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The plaintiffs who lost their bid to force the state to expand despite no funding for it will get their chance before the Missouri Supreme Court.
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.
Clipped from: https://www.kshb.com/news/local-news/missouri-supreme-court-to-hear-medicaid-expansion-lawsuit
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Councilmembers in the district are accusing each other of corrupt handling of MCO contract awards.
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.
Ward 7 Councilmember Vince Gray accused fellow lawmakers of attempted contract steering in the latest chapter of the Medicaid managed care contract debacle. Councilmembers framed the debate during the June 29 legislative meeting as a struggle between disruption in medical coverage for Medicaid enrollees versus fidelity to contracting law.
In a letter sent to all D.C. councilmembers Monday, Gray wrote that a bill from Chairman Phil Mendelson and Councilmembers Robert White (At-Large) and Kenyan McDuffie (Ward 5) “is a thinly veiled attempt to steer a contract to Amerigroup,” which last year lost its bid to manage healthcare for some of the District’s Medicaid beneficiaries. In June of 2020, the Office of Contracting and Procurement awarded the $1.5 billion Medicaid contract to MedStar, CareFirst, and AmeriHealth.
The bill in question would require OCP to re-evaluate bids from all four companies as ordered by the Contract Appeals Board. Last December, the CAB, a quasi-judicial body that adjudicates government contract disputes, upheld a protest from Amerigroup and ordered OCP to re-evaluate, but the agency has been dragging its feet for the past six months.
In its re-evaluation, OCP must take into consideration the CAB’s ruling in another case. In August 2020, the CAB ruled that bidders’ proposals must include a plan for how they will subcontract with small local businesses. D.C. law says the subcontracting plan must be included in the initial proposal. OCP has previously admitted that it has violated the law for years and allowed subcontracting plans to come in later in the process. Medstar did not submit a complete subcontracting plan in its initial proposal, so a re-evaluation could replace Medstar with Amerigroup.
“Ethically, this is a path Council should never contemplate, let alone take,” Gray wrote in the letter. He argued that with MedStar removed from consideration in the Medicaid contract, the bill would disrupt medical coverage for about 65,000 people.
White, responding to Gray’s letter during the legislative meeting, called the allegation of contract steering a red herring. The issue, as White sees it, is about holding local agencies accountable when they violate the law.
“That is offensive and unnecessary,” White said to Gray’s accusation of contract steering. “I have such great respect for my colleague, and I hope he will contradict what he put in his letter because it was inappropriate.”
McDuffie was more pointed.
“It is disgusting to me that there would be allegations of contract steering by the Council, when in fact what [Deputy Mayor Wayne Turnage] and mayor are asking us to do is steer a contract,” McDuffie said Tuesday. “To retroactively fix a mess they created.”
Since the CAB ruling, the Bowser administration has repeatedly tried to avoid it. Like Gray, executive branch officials have said the re-evaluation will be disruptive to tens of thousands of Medicaid enrollees.
During Tuesday’s debate, At-Large Councilmember Christina Henderson questioned why the bill was still necessary. She pointed to a letter Turnage sent to members of the Committee on Health last week. The letter, according to Henderson, said the re-evaluation has already begun.
McDuffie was still was not convinced.
“Who is it coming from?” McDuffie asked. “Because if it’s coming from the same deputy mayor, then when I ask questions about procurement, he doesn’t seem to know the answers to those, but he conveniently has answers about procurement when it benefits what he wants to see happen in terms of who gets this contract.”
McDuffie pointed out that instead of hearing from OCP Director George Schutter, Mayor Muriel Bowser, and Gray, who chairs the health committee and has oversight in this area, the Council is largely hearing from Turnage.
“He’s saying they’re doing this. There’s no real indication to me that they are,” McDuffie said of Turnage. “Do you have any evidence they’ve started re-evaluation? Because in terms of credibility, I’m not willing to just stand on what he’s saying these days.”
In an email to Loose Lips following the Council debate, Turnage emphasized his commitment to truthfulness in his dealings with the mayor and the Council since he became director of the Department of Healthcare Finance in 2011.
“I have always been completely transparent and honest in my communications with the Mayor’s office and the Council,” Turnage wrote in the email. “That Councilmember McDuffie would, without the slightest justification, impugn my character in a public meeting, says a lot more about him than it does me.”
