States Respond to COVID-19 Challenges but Also Take Advantage of New Opportunities to Address Long-Standing Issues: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2021 and 2022

Executive Summary
  1. Elizabeth Williams, Medicaid Enrollment & Spending Growth: FY 2021 & 2022
    (Washington, DC: KFF, October 27, 2021), https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-spending-growth-fy-2021-2022 

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  2. U.S. Department of Health and Human Services, Renewal of Determination That A Public Health Emergency Exists (October 15, 2021), https://www.phe.gov/emergency/news/healthactions/phe/Pages/COVDI-15Oct21.aspx

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  3. U.S. Department of Health and Human Services, Public Health Emergency Message to Governors (January 22, 2021), https://ccf.georgetown.edu/wp-content/uploads/2021/01/Public-Health-Emergency-Message-to-Governors.pdf

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  4. Rachel Dolan, and Madeline Guth, How Have States Used Medicaid Emergency Authorities During COVID-19 and What Can We Learn? (Washington, DC: KFF, August 26, 2021), https://www.kff.org/medicaid/issue-brief/how-have-states-used-medicaid-emergency-authorities-during-covid-19-and-what-can-we-learn/

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  5. FMAP = Federal Medicaid Assistance Percentage.

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  6. Rachel Dolan, MaryBeth Musumeci, Jennifer Tolbert, and Robin Rudowitz, Medicaid Maintenance of Eligibility (MOE) Requirements: Issues to Watch (Washington, DC: KFF, December 17, 2020), https://www.kff.org/medicaid/issue-brief/medicaid-maintenance-of-eligibility-moe-requirements-issues-to-watch/

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  7. Kellie Moss et al., The Families First Coronavirus Response Act: Summary of Key Provisions (Washington, DC: KFF, March 23, 2020), https://www.kff.org/global-health-policy/issue-brief/the-families-first-coronavirus-response-act-summary-of-key-provisions/

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  8. State fiscal years begin on July 1 except for these states: New York on April 1; Texas on September 1; Alabama, Michigan, and District of Columbia on October 1.

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  9. Delaware, Minnesota, New Mexico, and Rhode Island did not respond to the 2021 survey. In some instances, we used publicly available data or prior years’ survey responses to obtain information for these states. However, unless otherwise noted, these states are not included in counts throughout the survey.

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  10. Elizabeth Hinton, Robin Rudowitz, Lina Stolyar, and Natalie Singer, 10 Things to Know about Medicaid Managed Care (Washington, DC: KFF, October 29, 2020), https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-managed-care/

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  11. Elizabeth Hinton and MaryBeth Musumeci, Medicaid Managed Care Rates and Flexibilities: State Options to Respond to COVID-19 Pandemic (Washington, DC: KFF, September 9, 2020), https://www.kff.org/medicaid/issue-brief/medicaid-managed-care-rates-and-flexibilities-state-options-to-respond-to-covid-19-pandemic/

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  12. Lina Stolyar, Elizabeth Hinton, Natalie Singer, and Robin Rudowitz, Growth in Medicaid MCO Enrollment during the COVID-19 Pandemic (Washington, DC: KFF, June 24, 2021), https://www.kff.org/coronavirus-covid-19/issue-brief/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic/

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  13. Bradley Corallo and Avirut Mehta, Analysis of Recent National Trends in Medicaid and CHIP Enrollment (Washington, DC: KFF, September 21, 2021), https://www.kff.org/coronavirus-covid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment/

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  14. Laura Snyder and Robin Rudowitz, Trends in State Medicaid Programs: Looking Back and Looking Ahead (Washington, DC: KFF, June 21, 2016), https://www.kff.org/medicaid/issue-brief/trends-in-state-medicaid-programs-looking-back-and-looking-ahead/

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  15. Rachel Dolan, and Madeline Guth, How Have States Used Medicaid Emergency Authorities During COVID-19 and What Can We Learn? (Washington, DC: KFF, August 26, 2021), https://www.kff.org/medicaid/issue-brief/how-have-states-used-medicaid-emergency-authorities-during-covid-19-and-what-can-we-learn/

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  16. Rachel Dolan, and Madeline Guth, How Have States Used Medicaid Emergency Authorities During COVID-19 and What Can We Learn? (Washington, DC: KFF, August 26, 2021), https://www.kff.org/medicaid/issue-brief/how-have-states-used-medicaid-emergency-authorities-during-covid-19-and-what-can-we-learn/

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  17. Centers for Medicare and Medicaid (CMS), “Medicaid & CHIP and the COVID-19 Public Health Emergency,” last updated October 31, 2020, https://www.medicaid.gov/state-resource-center/downloads/covid-19-medicaid-data-snapshot.pdf

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  18. Elizabeth Hinton and Lina Stolyar, Medicaid Authorities and Options to Address Social Determinants of Health (SDOH), (Washington, DC: KFF, August 5, 2021), https://www.kff.org/medicaid/issue-brief/medicaid-authorities-and-options-to-address-social-determinants-of-health-sdoh/

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  19. Samantha Artiga, Bradley Corallo, and Olivia Pham, Racial Disparities in COVID-19: Key Findings from Available Data and Analysis (Washington, DC: KFF, August 17, 2020), https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-covid-19-key-findings-available-data-analysis/

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  20. Kendal Orgera, Rachel Garfield, and Robin Rudowitz, Tracking Social Determinants of Health During the COVID-19 Pandemic (Washington, DC: KFF, October 21, 2021), https://www.kff.org/coronavirus-covid-19/issue-brief/tracking-social-determinants-of-health-during-the-covid-19-pandemic/

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  21. Elizabeth Hinton, Robin Rudowitz, Lina Stolyar, and Natalie Singer, 10 Things to Know about Medicaid Managed Care (Washington, DC: KFF, October 29, 2020), https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-managed-care/

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  22. Elizabeth Hinton, Lina Stolyar, and Robin Rudowitz, A Look at How Medicaid Agencies Are Assisting with the COVID-19 Vaccine Roll-Out (Washington, DC: KFF, March 12, 2021), https://www.kff.org/coronavirus-covid-19/issue-brief/a-look-at-how-medicaid-agencies-are-assisting-with-the-covid-19-vaccine-roll-out/

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  23. MaryBeth Musumeci, Robin Rudowitz, Elizabeth Hinton, Rachel Dolan, and Olivia Pham, Options to Support Medicaid Providers in Response to COVID-19 (Washington, DC: KFF, June 17, 2020), https://www.kff.org/coronavirus-covid-19/issue-brief/options-to-support-medicaid-providers-in-response-to-covid-19/

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  24. Rachel Dolan, and Madeline Guth, How Have States Used Medicaid Emergency Authorities During COVID-19 and What Can We Learn? (Washington, DC: KFF, August 26, 2021), https://www.kff.org/medicaid/issue-brief/how-have-states-used-medicaid-emergency-authorities-during-covid-19-and-what-can-we-learn/

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  25. Nancy Ochieng, Jeannie Fuglesten Biniek, MaryBeth Musumeci, and Tricia Neuman, Funding for Health Care Providers During the Pandemic: An Update (Washington, DC: KFF, August 20, 2021), https://www.kff.org/policy-watch/funding-for-health-care-providers-during-the-pandemic-an-update/

