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Medicaid Concepts: Third Party Liability and Coordination of Benefits

This is part of our Medicaid Concepts series, in which we provide a high level overview of key concepts in the Medicaid industry today.

What do we mean by Third Party Liability (TPL) and Coordination of Benefits (COB)?


Some Medicaid members can have multiple sources of health insurance coverage besides their Medicaid coverage. (One GAO report estimates that 14% of Medicaid members had additional third party coverage in 2012). When this occurs, Medicaid is supposed to be the “payer of last resort.” In practical terms, this means that all other forms of insurance coverage should pay their share of the costs of a member’s care before Medicaid begins to pay.

There are various other types of payers that are required to pay before Medicaid does, including:

  • Employer sponsored health insurance
  • Pharmacy benefit managers
  • Medicare
  • Court-ordered health coverage
  • Settlements from a liability insurer
  • Workers’ compensation
  • Long-term care insurance

What role does Medicaid play?

In order to ensure compliance with the legal requirement for Medicaid to pay last, states are required to “take all reasonable measures to ascertain the legal liability of third parties to pay for care and services that are available under the Medicaid state plan.” This means states must operate business functions dedicated to ensuring the total coverage picture for each Medicaid member is known and incorporated into payment systems.

The state activities to ensure this are collectively referred to as “coordination of benefits” (COB). At a high level COB involves data-matching and identifying other responsible payers. In states that have Medicaid Managed Care, Medicaid plans often are paid to execute COB activities on behalf of the state.

Explore further

https://www.medicaid.gov/medicaid/eligibility/coordination-of-benefits-third-party-liability/index.html

https://medicaid.georgia.gov/programs/third-party-liability

https://www.in.gov/medicaid/files/third%20party%20liability.pdf

https://www.macpac.gov/subtopic/third-party-liability/

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Medicaid Concepts: Electronic Visit Verification

This is part of our Medicaid Concepts series, in which we provide a high level overview of key concepts in the Medicaid industry today.

What do we mean by electronic visit verification (EVV)?


Electronic visit verification (EVV) is a category of technologies and services used to validate that a visit actually occurred (usually in the member’s home). While EVV has been around for a long time, the 21st Century Cures Act made it mandatory for all state Medicaid programs by January 2020 for personal care services and January 2023 for home health services.

At a minimum, EVV systems must document:

  • Date of service
  • Location of service
  • Individual providing service
  • Type of service
  • Individual receiving service
  • Time the service begins and ends

What role does Medicaid play?


In addition to implementing required EVV systems, Medicaid agencies are in a unique position to leverage EVV data to improve member service provision. Medicaid agencies also play an important role in educating members on the benefits of EVV and reassuring those members that have privacy concerns related to GPS data tied to their home.

While EVV is primarily designed to prevent fraud in the Medicaid system, there are opportunities to use EVV data to improve care coordination and identify member quality gaps. The ability to use EVV to improve member outcomes is only beginning to be explored.

Explore further


https://www.medicaid.gov/federal-policy-guidance/downloads/cib080819-2.pdfhttps://www.medicaid.gov/sites/default/files/2019-12/evv-requirements-intensive.pdf

https://www.medicaid.gov/medicaid/data-systems/outcomes-based-certification/electronic-visit-verification-certification/index.html

https://medicaid.publicrep.org/feature/electronic-visit-verification-evv/

https://medicaid.ohio.gov/INITIATIVES/Electronic-Visit-Verification

https://medicaid.georgia.gov/programs/all-programs/georgia-electronic-visit-verification-evv

https://chfs.ky.gov/agencies/dms/dca/Pages/evv.aspx

https://dhhs.ne.gov/Documents/EVV%20October%20Slides.pdf

https://www.in.gov/medicaid/providers/1005.htm

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Medicaid Concepts: Member Engagement

This is part of our Medicaid Concepts series, in which we provide a high level overview of key concepts in the Medicaid industry today.

What do we mean by member engagement?