The bill passed 9-4. Gray, along with Councilmembers Brooke Pinto (Ward 2), Brianne Nadeau (Ward 1), and Mary Cheh (Ward 3), voted no.
Clipped from: https://washingtoncitypaper.com/article/521053/lucrative-medicaid-contract-prompts-finger-pointing-over-favoritism/
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Virginia’s adult dental benefit expansion went live this week.
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.
An estimated 750,000 more Virginians will have access to dental providers and services thanks to a new adult Medicaid benefit beginning July 1.
Lawmakers approved the funding in last year‘s General Assembly.
The Virginia Dental Association is encouraging Medicaid members to learn more about coverage and find dentists at the Virginia Department of Medical Assistance Services’ website.
“The new adult Medicaid benefit is an important step for connecting underserved Virginians with critical preventative, restorative and surgical dental care,” Dr. Frank Iuorno, Jr., president of the Virginia Dental Association, said. “Expanding access to oral healthcare is important for all Virginians. No person should have to go weeks or months in pain waiting for treatment. We’ve been working to educate our member dentists about how to participate and look forward to providing quality care to new patients this year.”
Virginia currently offers a comprehensive dental coverage benefit to children under 20 and pregnant women.
The new coverage includes preventative and diagnostic treatment, such as X-rays and exams, and oral surgery and prosthodontics, which includes items like dentures.
Clipped from: https://www.farmvilleherald.com/2021/06/dental-services-available-through-medicaid/
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Medicaid members in Ohio are getting vaxxed at less than half the rate of non-Medicaid members.
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.
The reasons why vaccination is lower among Medicaid beneficiaries are complex but could include economic barriers such as less flexible work schedules as well as a lack of access to transportation and child care. (Stephen Zenner/Getty Images file photo)
Ohio GOP Gov. Mike DeWine announced in May that COVID-19 vaccine uptake among Medicaid enrollees was 22 percent, compared with 45 percent of Ohioans overall — despite recent headlines about new incentives to get a shot, including a statewide $1 million lottery.
“Obviously, that’s not a number we’re happy with,” said DeWine. “We must get these numbers up. It’s simply unacceptable.”
Health inequities were brought to the forefront during the COVID-19 pandemic, amplified by socioeconomic barriers. Now, as the supply of COVID-19 vaccines in the United States remains stable and eligibility has been extended to almost all Americans, local data shows that Medicaid beneficiaries are getting vaccinated at lower rates than the general population.
This worries experts because the nation’s poorest individuals have historically faced worse health outcomes, including shorter life expectancy.
The reasons why vaccination is lower for this population are complex but could include economic barriers like lack of access to transportation and child care or less flexible work schedules.
Clipped from: https://www.rollcall.com/2021/06/30/medicaid-beneficiaries-less-likely-to-get-covid-19-shots/
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The Biden HHS is now de-authorizing individual components it doesn’t like from waivers that were approved years ago.
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.
WASHINGTON — The Biden administration’s decision to repeal Medicaid work requirement waivers in four states is getting mixed reviews from the health policy community.
Work requirements “definitely can be a barrier to access, and that is something that we definitely have to avoid at all costs,” said Ada Stewart, MD, president of the American Academy of Family Physicians, in a phone interview. “They could end up doing harm to patients who are at most need of Medicaid.”
Nina Schaefer, senior research fellow in health policy at the Heritage Foundation, a right-leaning think tank here, disagreed. “The whole purpose of a waiver is for states to experiment with different approaches on how they want to administer the Medicaid program,” she said in a phone interview. “There has been a lot done with work requirements on other welfare programs, so why not Medicaid? … The idea of welfare is not to have a life of permanent welfare, but as a ladder to move out of the welfare hole. Working and getting higher income — those types of things should be rewarded, not be seen as a negative.”
Last week, CMS officials notified Medicaid directors in Arizona and Indiana that they were withdrawing approval for Medicaid work requirements in those states. The administration also took similar action in New Hampshire and Arkansas in March, although those states are both appealing that action in a case now before the Supreme Court, according to Bloomberg Law.
The waivers, which were granted by the Trump administration under the 1115 waiver program, generally mandate that Medicaid enrollees show that they are participating in “community engagement” activities, which could include employment (at least 80 hours per month), job training, school enrollment, or volunteer work. The policies also come with exemptions — in Arkansas, for example, the requirement exempted students, the disabled, persons responsible for full-time care of a child or other family member, and pregnant women.