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  26. Elizabeth Hinton, Robin Rudowitz, Lina Stolyar, and Natalie Singer, 10 Things to Know about Medicaid Managed Care (Washington, DC: KFF, October 29, 2020), https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-managed-care/

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  27. Elizabeth Hinton and MaryBeth Musumeci, Medicaid Managed Care Rates and Flexibilities: State Options to Respond to COVID-19 Pandemic (Washington, DC: KFF, September 9, 2020), https://www.kff.org/medicaid/issue-brief/medicaid-managed-care-rates-and-flexibilities-state-options-to-respond-to-covid-19-pandemic/

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  28. Rachel Dolan and Marina Tian, Management and Delivery of the Medicaid Pharmacy Benefit (Washington, DC: KFF, December 6, 2019), https://www.kff.org/medicaid/issue-brief/management-and-delivery-of-the-medicaid-pharmacy-benefit/

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  29. Elizabeth Williams and Rachel Dolan, Utilization and Spending Trends in Medicaid Outpatient Prescription Drugs, 2015-2019 (Washington, DC: KFF, June 9, 2021), https://www.kff.org/medicaid/issue-brief/utilization-and-spending-trends-in-medicaid-outpatient-prescription-drugs-2015-2019/

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  30. Madeline Guth, Elizabeth Hinton, MaryBeth Musumeci, and Robin Rudowitz, The Landscape of Medicaid Demonstration Waivers Ahead of the 2020 Election (Washington, DC: KFF, October 30, 2020), https://www.kff.org/medicaid/issue-brief/the-landscape-of-medicaid-demonstration-waivers-ahead-of-the-2020-election/

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Introduction
  1. KFF, “Health Insurance Coverage of the Total Population (CPS), 2020, https://www.kff.org/other/state-indicator/health-insurance-coverage-of-the-total-population-cps/

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  2. Centers for Medicare & Medicaid Services (CMS), National Health Expenditure Data Fact Sheet: Table 4, National Health Expenditures by Source of Funds and Type of Expenditure: Calendar Years 2011-2018 (CMS, March 2020), https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet.html

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  3. Bradley Corallo and Avirut Mehta, Analysis of Recent National Trends in Medicaid and CHIP Enrollment (Washington, DC: KFF, September 21, 2021), https://www.kff.org/coronavirus-covid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment/

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  4. Rachel Dolan, and Madeline Guth, How Have States Used Medicaid Emergency Authorities During COVID-19 and What Can We Learn? (Washington, DC: KFF, August 26, 2021), https://www.kff.org/medicaid/issue-brief/how-have-states-used-medicaid-emergency-authorities-during-covid-19-and-what-can-we-learn/

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  5. Kellie Moss et al., The Families First Coronavirus Response Act: Summary of Key Provisions (Washington, DC: KFF, March 23, 2020), https://www.kff.org/global-health-policy/issue-brief/the-families-first-coronavirus-response-act-summary-of-key-provisions/

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  6. Kellie Moss et al., The Coronavirus Aid, Relief, and Economic Security Act: Summary of Key Health Provisions (Washington, DC: KFF, April 9, 2020), https://www.kff.org/global-health-policy/issue-brief/the-coronavirus-aid-relief-and-economic-security-act-summary-of-key-health-provisions/

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  7. Rachel Dolan, MaryBeth Musumeci, Jennifer Tolbert, and Robin Rudowitz, Medicaid Maintenance of Eligibility (MOE) Requirements: Issues to Watch (Washington, DC: KFF, December 17, 2020), https://www.kff.org/medicaid/issue-brief/medicaid-maintenance-of-eligibility-moe-requirements-issues-to-watch/

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  8. U.S. Department of Health and Human Services, Renewal of Determination That A Public Health Emergency Exists (October 15, 2021), https://www.phe.gov/emergency/news/healthactions/phe/Pages/COVDI-15Oct21.aspx

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  9. U.S. Department of Health and Human Services, Public Health Emergency Message to Governors (January 22, 2021), https://ccf.georgetown.edu/wp-content/uploads/2021/01/Public-Health-Emergency-Message-to-Governors.pdf

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  10. Centers for Medicare and Medicaid Services (CMS), “Updated Guidance Related to Planning for the Resumption of Normal State Medicaid, Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) Operations Upon Conclusion of the COVID-19 Public Health Emergency,” last updated August 13, 2021, https://www.medicaid.gov/federal-policy-guidance/downloads/sho-21-002.pdf

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  11. Marybeth Musumeci and Rachel Dolan, Key Issues for State Medicaid Programs When the COVID-19 Public Health Emergency Ends (Washington, DC: KFF, January 25, 2021), https://www.kff.org/medicaid/issue-brief/key-issues-for-state-medicaid-programs-when-the-covid-19-public-health-emergency-ends/

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  12. KFF, 50-State Medicaid Budget Survey Archives, (Washington, DC: KFF, October 2021), https://www.kff.org/medicaid/report/medicaid-budget-survey-archives/

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  13. Delaware, Minnesota, New Mexico, and Rhode Island did not respond to the 2021 survey. In some instances, we used publicly available data or prior years’ survey responses to obtain information for these states. However, unless otherwise noted, these states are not included in counts throughout the survey. Among responding states, four states (Georgia, Louisiana, Mississippi, and Texas) did not participate in a follow-up telephone interview.

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  14. State fiscal years begin on July 1 except for these states: New York on April 1; Texas on September 1; Alabama, District of Columbia, and Michigan on October 1.

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Delivery Systems
  1. Elizabeth Hinton, Robin Rudowitz, Lina Stolyar, and Natalie Singer, 10 Things to Know about Medicaid Managed Care (Washington, DC: KFF, October 29, 2020), https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-managed-care/

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  2. Elizabeth Hinton and MaryBeth Musumeci, Medicaid Managed Care Rates and Flexibilities: State Options to Respond to COVID-19 Pandemic (Washington, DC: KFF, September 9, 2020), https://www.kff.org/medicaid/issue-brief/medicaid-managed-care-rates-and-flexibilities-state-options-to-respond-to-covid-19-pandemic/

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  3. Lina Stolyar, Elizabeth Hinton, Natalie Singer, and Robin Rudowitz, Growth in Medicaid MCO Enrollment during the COVID-19 Pandemic (Washington, DC: KFF, June 24, 2021), https://www.kff.org/coronavirus-covid-19/issue-brief/growth-in-medicaid-mco-enrollment-during-the-covid-19-pandemic/

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  4. Connecticut does not have capitated managed care arrangements, but does carry out many managed care functions through ASO arrangements that include payment incentives based on performance, intensive care management, community workers, educators, and linkages with primary care practices. Connecticut also reported continuing to expand its Patient-Centered Medical Home Plus (PCMH+) program that uses PCCM authority to provide upside-only shared savings payments to providers.

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  5. Vermont runs a public, non-risk bearing prepaid health plan delivery model under its Section 1115 Global Commitment to Health waiver. At the time of the survey, the state reported that it had submitted a waiver renewal application to CMS, effective January 1, 2022, to transition to a state-run, risk-bearing Medicaid managed care plan.

