Health Equity blog

Nearly two years since releasing its Framework for Advancing Health Care in Rural, Tribal, and Geographically Isolated (RTGI) Communities, the Centers for Medicare & Medicaid Services (CMS) issued its FY2024 Year in Review, which describes progress made to address the unique needs of RTGI Communities, including increased investments for organizations critical to helping RTGI community members find and enroll in affordable health coverage through the Marketplace. In addition, CMS has streamlined the prior authorization process for Medicare Advantage, Medicaid, and CHIP, which are all vital to meeting these RTGI community needs. CMS also began implementing a policy that enables certain Indian Health Service (IHS) and Tribal facilities to convert to Rural Emergency Hospitals, as well as released tailored resources for American Indians and Alaska Natives to help make health care coverage more accessible.

On October 16, the Centers for Medicare & Medicaid Services (CMS) approved 1115 demonstrations for Arizona, California, New Mexico, and Oregon expanding their Medicaid and CHIP covered services to include traditional health care practices provided by Indian Health Services facilities, Tribal facilities, and urban Indian organizations. Recognizing the importance of traditional health care practices to American Indian and Alaska Native (AI/AN) populations, CMS hopes this policy effort will improve access to culturally appropriate and quality health care in Tribal communities. AI/AN populations experience significantly worse health disparities compared to the general population, including higher rates of diabetes, obesity, cancer, substance use disorder (SUD) and other mental illnesses. Studies have shown that traditional health care practices, including traditional healers and natural helpers, can improve the health outcomes for individuals facing these challenges. In particular, recognizing the fact that Native American populations are disproportionately affected by the opioid epidemic, Medi-Cal has announced that it will place a particular emphasis on traditional health care practices that have proven successful in treating SUD.

The Centers for Medicare & Medicaid Services (CMS) issued its final MPFS rule for CY2025 (to appear in Federal Register on Dec. 9). The new fee schedule is indicative of a broader federal government strategy to create a more equitable health care system that results in better accessibility, quality, and affordability for all Medicare beneficiaries, including those individuals most marginalized historically. For instance, with regard to opioid treatment programs (OTPs), while state law still applies, CMS is allowing telecommunication flexibilities that will promote access to care for populations that often face barriers to entering and participating in treatment and allow OTPs and their patients to mutually agree on the best modality for receiving care. The 2025 MPFS also finalizes a continued policy to delay the in-person visit requirement for mental health services furnished via communication technology by rural health clinics (RHCs) and federally qualified health centers (FQHCs) to beneficiaries in their homes until 2026, which is a critical win for patients in rural and other underserved communities who vitally need access to such services.

The Centers for Medicare & Medicaid Services (CMS) OPPS and ASC Final Rule was published in the Federal Register on November 27. In addition to customary payment rate updates, the 2025 final rule also addresses key Biden-Harris Administration policy objectives, including reducing health disparities, broadening access to behavioral health care, and responding to the maternal health crisis. In addition, the final rule reflects experience CMS gained from the COVID-19 pandemic that will also help eradicate persistent health inequities.

As part of Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements, nearly half the nation’s children are entitled to receive a comprehensive range of preventative, diagnostic, and treatment services, including mental health care, well-child visits, and dental, vision and hearing services. CMS’s guidance, issued on September 26, outlines strategies and best practices for states in implementing the EPSDT requirements. Ensuring that eligible children receive these health care services is vital to improving their long-term health care outcomes.

On October 4, the Centers for Medicare and Medicaid Services (CMS) issued its proposed Notice of Benefit and Payment Parameters for the 2026 plan year (published in the Federal Register on October 10) that would implement standards for plans operating in the health insurance Marketplace established by the Affordable Care Act (ACA). The proposed rule includes requiring carriers to set premium payment thresholds to help reduce enrollee coverage terminations, which particularly creates risk for lower income populations who often fail to timely pay smaller premium amounts. Another facet of the rule aimed at increasing health equity is more active federal monitoring of certain Marketplace plans to ensure their provider networks include a sufficient number and geographic distribution of Essential Community Providers (ECPs), who commonly serve people with traditionally unmet medical needs and/or are low-income. Comments on the proposed rule will be accepted through November 12, 2024.

CMS’s new Expanding Access to Women’s Health program seeks to solidify women’s health coverage and ensure access to critical health benefits in 14 states (AR, CO, HI, MA, ME, MS, NE, NH, NJ, NM, PA, VT, WA, and WI) and D.C. Recipients can use these funds to develop activities and foster educational campaigns to address historical disparities in access to reproductive and maternal health care. Improving and broadening women’s health care and coverage are critical to reducing maternal mortality rates and improving women’s overall well-being.

On October 7, the Supreme Court of the United States (SCOTUS) released a long list of cases for which it was either granting or denying a petitioner’s request for certiorari. Among the denials was a petition from the Department of Health and Human Services (HHS), seeking the Court’s review of a 5th Circuit decision that Emergency Medical Treatment and Active Labor Act’s (EMTALA’s) federal requirements with regard to when a pregnant individual’s life is in danger or is at serious risk of harm do not conflict with Texas state law that severely restricts access to abortions. The case began as a challenge by Texas and two medical groups to HHS guidance, which advised hospitals that EMTALA may require hospitals to provide abortions as stabilizing treatment, despite situations in which state law would otherwise prohibit the abortion. The 5th Circuit disagreed with HHS’s guidance, thus prohibiting its enforcement against Texas.

California leads the way once again in spearheading efforts to improve health equity and outcomes for its population. Early last year, Medi-Cal received federal approval for its Justice-Involved Reentry Initiative (JIRI) which offers targeted services to address some of the most critical health care needs of Medi-Cal eligible individuals returning to their communities after incarceration. Among these services will be mental health and substance use disorder (SUD)-related care that will begin 90 days prior to an individual’s release from custody. Effective October 1, 2024, the initial rollout of JIRI services will be available in 3 counties (Inyo, Santa Clara, and Yuba), but will expand to every California county by October 1, 2026. Given that a disproportionate percentage of the state’s incarcerated population is comprised of racial and ethnic minorities, this program will have a particular impact on individuals who are most at risk for their health care needs not being adequately addressed post-release.

Earlier this month, the Drug Enforcement Agency (DEA) submitted to the Office of Management and Budget (OMB) for approval its proposed final rule for extending virtual prescribing practices. The proposed rule is not yet publicly available, and remains subject to OMB clearance, but this action indicates it is expected soon. Without this extension, telemedicine prescribing of controlled substances absent a prior in-person consultation with the patient’s provider would be prohibited come January 1, 2025. During the COVID-19 pandemic, telemedicine consultations became critical to ensuring vitally needed medications were accessible by some of the most critically ill and vulnerable populations.