In her June 24 letter to Arizona Medicaid director Jami Snyder, CMS administrator Chiquita Brooks-LaSure noted that per federal law and regulations, “CMS may withdraw waivers or expenditure authorities if it ‘find[s] that [a] demonstration project is not likely to achieve the statutory purposes.'”
After noting the effects that the pandemic has had on the Medicaid program — including the increased unemployment and lack of economic opportunities as well as the long-term effects of COVID infection that require ongoing medical care — she continued, “At a minimum, in light of the significant risks and uncertainties described above about the adverse effects of the pandemic and its aftermath, the information available to CMS does not provide an adequate basis to support an affirmative judgment that the community engagement requirement is likely to assist in promoting the objectives of Medicaid.”
“Accordingly, CMS is hereby withdrawing its approval of that portion of the January 18, 2019 amendment that permits the state to require work and community engagement as a condition of eligibility under the [Medicaid] demonstration.”
The CMS letter to Indiana Medicaid director Allison Taylor contained similar sentiments. “We do not have evidence before us that suggests that the state has measures in place that are likely to reduce the risks of Indiana’s demonstration project resulting in substantial coverage losses at a time when losing access to healthcare coverage would cause significant harm to beneficiaries,” Brooks-LaSure wrote.
“CMS has determined that, on balance, the authorities that conditionally permit Indiana to require community engagement as a condition of continued eligibility are not likely to promote the objectives of the Medicaid statute. Therefore, we are withdrawing the community engagement authorities that were conditionally approved in the October 26, 2020, extension approval of the HIP [Healthy Indiana Plan] demonstration.”
This withdrawal of permission occurring after the waiver has already been approved opens a real Pandora’s box, according to Schaefer. “What is a precedent is that the government would now reopen what was an agreed-to contract between the federal government and the state regarding the provision of the waivers,” she said. “Is this a way that waivers are going to move in future administrations, where new administrations now reopen the Biden administration’s waivers and say, ‘OK, we don’t agree with these policies and we’re going to stop them again?’ That will have a real chilling effect on innovation at the state level.”
But Gary Rosenfield disagreed. “It could open a Pandora’s box, but when it’s bad policy, that is a Pandora’s box that needs to be opened,” said Rosenfield, senior vice president at ConsejoSano, a healthcare technology company specializing in culturally-aligned outreach to Medicaid plan members. “It’s targeting people who don’t necessarily have voices, and it’s taking the wrong approach … The whole notion that someone is sitting around saying, ‘I want to be on Medicaid so I’m not going to work’ is, in my opinion, a ridiculous thing. Statistics show that people who aren’t aged, blind, or disabled — the vast majority of them are working.”
“As long as the Biden administration makes it clear why they’re reversing the policy, and why it was bad policy to begin with, and sells it and justifies why they’re doing it … they could do it in a way that would make it defensible,” Rosenfield said, speaking during a phone interview at which a public relations person was present.
Thomas Johnson, executive director of the Population Health Alliance, a trade organization for groups interested in population health management, said in an email that although his organization has not taken a position on work requirements, “I haven’t seen any evidence from any state that has resulted in any goals being reached from supporters of such requirements.” In addition, “I think there were a number of challenges for enrollees around the country. In Arkansas, the state was solely reliant upon an online system for enrollees entering required information, and that state has the largest gap for access to the internet in the country.”
Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow
Clipped from: https://www.medpagetoday.com/publichealthpolicy/medicaid/93348
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After years of effort and multiple political challenges, North Carolina HHS officials have brought managed care to the state for the first time.
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.
A map shows North Carolina’s managed care regions. The state is switching to a new Medicaid system Thursday.
Thursday is a big day for Medicaid in North Carolina.
The state is officially switching to a new Medicaid system called a “managed care” model.
That means 1.6 million Medicaid recipients will receive health care through plans managed by a small group of companies. Instead of paying doctors directly for their services, the state will pay companies that will then pay doctors who treat Medicaid recipients.
About 40 other states use this model, according to the Kaiser Family Foundation. The goal is to save money and improve care.
But it will likely be a bumpy transition. Very few people in North Carolina have chosen their own health plan, according to state data, and many likely don’t even know the change is happening.
An advocacy group called North Carolina for Better Medicaid surveyed 170 Medicaid beneficiaries and found that 43% of them knew “very little” or “nothing” about the switch to managed care. Dave Richard, the head of NC Medicaid, said that’s not surprising.