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  6. Idaho’s Medicaid-Medicare Coordinated Plan has been recategorized by CMS as an MCO but is not counted here as such since it is secondary to Medicare. Publicly available data used to verify status of four states that did not respond to the 2021 survey (Delaware, Minnesota, New Mexico, and Rhode Island).

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  7. For purposes of this report, states contracting with “PCCM entities” are also counted as offering a PCCM program. In addition to furnishing basic PCCM services, PCCM entities also provide other services such as intensive case management, provider contracting or oversight, enrollee outreach, and/or performance measurement and quality improvement. 42 CFR §438.2.

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  8. Oklahoma was set to transition to comprehensive Medicaid managed care on October 1, 2021. However, implementation has been paused due to Oklahoma Supreme Court decision 2021 OK 30.

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  9. For purposes of this report, the following three states are not counted here as PCCM states: Connecticut and Arizona use PCCM authority to reimburse medical home-related costs and South Carolina uses PCCM authority to provide care management services to medically complex children.

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  10. Rhode Island did not respond to the 2021 survey. Therefore, Rhode Island’s dental services PHP status was confirmed via publicly available data.

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  11. In order of Medicaid enrollment size, the ten states are: California, New York, Texas, Florida, Pennsylvania, Illinois, Ohio, Michigan, Arizona, and Georgia.

    Centers for Medicare and Medicaid Services (CMS), “Medicaid & CHIP Monthly Application, Eligibility Determinations, and Enrollment Reports,” last updated September 2021, https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/monthly-reports/index.html

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  12. This does not include Missouri which had adopted, but not yet implemented, the ACA expansion as of July 1, 2021.

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  13. Maine’s primary care programs are the PCCM program, Primary Care Health Homes, and the Primary Care Provider Incentive Payment.

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  14. Maine Department of Health and Human Services, “MaineCare Primary Care 2.0 Reimbursement Webinar,” June 7, 2021, https://www.maine.gov/dhhs/sites/maine.gov.dhhs/files/inline-files/Primary-Care-Reimbursement-Presentation-Stakeholders-June2021.pdf

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Benefits and Telehealth
  1. Samantha Artiga, Elizabeth Hinton, Robin Rudowitz, and MaryBeth Musumeci, Current Flexibility in Medicaid: An Overview of Federal Standards and State Options (Washington, DC: KFF, January 31, 2017), https://www.kff.org/medicaid/issue-brief/current-flexibility-in-medicaid-an-overview-of-federal-standards-and-state-options/

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  2. 42 C.F.R. Section 440.230(b).

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  3. Laura Snyder and Robin Rudowitz, Trends in State Medicaid Programs: Looking Back and Looking Ahead (Washington, DC: KFF, June 21, 2016), https://www.kff.org/medicaid/issue-brief/trends-in-state-medicaid-programs-looking-back-and-looking-ahead/

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  4. Kathleen Gifford et al., “Benefits and Cost-Sharing,” A View from the States: Key Medicaid Policy Changes (Washington, DC: KFF, October 18, 2019), https://www.kff.org/report-section/a-view-from-the-states-key-medicaid-policy-changes-benefits-and-cost-sharing/

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  5. Samantha Artiga, Olivia Pham, Usha Ranji, and Kendal Orgera, Medicaid Initiatives to Improve Maternal and Infant Health and Address Racial Disparities (Washington, DC: KFF, November 10, 2020), https://www.kff.org/report-section/medicaid-initiatives-to-improve-maternal-and-infant-health-and-address-racial-disparities-issue-brief/

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  6. Rachel Dolan, and Madeline Guth, How Have States Used Medicaid Emergency Authorities During COVID-19 and What Can We Learn? (Washington, DC: KFF, August 26, 2021), https://www.kff.org/medicaid/issue-brief/how-have-states-used-medicaid-emergency-authorities-during-covid-19-and-what-can-we-learn/

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  7. Rachel Dolan, and Madeline Guth, How Have States Used Medicaid Emergency Authorities During COVID-19 and What Can We Learn? (Washington, DC: KFF, August 26, 2021), https://www.kff.org/medicaid/issue-brief/how-have-states-used-medicaid-emergency-authorities-during-covid-19-and-what-can-we-learn/

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  8. Although original CMS guidance on maintenance of eligibility (MOE) requirements during the COVID-19 Public Health Emergency (PHE) prohibited states from restricting benefits in order to receive an enhanced FMAP , a November 2020 Interim Final Rule reinterpreted the MOE to allow states to eliminate optional benefits as well as to change the scope of benefits, such as service authorization criteria. For more information, see:

    Rachel Dolan, MaryBeth Musumeci, Jennifer Tolbert, and Robin Rudowitz, Medicaid Maintenance of Eligibility (MOE) Requirements: Issues to Watch (Washington, DC: KFF, December 17, 2020), https://www.kff.org/medicaid/issue-brief/medicaid-maintenance-of-eligibility-moe-requirements-issues-to-watch/

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  9. MaryBeth Musumeci, Medicaid Provisions in the American Rescue Plan Act (Washington, DC: KFF, March 18, 2021), https://www.kff.org/medicaid/issue-brief/medicaid-provisions-in-the-american-rescue-plan-act/

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  10. Madeline Guth and Elizabeth Hinton, State Efforts to Expand Medicaid Coverage & Access to Telehealth in Response to COVID-19 (Washington, DC: KFF, June 22, 2020), https://www.kff.org/coronavirus-covid-19/issue-brief/state-efforts-to-expand-medicaid-coverage-access-to-telehealth-in-response-to-covid-19/

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  11. State Telehealth Medicaid Fee-For-Service Policy: A Historical Analysis of Telehealth: 2013-2019 (Center for Connected Health Policy, January 2020), https://www.cchpca.org/2021/04/Historical-State-Telehealth-Medicaid-Fee-For-Service-Policy-Report-FINAL.pdf

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  12. Rachel Dolan, and Madeline Guth, How Have States Used Medicaid Emergency Authorities During COVID-19 and What Can We Learn? (Washington, DC: KFF, August 26, 2021), https://www.kff.org/medicaid/issue-brief/how-have-states-used-medicaid-emergency-authorities-during-covid-19-and-what-can-we-learn/

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  13. CMS data shows that the number of Medicaid and CHIP services delivered via telehealth increased by more than 2700% in the period from March to October 2020 as compared to the same time period in 2019. Additionally, early 2021 data shows that although telehealth utilization across the entire health care system  has increased rapidly during the pandemic, it has not offset decreases in in-person care. See:

    Centers for Medicare and Medicaid (CMS), “Medicaid & CHIP and the COVID-19 Public Health Emergency,” last updated October 31, 2020, https://www.medicaid.gov/state-resource-center/downloads/covid-19-medicaid-data-snapshot.pdf

    Kieran Gallagher, Jackie Gerhart, Krutika Amin, Matthew Rae, and Cynthia Cox, Early 2021 Data Show No Rebound in Health Care Utilization (Washington, DC: Peterson-KFF Health System Tracker, August 17, 2021), https://www.healthsystemtracker.org/brief/early-2021-data-show-no-rebound-in-health-care-utilization/

