« Health Innovation Highlights: January 20, 2022 Issue

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Two New Case Studies Published in Medical Debt Resource Series

In December, Community Catalyst’s Community Benefit and Economic Stability Project released the first several in a set of resources on the successes state advocates are having in addressing medical debt at the state level. Those were a policy framework brief, an infographic which presents the key drivers of medical debt, and a case study from Maryland.

Now, two new case studies from Colorado and New York are available on the resources page, with additional states to be added in the coming months. This recent blog post summarizes the project and all the resources available to date.

In 2020, approximately one in four people reported having unpaid medical bills, and medical debt in collection reached approximately $140 billion. Medical debt threatens people’s health and economic stability. It causes people to postpone or forgo necessary care. It can ruin credit scores and also result in legal actions like wage garnishments and liens on homes or other property.

State Legislative Successes on Medical Debt Protections Outlined in JAMA Article

In 2021, local and state advocates in Colorado, Illinois, Maryland and New Mexico, who are also partners of Community Catalyst's Community Benefit and Economic Stability Project, helped pass new or strengthened laws that are some of the strongest to date and may serve as a model for other states and federal policy. Mark Rukavina, program director for the Community Benefit and Economic Stability Project, co-authored an article published this month in JAMA, New State Consumer Protections Against Medical Debt, which digs into those state laws and details the ways in which they provide new and much stronger protections to limit patient liability than the federal protections.

Alabama Arise Provides Testimony and Blogs on Priorities for Use ARPA Funds

Many states are experiencing their highest-ever budget surpluses due to investment income, economic growth, consumer spending and federal funds from the American Rescue Plan Act (ARPA). States that have historically struggled to fund basic services are now positioned to meet those demands, and state advocates are letting lawmakers know how to best use increased state revenue and ARPA funds to improve the lives of their constituents. Center partner Alabama Arise released a blog post outlining how their state Legislature can strengthen the state's investments in order to build a better, more inclusive, future for years to come. 

Alabama Arise Executive Director Robyn Hyden testified on January 19 before a joint meeting of the Alabama House and Senate’s General Fund budget committees. She discussed Arise’s top priorities for lawmakers’ allocation of federal relief funds under the American Rescue Plan Act. (Full testimony here.)

The blog post goes into more detail on Alabama Arise's six bold ideas to create long-term improvements for Alabamians:  

  • Serve underserved communities by addressing infrastructure needs
  • Modernize state technology to increase efficiency across systems
  • Expand Medicaid and strengthen public health by covering adults with low incomes
  • Reduce hunger and promote healthier communities through improved food infrastructure
  • Invest in affordable housing through the state Housing Trust Fund
  • Fund public transportation through the state Public Transportation Trust Fund 


Reimagining the State LTSS Scorecard: Invitation to Chart a Path Forward

For the past decade the AARP Public Policy Institute, with support from The SCAN Foundation, The Commonwealth Fund and AARP Foundation, has produced the Long-Term Services and Supports State Scorecard tool to measure performance within and across states. The Scorecard has empowered state and federal policymakers to assess state LTSS system performance across multiple dimensions and indicators. It offers a way to assess how we, as a nation, are performing as we strive to improve the lives of older adults, adults with disabilities and their family caregivers.

As the AARP Policy Institute writes, “The COVID-19 pandemic exposed both new and longstanding cracks in the long-term services and supports (LTSS) system—cracks that have serious implications for consumers in need of LTSS and their family caregivers. It is time to reimagine, redesign, and rebuild both LTSS systems and the ways we measure their performance.” The Scorecard team is reaching out to many LTSS stakeholders across the country to find ways to better measure state progress toward a truly high-performing LTSS system, and is inviting feedback on how the tool can be improved.

NPR/Kaiser Health News Story Profiles Failings of Medicaid NEMT

A report from NPR and Kaiser Health News on Non-Emergency Medical Transportation delves into chronic problems with NEMT contractors across many states – an issue the Center has long sought to bring attention to. States are required to set up transportation to medical appointments for adults, children and people with disabilities in the Medicaid health insurance program. Transportation brokers have subcontracts with local providers, often small "mom and pop" operations, to shuttle patients to and from needed appointments, including for dialysis, adult day care, and mental health and treatment for substance use disorders.