“We tried to do everything we could — reach out with social media, with radio and television media, direct mail-outs to beneficiaries,” Richard said. “But people’s lives are complicated and a lot of things are going on.”
Becca Friedman with the Charlotte Center for Legal Advocacy said she is particularly worried about problems with the mail.
“There’s definitely been a lot of notices that have gone out to beneficiaries that we’re nervous aren’t getting to them,” Friedman said.
She said a lot of Medicaid beneficiaries have moved or changed their addresses during the pandemic and the state may not have their updated mailing information.
Medicaid recipients had until May 21 to pick their own new health plan or the state would automatically assign one. According to Richard, only about 15% of people signed up, which he said is in line with what other states saw when they changed systems.
NCDHHS
“We would love to have had it higher,” Richard said. “But in consultation with other states who had gone live with managed care … it’s well within the norms that they experienced.”
Richard said the state based its health plan assignments for the other 85% of Medicaid recipients around people’s primary care doctors so that people could theoretically continue to see the same provider. He admits there will be problems with the auto-assignments.
For example, he said, the primary care doctor that the state has on file for someone might be outdated and not match the doctor that they have actually been seeing. Or their new plan might not include a specialist that they need.
“If you have heart disease … your primary care provider is really, really important. But your cardiologist is probably more important to you,” Richard said. “You may not have been assigned to a plan where your cardiologist is enrolled.”
Richard said he and his staff are bracing for a flood of phone calls and emails in the coming weeks and the state has planned for some hiccups. If a Medicaid recipient shows up for an appointment and the doctor isn’t on their new plan, that doctor can still bill Medicaid for the next 60 days.
“We have a rapid response team that’s ready, prepared to do this,” Richard said. “Our health plans are all ready for that. Our enrollment broker will continue to be there to address beneficiary issues.”
Recipients have until Sept. 30 to change their managed care plan for any reason.
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Clipped from: https://www.wfae.org/health/2021-06-30/big-change-to-nc-medicaid-system-takes-effect-thursday
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The proposed use of community engagement requirements to get Medicaid managed care (vs fee for service) is being targeted by opponents as a violation of the equal access clause of SSA.
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.
For the most part, Arkansas has been successful in navigating state politics and the federal waiver process to expand Medicaid coverage for its residents, albeit with that navigation resulting in some dubious policy choices. Arkansas intermittently added waiver features such as work and community engagement requirements, premium obligations for enrollees with household incomes above 100 percent of the federal poverty level, and health independence accounts (a swiftly discontinued feature that was operationally flawed) to achieve the required supermajority vote in both state legislative chambers to continue funding authorization for Medicaid expansion.
However, the major and most innovative feature of the state’s Medicaid expansion has been the use of “premium assistance”—a long-standing option for Medicaid but made feasible by standardization of the essential health benefit. Instead of enrolling eligible individuals in the Medicaid fee-for-service program or managed care organizations, Arkansas used Medicaid dollars to purchase individual market qualified health plans (QHPs) available on the Affordable Care Act’s newly established health insurance Marketplace. By doing so, the state unquestionably met the Medicaid “equal access” requirement—the requirement that payments are “sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area” for the expansion population.
Arkansas’ expansion program is currently undergoing another facelift with the passage of enabling legislation for Arkansas Health and Opportunity for Me, or ARHOME . This version of Medicaid expansion still sits on the chassis of premium assistance, but it incorporates incentives for “full-time work and attainment of economic independence” and “encourages personal responsibility for individuals to demonstrate that they value healthcare coverage and understand their roles and obligations in maintaining private insurance coverage.” Failure to participate in so-called “economic independence incentives,” including work and community engagement, does not result in loss of coverage as it did before. Courts and the Biden administration have closed that door. Instead, as initially proposed in the enabling legislation and as previously stated by supporters in remarks to the news media, an ARHOME enrollee in a QHP could be moved into Medicaid fee-for-service for failure to participate.
Being moved from a QHP to the Medicaid fee-for-service program could certainly be viewed as a penalty. After all, the stigma of Medicaid has been documented and is among the many reasons that Arkansas opted for a premium assistance model in the first place. The federally required evaluation of the Health Care Independence Program—the first iteration of expansion in Arkansas that was also known as the “Private Option”—showed that Medicaid enrollees in QHPs experienced better access—both perceived and actual—and higher-quality care than enrollees in fee-for-service. This is not at all surprising: It follows the mantra, “You get what you pay for.” The evaluation found that physician payment rates for outpatient services were about 95 percent higher in each of the three years under study for enrollees in a QHP compared to their Medicaid fee-for-service counterparts. For inpatient stays, there was a 53 percent difference in payment rates per discharge, inclusive of supplemental payments above the base rates.