    Cynthia Cox, Krutika Amin, and Rabah Kamal, How Have Health Spending and Utilization Changed During the Coronavirus Pandemic? (Washington, DC: Peterson-KFF Health System Tracker, March 22, 2021), https://www.healthsystemtracker.org/chart-collection/how-have-healthcare-utilization-and-spending-changed-so-far-during-the-coronavirus-pandemic/

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  14. MACPAC, Medicaid and Rural Health (Washington, DC: MACPAC, June 2021), https://www.macpac.gov/wp-content/uploads/2021/04/Medicaid-and-Rural-Health.pdf

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  15. Krutika Amin, Matthew Rae, Giorlando Ramirez, and Cynthia Cox, How Might Internet Connectivity Affect Health Care Access (Washington, DC: Peterson-KFF Health System Tracker, December 14, 2020), https://www.healthsystemtracker.org/chart-collection/how-might-internet-connectivity-affect-health-care-access/

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  16. Bradley Corallo, Housing Affordability, Adequacy, and Access to the Internet in Homes of Medicaid Enrollees (Washington, DC: KFF, September 22, 2021), https://www.kff.org/medicaid/issue-brief/housing-affordability-adequacy-and-access-to-the-internet-in-homes-of-medicaid-enrollees/

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  17. American Rescue Plan Act of 2021, Pub. L. No. 117-2 (March 11, 2021), https://www.congress.gov/117/plaws/publ2/PLAW-117publ2.pdf

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  18. U.S. Department of Health and Human Services, Biden-Harris Administration Invests over $19 Million to Expand Telehealth Nationwide and Improve Health in Rural, Other Underserved Communities (August 18, 2021), https://www.hhs.gov/about/news/2021/08/18/biden-harris-administration-invests-over-19-million-expand-telehealth-nationwide-improve-health-rural.html

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  19. Rachel Dolan, and Madeline Guth, How Have States Used Medicaid Emergency Authorities During COVID-19 and What Can We Learn? (Washington, DC: KFF, August 26, 2021), https://www.kff.org/medicaid/issue-brief/how-have-states-used-medicaid-emergency-authorities-during-covid-19-and-what-can-we-learn/

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  20. Throughout this section, we used publicly available data to verify benefit changes in four states that did not respond to the 2021 survey (Delaware, Minnesota, New Mexico, and Rhode Island).

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  21. MaryBeth Musumeci, Medicaid Provisions in the American Rescue Plan Act (Washington, DC: KFF, March 18, 2021), https://www.kff.org/medicaid/issue-brief/medicaid-provisions-in-the-american-rescue-plan-act/

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  22. In addition, eight states (District of Columbia, Georgia, New Mexico, North Dakota, Oklahoma, Rhode Island, South Carolina, and Tennessee) reported new or expanded medication-assisted treatment (MAT) benefits in FY 2021. Federally required changes, such as coverage of MAT (including all FDA-approved drugs, counseling services, and behavioral therapy) as mandated by the SUPPORT Act, are not counted as positive or negative benefit changes for purposes of this report.

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  23. 430 ILCS 69/35-55 (June 17, 2021), https://casetext.com/statute/illinois-compiled-statutes/health-and-safety/chapter-430-public-safety/act-69-reimagine-public-safety-act/section-430-ilcs-6935-55-medicaid-trauma-recovery-services-for-children-and-youth

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  24. California Welfare and Institutional Code § 14132.755 (2021), https://casetext.com/statute/california-codes/california-welfare-and-institutions-code/division-9-public-social-services/part-3-aid-and-medical-assistance/chapter-7-basic-health-care/article-4-the-medi-cal-benefits-program/section-14132755-dyadic-behavioral-health-visits-a-covered-benefit-under-medi-cal-program

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  25. Wisconsin Department of Health Services, “Hub and Spoke Health Home Pilot Program,” https://www.dhs.wisconsin.gov/aoda/hubandspoke-sud-hh.htm

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  26. The six states are: California, Illinois, Maryland, New Jersey, Nevada, and Virginia.

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  27. KFF, “Medicaid Postpartum Coverage Extension Tracker,” last updated October 21, 2021, https://www.kff.org/medicaid/issue-brief/medicaid-postpartum-coverage-extension-tracker/

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  28. The seven states are: Delaware, Massachusetts, Minnesota, Oklahoma, South Carolina, Virginia, and West Virginia.

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  29. Jennifer Garvin, ADA Supports Silver Diamine Fluoride for Caries Management (American Dental Association, October 26, 2020), https://www.ada.org/en/publications/ada-news/2020-archive/october/ada-supports-silver-diamine-fluoride-for-caries-management

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  30. KFF, “Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State,” last updated October 22, 2021, https://www.kff.org/medicaid/issue-brief/medicaid-waiver-tracker-approved-and-pending-section-1115-waivers-by-state/

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  31. Elizabeth Hinton and Lina Stolyar, Medicaid Authorities and Options to Address Social Determinants of Health (SDOH), (Washington, DC: KFF, August 5, 2021), https://www.kff.org/medicaid/issue-brief/medicaid-authorities-and-options-to-address-social-determinants-of-health-sdoh/

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  32. South Carolina Department of Health and Human Services, “Vaccines for Children Policy and Coding Update,” July 30, 2021, https://www.scdhhs.gov/press-release/vaccines-children-policy-and-coding-update-0

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  33. Madeline Guth and Elizabeth Hinton, State Efforts to Expand Medicaid Coverage & Access to Telehealth in Response to COVID-19 (Washington, DC: KFF, June 22, 2020), https://www.kff.org/coronavirus-covid-19/issue-brief/state-efforts-to-expand-medicaid-coverage-access-to-telehealth-in-response-to-covid-19/

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  34. Tennessee enrolls 100% of its Medicaid enrollees in MCOs and has no FFS telehealth coverage policies; however, Tennessee’s status in Figure 4 reflects state legislation requiring Tennessee insurers, including Medicaid MCOs, to cover telehealth in the same manner as in-person care.

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  35. This count excludes Tennessee, which enrolls 100% of its Medicaid enrollees in MCOs and has no FFS telehealth coverage policies.

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  36. Rose C. Chu, Christie Peters, Nancy De Lew, and Benjamin D. Sommers, State Medicaid Telehealth Policies Before and During the COVID-19 Public Health Emergency (Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, July 19, 2021), https://aspe.hhs.gov/sites/default/files/2021-07/medicaid-telehealth-brief.pdf

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  37. KFF, “Medicaid Emergency Authority Tracker: Approved State Actions to Address COVID-19,” last updated July 1, 2021, https://www.kff.org/medicaid/issue-brief/medicaid-emergency-authority-tracker-approved-state-actions-to-address-covid-19/

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  38. Tennessee enrolls 100% of its Medicaid enrollees in MCOs and has no FFS telehealth reimbursement policies; however, we include Tennessee in this count of states to reflect state legislation requiring Tennessee insurers, including Medicaid MCOs, to reimburse telehealth in the same manner as in-person care.

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  39. North Carolina reported that as of July 1, 2021, audio-visual services are paid at parity with in-person visits, but audio-only services are reimbursed at 80% the in-person rate. Mississippi reported that several audio-only codes are reimbursed slightly differently as compared to the comparable in-person evaluation & management codes.

