

Correction: An earlier version of this story misstated Laurie Stradley’s title and the form in which Caja Solidaria started out.

Posted on

REFORM (OR)- Historic Move: Oregon’s medically necessary Medicaid benefit

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: The new OR waiver will get members AC unit, food and help with rent. It puts $1B towards health-related social needs (HRSN- that’s the new SDH password ICYMI).



Clipped from:


Oregon is moving to leverage Medicaid benefits to prevent homelessness, support behavioral health services, mitigate the impacts of climate change, pending federal approval.

Metro Creative Connection

The Oregon Health Authority (OHA is moving to leverage Medicaid benefits to prevent homelessness, support behavioral health services, mitigate the impacts of climate change, pending federal approval.

The OHA, in collaboration with Oregon Housing and Community Services (OHCS), has announced proposed timelines to begin offering new Medicaid benefits that eligible Oregon Health Plan (OHP/Medicaid) members would receive under Oregon’s ground-breaking 1115 Medicaid waiver agreement with the federal government.

If the federal government agrees to the proposal, eligible OHP members would start receiving benefits for climate-related supports in January 2024, housing insecurity in November 2024, and food insecurity in January 2025.

Oregon would be the first state in the nation to gain federal approval to offer six months of temporary rent assistance as a medically necessary Medicaid benefit. These benefits would first roll-out to people who are at risk of losing their current housing, beginning on Nov. 1, 2024, if the federal government approves the plan.

In lockstep with Governor Tina Kotek’s priority to reduce homelessness, state health officials have determined that the most immediate and effective way to implement Oregon’s new short-term Medicaid housing benefit is to help people who are medically and economically vulnerable avoid becoming homeless in the first place, according to a release from the OHA.

The rate of Oregonians losing housing is increasing faster than state and local programs can rehouse them, due to a critical statewide shortage in affordable housing, state housing experts said.

The short-term Medicaid rent assistance benefit will help prevent people from losing housing due to a health issue that disrupts their ability to stay current on their housing payments, or because they need to be connected to mental health or substance use services to maintain stable housing. The OHA said this preventive approach should help slow the rate of growth in the homeless population.

State officials estimate approximately 125,000 OHP members currently meet the federal housing definition of “at risk for homelessness” and could be eligible for the short-term housing benefit if they have health and housing needs that would require up to six months of rent assistance or other housing supports.

While assuring that these benefits help keep people housed, OHA will continue to have a strong focus on assisting OHP members that have a significant mental health or substance use disorder that exacerbates their housing insecurity.

“As a first step, we want to use these new and innovative Medicaid housing benefits to make sure that someone with a health problem stays in stable housing,” OHA’s interim Director Dave Baden said. “We can’t let more people wind up on the streets, where their health issues will worsen and get harder to treat, making sustainable, long-term housing harder to find, especially given the lack of affordable housing across the state.”

Medically necessary temporary rent assistance and other housing supports would become available to other OHP members, including people who are already homeless, later in the state’s five-year waiver implementation. That date has not been specified as state health and housing officials continue to work with federal partners to address barriers to housing access and other questions.

Input from housing providers, coordinated care organizations (CCOs) and other community voices informed the state’s strategy to focus on preventing homelessness in this first phase.

“Today’s actions build upon a longstanding commitment to addressing the social determinants of health in action,” OHCS Director Andrea said. “This historic rent assistance provision is a tangible pathway to deliver rent assistance as a health intervention. Housing and health barriers are connected. The solutions should be reflective of that reality.”

State officials also announced that climate-related supports for some OHP members will become available starting Jan. 1, 2024, if federal officials approve the proposed timelines. Under this benefit, eligible OHP members could qualify to receive air conditioners to help reduce health risks during extreme heat emergencies (if medically necessary) or air filters to protect from the respiratory effects of wildfire smoke.

Nutrition benefits, such as medically tailored meals, would become available starting Jan. 1, 2025.

Oregon’s five-year 1115 Medicaid waiver provides OHP coverage and more than $1 billion in federal funding to address the health-related social needs (HRSN) of people whose health is affected by the most pressing problems affecting Oregon communities, including homelessness, climate change and poverty. Under the state’s agreement with CMS, Oregon is required to begin making health-related social needs benefits available no later than Jan. 1, 2025.

1115 Medicaid waivers allow states flexibility to test new ways to deliver and pay for Medicaid benefits. A state must receive CMS approval to implement a waiver.

Medicaid provides health coverage to income-eligible people. Currently, more than 1.4 million Oregonians – or 1 in 3 state residents – are covered by OHP. Most people who qualify for Medicaid in Oregon are covered by OHP. Approximately nine in 10 OHP members have their care coordinated through one of 16 CCOs which operate in defined regions across the state.

Follow this developing story at and in the Wednesday print editions of The Pilot.