These cost-related findings from the evaluation have been used by some Arkansas legislators to argue that the state should save its money by ending the premium assistance approach and moving all of the enrollees into Medicaid fee-for-service. In fact, a group of legislators filed a bill to do exactly that. Fortunately, the majority of the Arkansas General Assembly has not been tempted to move in that direction, confident that the premium assistance approach has not only improved quality and access for expansion enrollees but has also benefitted the individual insurance market by promoting enhanced competition and stabilizing premiums. Equally if not more attractive are the fiscal benefits to the state budget and providers from higher QHP reimbursement rates, which have shored up the state’s rural hospitals (only one has closed in Arkansas in recent years, compared to 57 in surrounding states that did not expand).
The ARHOME waiver application appears to have walked back on “reassignment” of QHP enrollees to Medicaid fee-for-service for failure to participate in economic independence incentives as originally proposed. The application indicates both a delay in implementation until 2023 and a regulatory process for defining what it means to be an “inactive” beneficiary for purposes of reassignment. Regardless, the waiver feature as originally proposed has sparked a debate about the Medicaid “equal access” requirement and whether compliance is in question.
Evaluation of the premium assistance model in Arkansas established that the QHPs provided beneficiaries with enhanced access and quality. Ideally, state officials would have used the evaluation findings to acknowledge and address what led to the disparities in access and quality—that is, the insufficiency of Medicaid fee-for-service payments. Instead, the ARHOME waiver application now proposes to evaluate “whether beneficiaries enrolled in a QHP recognize and value the health coverage as insurance above and beyond Medicaid medical assistance.” Federal officials should vigilantly examine compliance with Medicaid “equal access” requirements before considering waiver proposals from any state that would reassign a beneficiary to a care delivery strategy with lower provider payments.
To be fair, Arkansas Medicaid officials have launched a systematic review of reimbursement rates in response to a 2019 executive order issued by the governor, and the review must consider “the availability and access to care in each area of the state.” Prior to the executive order, there was no schedule or standardized process for rate review, despite the state’s being subject to a consent decree that requires court review of rate changes. In place since 1993, the consent decree is the result of a lawsuit brought by provider groups, and, while intended to ensure sufficient Medicaid payment rates, rates have actually stagnated under court oversight, with some providers not seeing rate increases in more than a decade.
Consent decrees resulting from “equal access” lawsuits have been at risk of being dissolved since the US Supreme Court held in 2015 that health care providers have no right to sue to enforce the terms of the federal Medicaid statute. To date, Arkansas Medicaid officials have not moved to dissolve the consent decree, but recent legislation passed by the Arkansas General Assembly requires the state to seek reconsideration of the consent decree in light of the 2015 Supreme Court decision.
Following the 2015 decision, the Obama administration issued regulations requiring states to regularly submit reports documenting their monitoring of access for Medicaid enrollees and to prospectively submit for federal review any proposed rate reductions or changes that could result in diminished access. However, as documented in this Health Affairs blog post, in 2019 the Trump administration proposed regulations that would have abandoned efforts to ensure some level of state-based monitoring. What is more, the proposal fully retreated from prospective federal review of Medicaid provider payment reductions. Interestingly, the Trump administration’s proposed regulations were never finalized, which means that the Biden administration could rescind the proposed rule and reexamine whether the Obama-era regulations are effective at ensuring access.
Such an examination should consider the following questions at minimum:
As has been the case with demonstration waiver evaluations, the administration should be clear about the data collection, methodological, and measurement expectations for state reporting. It should also consider requiring an independent assessment.
Data to enable these types of comparisons are increasingly available. Both states and the federal government have invested in state-based all-payer claims databases, and they should use them as an available tool to enhance the assessment.
Clearly Arkansas’ fee-for-service rates fall short of meeting the Medicaid “equal access” provision, and many other states report similar disparities, despite federally required access monitoring and reporting requirements. While offering the opportunity for more comprehensive measuring and stringent monitoring of access and quality contractually, managed care strategies similarly disappoint on the payment front. State requirements for managed care plans to offer minimum provider reimbursement—if there are requirements—are often tethered to Medicaid fee-for-service rates. The use of Medicaid premium assistance through QHPs by definition meets the “equal access” standard. Should we not expect more of other Medicaid delivery strategies?