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  40. This count excludes Tennessee, which enrolls 100% of its Medicaid enrollees in MCOs and has no FFS telehealth reimbursement policies.

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  41. Sixteen states indicated similar growth in telehealth utilization for rural and urban populations: Arizona, Florida, Georgia, Indiana, Maine, Missouri, Montana, North Dakota, Nebraska, New Hampshire, New York, Ohio, Oklahoma, Utah, West Virginia, and Wyoming.

    Ten states indicated that telehealth utilization increased more for urban populations: Colorado, District of Columbia, Illinois, Louisiana, North Carolina, Nevada, Pennsylvania, Tennessee, Texas, and Virginia.

    Two states indicated that telehealth utilization increased more for rural populations: Alaska and California.

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  42. Regarding changes to FFS telehealth coverage or reimbursement policy planned for FY 2022, the MCO states generally reported that they will require MCOs to implement the same policy.

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Social Determinants of Health
  1. Elizabeth Hinton and Lina Stolyar, Medicaid Authorities and Options to Address Social Determinants of Health (SDOH), (Washington, DC: KFF, August 5, 2021), https://www.kff.org/medicaid/issue-brief/medicaid-authorities-and-options-to-address-social-determinants-of-health-sdoh/

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  2. Centers for Medicare and Medicaid Services (CMS), “Opportunities in Medicaid and CHIP to Address Social Determinants of Health (SDOH),” last updated January 7, 2021, https://www.medicaid.gov/federal-policy-guidance/downloads/sho21001.pdf

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  3. Samantha Artiga, Rachel Garfield, and Kendal Orgera, Communities of Color at Higher Risk for Health and Economic Challenge due to COVID-19 (Washington, DC: KFF, April 7, 2020), https://www.kff.org/coronavirus-covid-19/issue-brief/communities-of-color-at-higher-risk-for-health-and-economic-challenges-due-to-covid-19/

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  4. Samantha Artiga, Bradley Corallo, and Olivia Pham, Racial Disparities in COVID-19: Key Findings from Available Data and Analysis (Washington, DC: KFF, August 17, 2020), https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-covid-19-key-findings-available-data-analysis/

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  5. Samantha Artiga, Bradley Corallo, and Olivia Pham, Racial Disparities in COVID-19: Key Findings from Available Data and Analysis (Washington, DC: KFF, August 17, 2020), https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-covid-19-key-findings-available-data-analysis/

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  6. Kendal Orgera, Rachel Garfield, and Robin Rudowitz, Tracking Social Determinants of Health During the COVID-19 Pandemic (Washington, DC: KFF, October 21, 2021), https://www.kff.org/coronavirus-covid-19/issue-brief/tracking-social-determinants-of-health-during-the-covid-19-pandemic/

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  7. Liz Hamel et al., KFF COVID-19 Vaccine Monitor: September 2021 (Washington, DC: KFF, September 28, 2021), https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-september-2021/

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  8. Elizabeth Hinton, Robin Rudowitz, Lina Stolyar, and Natalie Singer, 10 Things to Know about Medicaid Managed Care (Washington, DC: KFF, October 29, 2020), https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-managed-care/

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  9. Elizabeth Hinton, Lina Stolyar, and Robin Rudowitz, A Look at How Medicaid Agencies Are Assisting with the COVID-19 Vaccine Roll-Out (Washington, DC: KFF, March 12, 2021), https://www.kff.org/coronavirus-covid-19/issue-brief/a-look-at-how-medicaid-agencies-are-assisting-with-the-covid-19-vaccine-roll-out/

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  10. Elizabeth Hinton and Lina Stolyar, Medicaid Authorities and Options to Address Social Determinants of Health (SDOH), (Washington, DC: KFF, August 5, 2021), https://www.kff.org/medicaid/issue-brief/medicaid-authorities-and-options-to-address-social-determinants-of-health-sdoh/

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  11. For more information on WPCI: Arizona Health Care Cost Containment System, “AHCCCS Whole Person Care Initiative (WPCI),” https://www.azahcccs.gov/AHCCCS/Initiatives/AHCCCSWPCI/

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  12. Elizabeth Hinton and Lina Stolyar, Medicaid Authorities and Options to Address Social Determinants of Health (SDOH), (Washington, DC: KFF, August 5, 2021), https://www.kff.org/medicaid/issue-brief/medicaid-authorities-and-options-to-address-social-determinants-of-health-sdoh/

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  13. Louisiana and Texas did not provide answers to this specific question about non-MCO initiatives.

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  14. More information the Homeless Management Information System can be found here: “HMIS Homeless Management Information System,” HMIS Arizona, accessed October 15, 2021, https://hmisaz.com/

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  15. “Homeless Management Information System,” HUD Exchange, accessed October 15, 2021, https://www.hudexchange.info/programs/hmis/

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  16. Elizabeth Hinton and Lina Stolyar, Medicaid Authorities and Options to Address Social Determinants of Health (SDOH), (Washington, DC: KFF, August 5, 2021), https://www.kff.org/medicaid/issue-brief/medicaid-authorities-and-options-to-address-social-determinants-of-health-sdoh/

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  17. California Association of Public Hospitals and Health Systems, “Whole Person Care Lays Groundwork For Quick COVID-19 Response,” August 31, 2020, https://caph.org/2020/08/31/whole-person-care-lays-groundwork-for-quick-covid-19-response/

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  18. North Carolina Department of Health and Human Services, “Community Health Workers,” https://www.ncdhhs.gov/divisions/office-rural-health/community-health-workers

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  19. Jim Lloyd, Kathy Moses, and Rachel Davis, Recognizing and Sustaining the Value of Community Health Workers and Promotores (Center for Health Care Strategies, Inc., January 2020), https://www.chcs.org/media/CHCS-CHCF-CHWP-Brief_010920_FINAL.pdf

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  20. Centers for Disease Control and Prevention (CDC), “States Implementing Community Health Worker Strategies,” https://www.cdc.gov/dhdsp/programs/spha/docs/1305_ta_guide_chws.pdf

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  21. Rural Health Information Hub, “Roles of Community Health Workers,” https://www.ruralhealthinfo.org/toolkits/community-health-workers/1/roles

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  22. Elinor Higgins, States Engage Community Health Workers to Combat COVID-19 and Health Inequities (National Academy for State Health Policy, June 22, 2020), https://www.nashp.org/states-engage-community-health-workers-to-combat-covid-19-and-health-inequities/

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  23. Two states (Arkansas and Vermont) cited peer supports as CHW initiatives. Arkansas is looking to expand its “peer support” network, a network of individuals who have received or are currently receiving behavioral health services provide support, education, and advocacy to others receiving behavioral health services while Vermont will be adding peer support services to their Medicaid state plan in 2022.