While a lucrative business for the companies, with transportation management contracts that can be worth tens of millions of dollars, the riders and their families face a number of issues. As the article highlights, many riders are left stranded as transportation takes hours to show up or do not show up at all, some face injuries due to inappropriate wheelchair security or face unsafe conditions. Across the country, consumers have pending lawsuits against companies who provide this service, such as Modivcare and Southeastrans. 

Using a Tool to Measure Return on Investment in Addressing Health-Related Social Need

The Commonwealth Fund has published an article on its study of the utility of a Return on Investment Calculator tool for health care organizations to use to evaluate their community benefit investments, finding mixed results. By synthesizing learnings from ROI Calculator project activities, this report offers insights into the benefits and challenges of offering tools and resources to promote the development of cross-sector partnerships for addressing health-related social needs. The ROI Calculator was developed with support from the Commonwealth Fund and The SCAN Foundation.

Supporting Family Caregivers: A Collection of Evidence, Tools, and Case Studies

The Better Care Playbook for People with Complex Needs has come out with a new collection about supporting family caregivers. Family caregivers provide care for individuals with complex health needs, including older adults, people living with dementia and people with disabilities, and are often responsible for taking on medical tasks such as medication management, wound care and assisting with mobility. This Playbook explains what a supportive family caregiving model looks like and how organizations can implement these approaches in their work.

Justice In Aging Issue Brief: What Advocates Need to Know About D-SNP

A new Justice in Aging issue brief, D-SNPs: What Advocates Need to Know, provides basic information about Dual Eligible Special Needs Plans (D-SNPs), their structure and how they are regulated. It also identifies specific areas where advocates can engage with their states to ensure these plans work effectively to coordinate care and benefits for dual eligibles, including strategies for centering equity from the outset in the design of D-SNPs.

Almost three million individuals eligible for both Medicare and Medicaid (dual eligibles) D-SNPs and that enrollment is expected to rapidly rise. An increasing number of states are focusing on D-SNPs as a primary vehicle for integrating care and improving coordination of services for their dual eligible populations. Yet many advocates know little about what D-SNPs are, what makes them unique, and how they operate.

NASHP Report on Recent State Legislation to Address Hospital Community Benefit Policy

Despite the changes in federal hospital community benefit policies in recent years as well as influx of federal dollars through the American Resue Plan Act (ARPA) to many hospitals, there remains significant opportunities for hospital investments to align with community-identified needs and  gaps in federal oversight of hospitals’ community benefit programs. Although there is some level of congressional interest pursuing additional clarity at the federal level about what activities constitute sufficient community benefit provision, state legislatures also are addressing enhanced transparency in and accountability of hospital community benefit programs. The National Academy for State Health Policy (NASHP) has compiled a report on a number of recently enacted state laws to address the requirements of hospital community benefit policy. In 2021, a number of states were interested in overseeing how hospitals implement federal community benefit requirements. Eight states introduced community benefit bills and four states enacted legislation.



In mid-December, Arkansas Gov. Asa Hutchinson proposed a $60 million increase to the state's Medicaid budget for fiscal year 2023. $37.6 million of that increase is earmarked to fund more Community and Employment Support waiver slots. If approved, this increased budget will eliminate the waitlist for home and community-based services for people with intellectual and developmental disabilities by 2025.


Gov. Newsom has proposed a plan to expand Medicaid coverage regardless of immigration status.  This proposal, part of 2022-2023 budget proposal referred to as the California Blueprint, poises California to be the first state in the nation to achieve universal access to health coverage. Other important items included are: $1.7 billion to support frontline workers and expand and diversify the state’s health and community care workforce; $1.5 billion to address the needs of people experiencing homelessness with serious and persistent behavioral health conditions; and $1.4 billion to add mental health and substance use services to Medi-Cal benefits.

California also announced federal approval of its CalAIM initiative. CalAIM builds on successful pilot efforts to transform the state’s Medicaid program, Medi-Cal, to a population health approach which prioritizes social determinants of health, equity and prevention by scaling innovations to be statewide.  CalAIM launched on Jan. 1, 2022.