The “equal access” quandary might not be at the top of the Biden administration’s policy priorities, but Arkansas’ waiver proposal is certain to provoke questions about how the administration can possibly square approval of a reassignment feature while advancing broadly applicable equal-access regulations. As the administration negotiates with states on one-off waiver features, it should be careful not to send mixed messages and erode long-established—albeit ill-defined and tepidly enforced—beneficiary protections engrained in Medicaid law.
Clipped from: https://www.healthaffairs.org/do/10.1377/hblog20210624.640822/full/
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Louisiana HHS officials have now sent the 2nd in a series of letters notifying members they need to submit documentation to maintain their Medicaid coverage.
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.
Louisiana residents who are enrolled in Medicaid may begin receiving letters from the Louisiana Department of Health informing them that their coverage will end when the federal public health emergency declaration for COVID-19 is lifted.
These “preclosure” letters are among the first public-facing steps Medicaid has taken towards a return to normal operations after a year and a half of emergency response.
The federal public health emergency, which underpins that emergency response, is expected to last until at least the end of 2021. But when it does end, the state’s Medicaid office will be faced with a backload of renewals and eligibility checks.
Over the course of the pandemic, the number of Louisiana Medicaid recipients has grown substantially. Emergency programs have supported much of that growth the past year, but the federal government has asked states to begin planning how to wind down emergency measures, which means, in large part, resuming eligibility checks and disenrolling recipients.
Most of Medicaid’s growth has come from the Affordable Care Act’s expansion program, which covers low-income adults.
In March 2020, 483,000 people received Medicaid under the Affordable Care Act’s expansion, and 1.6 million people were enrolled in total. By May 2021, those numbers were 639,000 and 1.9 million respectively — roughly 40 percent of the state’s residents.
That mirrors a national trend. According to a report released this week by the Centers for Medicare & Medicaid Services, fully a quarter of the U.S. population is now enrolled in Medicaid.
That rise comes partly because of job losses caused by the pandemic, and partly because over the course of the pandemic, Louisiana, like every other state, has virtually halted all Medicaid disenrollments.
That’s important because under normal circumstances, recipients would be subject to regular eligibility checks.
Those eligibility checks happen in several ways: On the most basic level, Medicaid recipients need to renew their coverage every year, either online or over the phone.
But Louisiana conducts the extra step of quarterly wage checks to determine whether someone has exceeded income limits over the course of the year. The checks are automated using a Louisiana Workforce Commission database, and when someone does not pass a check, they receive a letter asking them to provide more information or contest the decision.
The eligibility checks and renewals have been paused by a federal policy related to pandemic Medicaid funding. The cost of Medicaid is split between the state and the federal government, and during the pandemic, the federal government has paid for a larger share. The agreement required states to maintain their Medicaid rolls, with a few narrow exceptions for those who died or moved out of state. That will soon be coming to an end.
In December, the federal government asked states to begin planning for renewed eligibility checks. That guidance was released under the Trump administration, and according to a statement provided by Medicaid to the Lens, “we are prepared with an operational plan. Additional guidance from [the Centers for Medicare & Medicaid Services] is forthcoming.”
Many of the people who are disenrolled may in fact no longer be eligible for Medicaid benefits. But the return to eligibility checks also creates the risk of disenrolling people who are eligible, a phenomenon known as “churn.”
Churn, in which eligible people repeatedly lose and reapply for coverage because of administrative procedures, predates the pandemic, said Stacey Roussell, the policy director of the Louisiana Budget Project, a left-leaning policy think tank.
“What you find in the income level of people who qualify for the Medicaid expansion is, it’s very common throughout the year to have fluctuations in income,” Roussell says. “There are parts of the year where maybe their household need is greater, and they’re going to pick up extra shifts.”
So even though a household may qualify for Medicaid on the basis of its annual income, a quarterly wage check may flag a seasonal fluctuation — like the spring tourist season — as a reason to end eligibility. When that happens, Medicaid sends the recipient a letter asking for more information.
But the recipient has only 10 days to respond, starting from the date the letter was mailed. That tight window, according to an April policy brief from the U.S. Department of Health and Human Services, “rais[es] concerns about the limited time allowed to gather appropriate documentation.”