    More information on Arkansas’s definition of peer supports can be found here: Arkansas Department of Human Services, “Adult Behavioral Health Services for Community Independence,” https://humanservices.arkansas.gov/wp-content/uploads/ABHSCI_II.doc

    More information on Vermont’s plan to add peer support services can be found here: Letter from Vermont Governor to CMS (June 29, 2021), https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-pa4.pdf

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  24. Oregon House Bill 2088 (June 2021), https://olis.oregonlegislature.gov/liz/2021R1/Downloads/MeasureDocument/HB2088/Enrolled

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  25. Oregon Community Health Workers Association, “Community Health Worker Payment Model Guide,” November 2020, https://www.orchwa.org/resources/Documents/ORCHWA%20Payment%20Model%20Guide%202020.pdf

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  26. For more information on the Healthcare Transformation Collaboratives: Illinois Department of Healthcare and Family Services, “Healthcare Transformation Collaboratives,” https://www2.illinois.gov/hfs/Pages/HealthcareTransformation.aspx

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  27. Illinois Department of Healthcare and Family Services, Provider Notice, “Healthcare Transformation Collaboratives Program Application for Funding Awards,” March 8, 2021, https://www2.illinois.gov/hfs/MedicalProviders/notices/Pages/prn210308b.aspx

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  28. Samantha Artiga, Rachel Garfield, and Kendal Orgera, Communities of Color at Higher Risk for Health and Economic Challenge due to COVID-19 (Washington, DC: KFF, April 7, 2020), https://www.kff.org/coronavirus-covid-19/issue-brief/communities-of-color-at-higher-risk-for-health-and-economic-challenges-due-to-covid-19/

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  29. Samantha Artiga, Bradley Corallo, and Olivia Pham, Racial Disparities in COVID-19: Key Findings from Available Data and Analysis (Washington, DC: KFF, August 17, 2020), https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-covid-19-key-findings-available-data-analysis/

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  30. National Committee for Quality Assurance, “Multicultural Health Care,” https://www.ncqa.org/programs/health-plans/multicultural-health-care-mhc/

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  31. Additionally, several states cited that current or planned expansions of doula coverage and other maternity services would address health disparities. These benefit changes are included in the Benefits and Telehealth section of this report.

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  32. Elizabeth Hinton, Lina Stolyar, and Robin Rudowitz, A Look at How Medicaid Agencies Are Assisting with the COVID-19 Vaccine Roll-Out (Washington, DC: KFF, March 12, 2021), https://www.kff.org/coronavirus-covid-19/issue-brief/a-look-at-how-medicaid-agencies-are-assisting-with-the-covid-19-vaccine-roll-out/

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  33. Elizabeth Hinton, Robin Rudowitz, Lina Stolyar, and Natalie Singer, 10 Things to Know about Medicaid Managed Care (Washington, DC: KFF, October 29, 2020), https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-managed-care/

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  34. Florida Agency for Healthcare Administration, Policy Transmittal, “Statewide Medicaid Managed Care (SMMC),” June 18, 2021, https://ahca.myflorida.com/medicaid/statewide_mc/pdf/2018-23_plan_comm/PT_2021-21_COVID-19_SOE_Vaccine.Administration.Initiative_06.18.2021.pdf

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Provider Rates and Taxes
  1. MaryBeth Musumeci, Robin Rudowitz, Elizabeth Hinton, Rachel Dolan, and Olivia Pham, Options to Support Medicaid Providers in Response to COVID-19 (Washington, DC: KFF, June 17, 2020), https://www.kff.org/coronavirus-covid-19/issue-brief/options-to-support-medicaid-providers-in-response-to-covid-19/

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  2. Rachel Dolan, and Madeline Guth, How Have States Used Medicaid Emergency Authorities During COVID-19 and What Can We Learn? (Washington, DC: KFF, August 26, 2021), https://www.kff.org/medicaid/issue-brief/how-have-states-used-medicaid-emergency-authorities-during-covid-19-and-what-can-we-learn/

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  3. Nancy Ochieng, Jeannie Fuglesten Biniek, MaryBeth Musumeci, and Tricia Neuman, Funding for Health Care Providers During the Pandemic: An Update (Washington, DC: KFF, August 20, 2021), https://www.kff.org/policy-watch/funding-for-health-care-providers-during-the-pandemic-an-update/

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  4. Elizabeth Hinton, Robin Rudowitz, Lina Stolyar, and Natalie Singer, 10 Things to Know about Medicaid Managed Care (Washington, DC: KFF, October 29, 2020), https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-managed-care/

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  5. Elizabeth Hinton, Robin Rudowitz, Lina Stolyar, and Natalie Singer, 10 Things to Know about Medicaid Managed Care (Washington, DC: KFF, October 29, 2020), https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-managed-care/

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  6. Elizabeth Hinton and MaryBeth Musumeci, Medicaid Managed Care Rates and Flexibilities: State Options to Respond to COVID-19 Pandemic (Washington, DC: KFF, September 9, 2020), https://www.kff.org/medicaid/issue-brief/medicaid-managed-care-rates-and-flexibilities-state-options-to-respond-to-covid-19-pandemic/

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  7. Robin Rudowitz, Kendal Orgera, and Elizabeth Hinton, Medicaid Financing: The Basics (Washington, DC: KFF, March 21, 2019), https://www.kff.org/report-section/medicaid-financing-the-basics-issue-brief/

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  8. Laura Snyder and Robin Rudowitz, Trends in State Medicaid Programs: Looking Back and Looking Ahead (Washington, DC: KFF, June 21, 2016), https://www.kff.org/medicaid/issue-brief/trends-in-state-medicaid-programs-looking-back-and-looking-ahead/

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  9. For more information on state emergency Medicaid actions in response to COVID-19, including payment changes, see:

    KFF, “Medicaid Emergency Authority Tracker: Approved State Actions to Address COVID-19,” last updated July 1, 2021, https://www.kff.org/medicaid/issue-brief/medicaid-emergency-authority-tracker-approved-state-actions-to-address-covid-19/

    Rachel Dolan, and Madeline Guth, How Have States Used Medicaid Emergency Authorities During COVID-19 and What Can We Learn? (Washington, DC: KFF, August 26, 2021), https://www.kff.org/medicaid/issue-brief/how-have-states-used-medicaid-emergency-authorities-during-covid-19-and-what-can-we-learn/

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  10. Julia Paradise and MaryBeth Musumeci, CMS's Final Rule on Medicaid Managed Care: A Summary of Major Provisions, (Washington, DC: KFF, June 9, 2016), https://www.kff.org/medicaid/issue-brief/cmss-final-rule-on-medicaid-managed-care-a-summary-of-major-provisions/

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  11. Daniel McDermott et al., Health Insurer Financial Performance in 2020 (Washington, DC: KFF, May 3, 2021), https://www.kff.org/private-insurance/issue-brief/health-insurer-financial-performance-in-2020/

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  12. Center for Medicare and Medicaid (CMS), “Medicaid Managed Care Regulations with July 1, 2017 Compliance Dates,” last updated June 30, 2017, https://www.medicaid.gov/federal-policy-guidance/downloads/cib063017.pdf

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  13. Center for Medicare and Medicaid (CMS), “Medicaid Managed Care Frequently Asked Questions (FAQs) – Medical Loss Ratio,” June 5, 2020, https://www.medicaid.gov/sites/default/files/Federal-Policy-Guidance/Downloads/cib060520_new.pdf

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  14. Elizabeth Hinton and MaryBeth Musumeci, Medicaid Managed Care Rates and Flexibilities: State Options to Respond to COVID-19 Pandemic (Washington, DC: KFF, September 9, 2020), https://www.kff.org/medicaid/issue-brief/medicaid-managed-care-rates-and-flexibilities-state-options-to-respond-to-covid-19-pandemic/

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  15. Among reporting states that contract with MCOs, an equal number of states reported contracting with MCOs on a calendar year basis (15) vs. on a state fiscal year basis (15). One state reported having both calendar year and state fiscal year contracts and six states reported “other” contract terms.