The Minnesota Department of Humans Services announced plans to distribute approximately $4 million in grants to support older Minnesotans maintain their health, independence and community involvement. These Live Well at Home grants will be distributed across 42 organizations in 2022 and will be used to:

  • Outreach and support older adults of all cultures
  • Support housing development
  • Support older residents experiencing homelessness


As Nebraska begins the process of Medicaid management care procurement for 2022, Kevin Bagley, director of the state's Department of Health and Human Services (DHHS) has announced opportunities for community input. DHHS will host six community listening sessions, which started on Jan. 11 and will continue through Jan. 25.

Rhode Island

CMS posted a combined first and second evaluation report for the ongoing Rhode Island demonstration under the Medicare-Medicaid Financial Alignment Initiative (FAI). Over two-thirds of respondents enrolled in the demonstration rated their health plan at the highest levels. The Rhode Island demonstration significantly reduced emergency department (ED) use through 2018. The probability of an ED visit and the count of preventable ED visits declined over this period, though the evaluation did not find evidence of Medicare savings.

All FAI evaluation reports are available at https://innovation.cms.gov/innovation-models/financial-alignment

South Carolina

CMS posted the second evaluation report for the ongoing South Carolina demonstration under the Medicare-Medicaid Financial Alignment Initiative (FAI). Over two-thirds of respondents enrolled in the demonstration rated their health plan at the highest levels. The demonstration led to a decline in inpatient admissions through 2018 with no impact on Medicare costs, but also an increased probability of any long-stay NF use, and an increase in Medicaid costs.

All FAI evaluation reports are available at https://innovation.cms.gov/innovation-models/financial-alignment


CMS posted the fifth evaluation report for the ongoing Washington demonstration under the Medicare-Medicaid Financial Alignment Initiative (FAI). Washington respondents reported high levels of satisfaction with care coordination services.

Over the first 6 years (through 2019), the Washington demonstration reduced gross Medicare Parts A and B expenditures by $385 million. These evaluation results are consistent with the findings of a separate actuarial analysis. Other declines during this period included skilled nursing facility admissions, the annual probability of any long stay nursing facility use, and the probability of a 30-day follow-up visit after a mental health discharge.


Responding to calls from Wisconsin’s Department of Health Services in December, the state has used funds from the American Rescue Plan Act to increase reimbursement rates for home and community-based services by 5 percent. This rate increase went into effect Jan. 1, and is expected to assist in workforce recruitment and retention.


 Tuesday, Jan. 25 (12:30-4:30 p.m. Eastern) - Virtual Meeting: Joint Meeting of the RAISE Family Caregiving and Supporting Grandparents Raising Grandchildren Advisory Councils, presented by the Administration for Community Living. The virtual meeting link will be posted on this page at the time of meeting, with no pre-registration required.

Tuesday, Jan. 25 (1-2 p.m. Eastern) - Webinar: Primary Care at Home – How One Area Agency on Aging Is Bringing Back the House Call, presented by American Society on Aging. Please register for the webinar.  

Wednesday, Jan. 26 (4-5 p.m. Eastern) - Webinar: Enhancing Tribal Environmental Health Program Capabilities and Engagement in COVID-19 Response, presented by the The National Indian Health Board (NIHB). Please register for the webinar.  

Thursday, Jan. 27 (2-3 p.m. Eastern) - Webinar: Using Data for Good: Towards More Equitable Home and Community-Based Services in Medi-Cal, presented by Justice In Aging. Please register for the webinar.  

Thursday, Jan. 27 (4-5:30 p.m. Eastern) - Webinar: HCBS Settings Regulation: Where Are We Now and Where Are We Going, presented by The Administration for Community Living and Centers for Medicare and Medicaid Services. Please register for the webinar.  

Tuesday, Feb. 8 (1-2 p.m. Eastern) - Webinar: NASHP Webinar: State Policies to Strengthen the Direct Care Workforce , presented by The National Academy for State Health Policy's (NASHP) RAISE Family Caregiver Resource and Dissemination Center. Please register for the webinar.

Friday, April 15 - Application Deadline: Applications due for the Health & Aging Policy Fellows Program (2022-23). Please click here for an overview of the fellowship, including program tracks, eligibility and selection criteria, and application information.