LDH has published similar conclusions: a 2019 report to the state legislature found that 85 percent of Medicaid eligibility cases were closed because a recipient failed to respond to a request for information.
“These closures do not necessarily indicate ineligibility for Medicaid benefits, and individuals may return to eligibility if supporting information is provided,” the report reads.
The HHS policy brief also noted that churn may lead to higher per-patient Medicaid costs, both because recipients with sporadic coverage are less likely to seek preventative care, which is generally less expensive than emergency care, and because disenrolling and re-enrolling recipients creates high administrative costs for states.
Louisiana enrollees will have months before the end of the pandemic to respond to or contest Medicaid’s inquiries. Still, proving eligibility can present its own challenges, especially for people who may have lost shift work because of the pandemic.
In a December report produced by the legislature’s Joint Medicaid Oversight Committee, LDH estimated that 160,000 people would become ineligible as a result of reinstating eligibility checks. That’s more than the total growth during the pandemic to that point.
However, said Courtney Foster, the Louisiana Budget Project’s Medicaid policy advocate, “we have some issues with this number, because they estimate based on the number of people disenrolled at prior [quarterly wage checks]… [which] does not automatically mean they were ineligible. The number could set an expectation from the legislature or others that they should expect at least that number of people to be disenrolled immediately when the [Public Health Emergency] ends.”
“We want to make sure that, post COVID, as people have delayed care, that they’re as connected to the available health insurance as possible, or else I think we will see an increase in medical debt, or showing up in emergency rooms in need of care that they’ve forgone because they didn’t have health insurance,” said Roussell. “There’s a lot at stake going into 2022 and getting it right.”
A January report from the Commonwealth Fund warned that “erroneous disenrollment could affect tens of millions of Medicaid enrollees” across the country.
In the December report, LDH says that it expects an “overwhelming workload of over 500,000 tasks that are anticipated at the end of the [Public Health Emergency].” In that report, LDH expected to complete the transition process by six months after the end of the public health emergency.
That began with letters sent out in January to those who were up for renewal, “asking them to renew their coverage or to supply additional information,” according to a statement attributed to Medicaid provided by LDH spokesman Kevin Litten.
The letters sent this month are a follow up to those initial communications.
“Starting this month, if members do not respond to these letters, they will lose their coverage when the public health emergency ends,” according to the Medicaid statement Litten provided. “At the end of the public health emergency, members will receive one final letter alerting them to their final date of health care coverage.”
There are steps that the state could take to soften the blow. One of them, expanding Medicaid coverage for people who have just given birth using funding from the American Rescue Plan, died in the 2021 legislative session. It’s also unclear how the legislature’s decision to set the Medicaid budget $24 million below Gov. John Bel Edwards’ original budget proposal will impact recipients.
Roussell said that her organization’s goal is to see the process slow down and focus on people who still need coverage.
“If you’re entering into it just to say, ‘we must get everybody who is ineligible off the rolls as fast as possible,’ then you’re willing to sacrifice a huge number of people who may still be eligible,” she said. “We want to say, let’s first make sure that everybody has the best chance possible to show that they’re eligible.”
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The requirement to ensure a local plan wins contracts has been removed from the latest Ohio budget bill.
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.
The full implications of this week’s budget negotiations for a redesign of the Medicaid managed-care system seemed unclear Tuesday.
The Toledo Blade reported that language that would have required the Ohio Department of Medicaid to re-do a massive redesign and procurement in its managed-care system was stripped from the version of the state budget that was passed Monday. But the package was said to retain special considerations for Medicaid managed-care companies that are headquartered in Ohio.
Advocates following the issue closely said they were still studying the matter. The office of Gov. Mike DeWine declined to comment.
Two Northwest Ohio lawmakers, Senate President Matt Huffman, R-Lima, and Sen. Theresa Gavarone, R-Bowling Green, had inserted language requiring that the Medicaid system rebid the work after Paramount Advantage, a subsidiary of Toledo-based ProMedica, lost out badly in the original procurement earlier this year. Paramount said the process was biased against it.
The loss of the business, ProMedica has said, will cost the region 600 jobs. The company didn’t respond to a request for comment Tuesday.
Gavarone told The Blade that she was disappointed that language that would give Paramount another shot was stripped out during conference-committee negotiations. She was a member of the committee.