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  16. States that noted having risk corridors in place for at least one MCO program unrelated to the pandemic include: Arkansas, California, Hawaii, Massachusetts, Nebraska, Pennsylvania, Texas, and Utah.

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  17. 42 CFR §§ 438.6 and 438.60.

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  18. Prior to 2016, a number of states made pass-through payments to providers by increasing MCO capitation rates and then requiring MCOs to direct these additional funds to designated providers. The 2016 Medicaid and CHIP Managed Care Final Rule required states to phase out “pass-throughs” of state supplemental provider payments in the capitation rates paid to MCOs and limited benefit PHPs over five to ten years because they are not tied to the provision of services covered under plan contracts and therefore conflict with the actuarial soundness requirement.

    The 2016 Rule created an exception that permits “state directed payments” that comply with 42 CFR Section 438.6(c). CMS added this exception in recognition of the fact that pass-through payments are often an important revenue source for safety-net providers and that states also had interests in contractually directing MCO payments to improve and integrate care, enhance quality, reduce costs, and promote delivery system reforms.

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  19. States also can seek CMS approval to require MCOs to implement value-based purchasing models for provider reimbursement (e.g., pay-for-performance, bundled payments) or participate in multi-payer or Medicaid-specific delivery system reform or performance improvement initiatives (discussed in more detail in Social Determinants of Health section of this report).

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  20. In January 2021, CMS issued state directed payment updated guidance. See: Center for Medicare and Medicaid (CMS), SMD#21-001, “Additional Guidance on State Directed Payments in Medicaid Managed Care,” last updated January 8, 2021, https://www.medicaid.gov/Federal-Policy-Guidance/Downloads/smd21001.pdf

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  21. Center for Medicare and Medicaid (CMS), “Medicaid Managed Care Options in Responding to COVID-19,” last updated May 14, 2020, https://www.medicaid.gov/sites/default/files/Federal-Policy-Guidance/Downloads/cib051420.pdf

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  22. The 13 states are: Arizona, Iowa, Illinois, Louisiana, Massachusetts, New Hampshire, New Jersey, New York, Ohio, Oregon, Tennessee, Washington, and West Virginia.

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  23. Fifteen states reported minimum fee schedules for “other” provider types not specified in Exhibit 6: Hawaii, Iowa, Illinois, Kentucky, Maryland, Missouri, Mississippi, North Carolina, New Hampshire, New York, Ohio, Pennsylvania, Virginia, Wisconsin, and West Virginia.

    Provider types cited in this “other” category include: durable medical equipment (DME) (Kentucky, North Carolina, New Hampshire, Virginia, and West Virginia), BH providers (Ohio and West Virginia), hospice (Hawaii), Federally Qualified Health Centers (FQHC)/rural health clinics (RHC) (Iowa), critical access pharmacy (Illinois), ambulance (Missouri), autism spectrum disorder (Mississippi), pregnancy management program (North Carolina), psychiatric designated receiving facilities and BH community residential providers (New Hampshire), Indian Health Center providers (New York), opioid use disorder Centers of Excellence and Integrated Community Wellness Centers (Pennsylvania), sub-acute psychiatric providers (Wisconsin), and family planning providers (West Virginia).

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  24. The six states are: Florida, Massachusetts, Missouri, Pennsylvania, Tennessee, and Wisconsin.

    Five states (Florida, Massachusetts, Missouri, Tennessee, and Wisconsin) set a maximum fee schedule for hospitals; Wisconsin also sets maximum fee schedules for several other provider types (described in text). Pennsylvania sets a maximum fee schedule for an “other” provider type not specified in Exhibit 6 (Opioid Use Disorder Centers of Excellence and Integrated Community Wellness Centers).

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  25. Twenty-four states reported any MCO or PHP directed payments in place as of July 1, 2021: Arizona, California, Florida, Georgia, Hawaii, Iowa, Illinois, Kansas, Kentucky, Massachusetts, Michigan, Missouri, Mississippi, Nebraska, New Hampshire, New Jersey, Ohio, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, and West Virginia.

    Specifically, 19 states reported directed payments for hospitals: Arizona, California, Florida, Hawaii, Iowa, Illinois, Kansas, Kentucky, Michigan, Mississippi, New Hampshire, New Jersey, Ohio, Tennessee, Texas, Utah, Virginia, Wisconsin, and West Virginia.

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  26. Government Accountability Office, Medicaid: CMS Needs More Information on States’ Financing and Payment Arrangements to Improve Oversight (Washington, DC: Government Accountability Office, December 2020), https://www.gao.gov/assets/gao-21-98.pdf

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  27. Throughout this section, we use 2020 survey data for Minnesota and 2019 survey data for Delaware, New Mexico, and Rhode Island because these four states did not response to the 2021 survey.

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  28. The Deficit Reduction Act of 2005 amended the federal Medicaid provider tax law to restrict the use of MCO taxes effective July 1, 2009. Prior to that date, states could apply a provider tax to Medicaid MCOs that did not apply to MCOs more broadly and could use that revenue to match Medicaid federal funds. Since 2009, several states have implemented new MCO taxes that tax member months rather than premiums and that meet the federal statistical requirements for broad-based and uniform taxes. In addition to the 12 states reporting implemented MCO taxes, some states have implemented taxes on health insurers more broadly that generate revenue for their Medicaid programs.

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  29. Seven states reported having an ambulance tax in place in FY 2021: California, Louisiana, Michigan, Missouri, Tennessee, Utah, and Vermont.

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  30. Eleven states reported planned increases to one or more provider taxes in FY 2022: California, Hawaii, Illinois, Indiana, Louisiana, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, and Utah. These increases were most commonly for taxes on hospitals.

    Two states reported planned decreases to one or more provider taxes in FY 2022: Maryland and Missouri.

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Pharmacy
  1. Kathleen Gifford et al., How State Medicaid Programs are Managing Prescription Drug Costs: Results from a State Medicaid Pharmacy Survey for State Fiscal Years 2019 and 2020 (Washington, DC: KFF, April 2020), https://files.kff.org/attachment/How-State-Medicaid-Programs-are-Managing-Prescription-Drug-Costs.pdf

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  2. Elizabeth Williams and Rachel Dolan, Utilization and Spending Trends in Medicaid Outpatient Prescription Drugs, 2015-2019 (Washington, DC: KFF, June 9, 2021), https://www.kff.org/medicaid/issue-brief/utilization-and-spending-trends-in-medicaid-outpatient-prescription-drugs-2015-2019/

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  3. Rachel Dolan, Understanding the Medicaid Prescription Drug Rebate Program (Washington, DC: KFF, November 12, 2019), https://www.kff.org/medicaid/issue-brief/understanding-the-medicaid-prescription-drug-rebate-program/

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  4. Rachel Dolan and Marina Tian, Pricing and Payment for Medicaid Prescription Drugs (Washington, DC: KFF, January 23, 2020), https://www.kff.org/medicaid/issue-brief/pricing-and-payment-for-medicaid-prescription-drugs/

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  5. Rachel Dolan and Marina Tian, Management and Delivery of the Medicaid Pharmacy Benefit (Washington, DC: KFF, December 6, 2019), https://www.kff.org/medicaid/issue-brief/management-and-delivery-of-the-medicaid-pharmacy-benefit/

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  6. State policymakers remain concerned about Medicaid prescription drug spending growth and the entry of new high-cost drugs to the market, like Aduhelm, which could cost states anywhere from $230 to $695 million and states report developing strategies and policies to address these drugs is a priority. See:

    Rachel Dolan and Elizabeth Williams, How Might the FDA’s Approval of a New Alzheimer’s Drug Impact Medicaid? (Washington, DC: KFF, July 13, 2021), https://www.kff.org/medicaid/issue-brief/how-might-the-fdas-approval-of-a-new-alzheimers-drug-impact-medicaid/

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  7. Juliette Cubanski, Meredith Freed, and Tricia Neuman, A Status Report on Prescription Drug Policies and Proposals at the Start of the Biden Administration (Washington, DC: KFF, February 11, 2021), https://www.kff.org/medicare/issue-brief/a-status-report-on-prescription-drug-policies-and-proposals-at-the-start-of-the-biden-administration/

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  8. Rachel Dolan, How Might Current Federal Drug Pricing Proposals Impact Medicaid? (Washington, DC: KFF, May 24, 2021), https://www.kff.org/policy-watch/how-might-current-federal-drug-pricing-proposals-impact-medicaid/

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  9. American Rescue Plan Act of 2021, Pub. L. No. 117-2 (March 11, 2021), https://www.congress.gov/117/plaws/publ2/PLAW-117publ2.pdf

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  10. Rachel Dolan, Rachel Garfield, and Robin Rudowitz, Potential Implications of Policy Changes in Medicaid Drug Purchasing (Washington, DC: KFF, May 4, 2021), https://www.kff.org/medicaid/issue-brief/potential-implications-of-policy-changes-in-medicaid-drug-purchasing/

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  11. Rachel Garfield, Rachel Dolan, and Elizabeth Williams, Costs and Savings under Federal Policy Approaches to Address Medicaid Prescription Drug Spending (Washington, DC: KFF, June 22, 2021), https://www.kff.org/medicaid/issue-brief/costs-and-savings-under-federal-policy-approaches-to-address-medicaid-prescription-drug-spending/

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  12. Survey data from KFF’s Pharmacy Survey were used for the four states that did not respond to the 2021 survey (Delaware, Minnesota, New Mexico, and Rhode Island) for this question. See:

    Kathleen Gifford et al., How State Medicaid Programs are Managing Prescription Drug Costs: Results from a State Medicaid Pharmacy Survey for State Fiscal Years 2019 and 2020 (Washington, DC: KFF, April 2020), https://files.kff.org/attachment/How-State-Medicaid-Programs-are-Managing-Prescription-Drug-Costs.pdf

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  13. Ohio is “unbundling” many components of pharmacy benefit administration from MCO responsibilities and will contract with a single PBM instead. It is also contracting with a Pharmacy Pricing and Audit Consultant (PPAC) who will provide operational and consulting support in the areas of pharmacy reimbursement, benefit design, oversight, and auditing. Additional information about the program change is available at Ohio Medicaid Managed Care, “Ohio Medicaid Single Pharmacy Benefit Manager (SPBM),” https://managedcare.medicaid.ohio.gov/wps/portal/gov/manc/managed-care/single-pharmacy-benefit-manager

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  14. California’s pharmacy carve-out was originally scheduled for a January 2021 implementation, but the implementation date was moved to January 2022. New York’s pharmacy carve-out was delayed by two years, until April 2023, in the recently enacted FY 2022 state budget

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  15. Kentucky Cabinet for Health and Family Services, Provider Bulletin “Kentucky Managed Care Organization Single Pharmacy Benefit Manager Announcement,” April 1, 2021,  https://chfs.ky.gov/agencies/dms/dpo/ppb/Documents/ProviderMailingApril2021Final.pdf

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  16. Kathleen Gifford et al., How State Medicaid Programs are Managing Prescription Drug Costs: Results from a State Medicaid Pharmacy Survey for State Fiscal Years 2019 and 2020 (Washington, DC: KFF, April 2020), https://files.kff.org/attachment/How-State-Medicaid-Programs-are-Managing-Prescription-Drug-Costs.pdf

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  17. The ten states are: Hawaii, Indiana, Iowa, Kansas, Louisiana, Mississippi, Nevada, New Hampshire, Ohio, and West Viriginia.

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  18. Kathleen Gifford et al., How State Medicaid Programs are Managing Prescription Drug Costs: Results from a State Medicaid Pharmacy Survey for State Fiscal Years 2019 and 2020 (Washington, DC: KFF, April 2020), https://files.kff.org/attachment/How-State-Medicaid-Programs-are-Managing-Prescription-Drug-Costs.pdf

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  19. Kathleen Gifford et al., How State Medicaid Programs are Managing Prescription Drug Costs: Results from a State Medicaid Pharmacy Survey for State Fiscal Years 2019 and 2020 (Washington, DC: KFF, April 2020), https://files.kff.org/attachment/How-State-Medicaid-Programs-are-Managing-Prescription-Drug-Costs.pdf

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  20. The thirteen states are Arkansas, Colorado, Illinois, Indiana, Nevada, New York, North Carolina, Ohio, Oregon, Tennessee, Texas, Vermont, and Wisconsin.

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Key Priorities and Challenges in FY 2022 and Beyond and Conclusion
  1. Centers for Medicaid and Medicaid (CMS), “RE: Implementation of American Rescue Plan Act of 2021 Section 9817: Additional Support for Medicaid Home and Community-Based Services during the COVID-19 Emergency,” May 13, 2021, https://www.medicaid.gov/federal-policy-guidance/downloads/smd21003.pdf

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  2. Madeline Guth, Elizabeth Hinton, MaryBeth Musumeci, and Robin Rudowitz, The Landscape of Medicaid Demonstration Waivers Ahead of the 2020 Election (Washington, DC: KFF, October 30, 2020), https://www.kff.org/medicaid/issue-brief/the-landscape-of-medicaid-demonstration-waivers-ahead-of-the-2020-election/

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Methods
  1. KFF, 50-State Medicaid Budget Survey Archives, (Washington, DC: KFF, October 2021), https://www.kff.org/medicaid/report/medicaid-budget-survey-archives/

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  2. State fiscal years begin on July 1 except for these states: New York on April 1; Texas on September 1; Alabama, District of Columbia, and Michigan on October 1.

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  3. Delaware, Minnesota, New Mexico, and Rhode Island did not respond to the 2021 survey. In some instances, we used publicly available data or prior years’ survey responses to obtain information for these states. However, unless otherwise noted, these states are not included in counts throughout the survey.

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  4. Among responding states, four states (Georgia, Louisiana, Mississippi, and Texas) did not participate in the follow-up telephone interview.

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