Critics of the attempted do-over said it threatened the launch of OhioRISE, a program that would create wraparound services to up to 60,000 kids with complex behavioral needs. Such children are currently in the care of multiple agencies and in some cases, parents have to surrender custody to county health officials so that they can get the services they need. The program is a major priority of DeWine’s.
Also, rebidding the work threatened to at least delay restructuring the way the $29 billion-a-year Medicaid system purchases most of its prescription drugs. Managed-care providers currently hire pharmacy middlemen who work behind a veil of secrecy and have been shown to mark up generic drugs by hundreds of millions of dollars on Ohio.
The Medicaid redesign takes that work away from managed-care companies and gives it instead to a separate pharmacy middleman, or benefit manager, who would work directly for the state. The idea is to give state officials a window onto pricing and reimbursement data, as well as decisions regarding which drugs get preferred treatment.
Perhaps most significantly, when the budget conferees apparently eliminated language requiring that Medicaid managed-care business be re-bid, they upheld the philosophy of competitive procurement. Some critics expressed fears that if the re-bidding requirement stayed in the budget, it would have sent the wrong message to future disappointed bidders: If you lose out initially, all you have to do is lobby and litigate your way back into the game.
Clipped from: https://ohiocapitaljournal.com/2021/06/30/medicaid-rebid-stripped-from-ohio-budget-other-actions-unclear/
MM Curator summary
Daniel Tsai will head up the highest department for Medicaid within CMS.
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.
The Centers for Medicare and Medicaid Services has announced Daniel Tsai as Deputy Administrator and Director of Center for Medicaid and CHIP Services (CMCS).
With 80 million people receiving health coverage through Medicaid and the Children’s Health Insurance Program (CHIP), Tsai will lead the center’s efforts in addressing disparities in health equity and serving the needs of children, pregnant people, parents, seniors and individuals with disabilities who rely on these programs, CMS said this week. Tsai will start on July 6.
WHAT’S THE IMPACT
Originally from Massachusetts, Tsai served as the Assistant Secretary for MassHealth and Medicaid Director. His tenure focused on building a sustainable Medicaid program focused on equitable coverage for individuals and families in the state.
Tsai helped lead Massachusetts Medicaid through a significant restructuring through the 2016 Medicaid 1115 waiver. Under these reforms, MassHealth implemented an at-scale shift to value-based care.
Through the waiver, MassHealth also launched a program committing investments for nutritional and housing supports to address the social determinants of health for high cost, at-risk individuals. Also during his tenure, the agency made investments in strengthening community health centers, behavioral health and home and community-based services.
Tsai earned a Bachelor of Arts in Applied Mathematics and Economics from Harvard University, summa cum laude.
THE LARGER TREND
According to an enrollment trends snapshot released last week by the CMS, more than 80 million people have signed up for health coverage through Medicaid and CHIP, a record high.
Between February 2020 and January 2021 there was a 13.9% increase in people who enrolled in coverage, representing about 9.9 million people. That means the increases were seen over the course of the public health emergency caused by the COVID-19 pandemic.
Among the 50 states and Washington D.C., a total of 80,543,351 people were enrolled and receiving full benefits from the Medicaid and CHIP programs by the end of January 2021. In the 50 states that reported total Medicaid child and CHIP enrollment data for January 2021, more than 38.3 million children were enrolled in Medicaid and CHIP combined – about 50% of the total Medicaid and CHIP enrollment.
CMS attributes the increase in total Medicaid and CHIP enrollment to the impact of the pandemic, in particular, enactment of section 6008 of the Families First Coronavirus Response Act (FFCRA). FFCRA provides states with a temporary 6.2% payment increase in Federal Medical Assistance Percentage (FMAP) funding.
ON THE RECORD
“As someone who has successfully led a state Medicaid program to focus on value-based care for its recipients, Dan brings invaluable experience to CMS,” said CMS Administrator Chiquita Brooks-LaSure. “The COVID-19 pandemic has made clear what a lifeline Medicaid and CHIP are for families and individuals across the country. As we continue to navigate the COVID-19 pandemic and look ahead to meeting the needs of enrollees, I look forward to working with Dan to serve individuals who rely on CMS for health coverage and ensure accessible and comprehensive coverage is available for all.”
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
Clipped from: https://www.healthcarefinancenews.com/news/cms-announces-new-director-center-medicaid-and-chip-services