With so much focus in the Medicaid space on improving health outcomes for the sickest, most vulnerable populations, the need to have the member engaged in their own health is clear. “Member engagement” is a broad term that includes a range of ideas: treatment compliance, emergency room avoidance, self-directed care, decision-making, health assessments, and member onboarding.

All efforts centered on member engagement are based on the idea that people will make better healthcare decisions when they are more engaged. One of the biggest obstacles to increasing member engagement today is the overload of information. It is increasingly difficult to get the member’s attention in an information-rich world of social media, email and entertainment.

Member engagement should not be confused with care management. Care management describes a model focused on care coordination, treatment pathways and targeting members with complex needs. While care management also relies on member engagement, the two terms are not synonymous.

What role does Medicaid play?

Over the past several decades, Medicaid agencies have worked to improve member-engagement. Many of the earlier efforts evolved out of the disease management programs of the late 1980s and 1990s. Newer efforts focus on maximizing the effectiveness of communications to members, targeting specific members to close quality gaps and aligning incentive programs to encourage healthy behaviors.

While much of the member engagement effort focuses on newer technology solutions (think smartphones or telehealth), there are still important functions related member engagement that happen in a call center, or when a member fills out a member satisfaction survey. Medicaid agencies, health plans, and providers all have opportunities to increase member engagement in a wide range of settings and thereby improve health outcomes.

Explore further

https://carenethealthcare.com/medicaid-member-engagement-strategies/

https://medcitynews.com/2018/09/here-are-some-high-impact-engagement-strategies-for-medicaid/?rf=1

https://www.chcs.org/media/PRIDE-Culture-of-Engagement-FINAL.pdf

https://healthpayerintelligence.com/news/how-to-improve-medicaid-member-engagement-care-coordination

https://www.colorado.gov/pacific/hcpf/performance-measurement-and-member-engagement

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Anthem To Buy Puerto Rico Medicare And Medicaid Plans

MM Curator summary

 
 

Anthem will pick up more than 500,000 lives with the purchase.

 
 

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.

 
 

 
 

Anthem said it is buying Medicaid and Medicare Advantage health plans in Puerto Rico for an undisclosed sum from InnovaCare Health.

The deal to buy InnovaCare’s MMM Holdings subsidiaries will bring Anthem more than 267,000 new Medicare Advantage health plan members and more than 305,000 new Medicaid enrollees. Anthem said MMM is the “ninth-largest MA plan in the country and second-largest Medicaid plan on the island of Puerto Rico.”

The addition of the Puerto Rico operations comes as Anthem continues to bolster its government health insurance businesses, which have been a big growth driver for the company. Anthem operates Blue Cross and Blue Shield health plans in 14 states.

Medicare Advantage, in particular, has been a target for Anthem and health insurer rivals as more seniors flock to such coverage. Medicare Advantage growth also comes amid unprecedented competition given a record number of health plans are participating in a program that offers seniors the same benefits as traditional Medicare plus extras like preventative care and outpatient healthcare services.

Health insurers have been selling perhaps their richest benefit packages for Medicare Advantage, thanks to new rules that allow Medicare Advantage plans to offer more benefits to seniors. Medicare Advantage plans contract with the federal government to provide extra benefits and services to seniors, such as disease management and nurse help hotlines with some also offering vision, dental care and wellness programs.

“We are pleased to expand Anthem’s commitment to serve Medicare and Medicaid-eligible individuals and consumers to Puerto Rico,” Anthem president and chief executive Gail Boudreaux said. “We remain focused on providing services that drive greater value while giving members access to care and services that meet their diverse needs, enhance their experience, and help them lead healthier lives.”

Anthem said the acquisition is expected to close by the second quarter of 2021.

 
 

Clipped from: https://www.forbes.com/sites/brucejapsen/2021/02/02/anthem-to-buy-puerto-rico-health-plans-medicare-and-medicaid-business/?sh=412dcecd76f6

 
 

 
 

 
 

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Public Charge Executive Order Met With Cheers and Jeers

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The new HHS administration has been ordered to review the Public Charge rule designed to reduce welfare spending for immigrants.

 
 

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.

 
 

— But what might happen next is complicated, experts say

 
 

WASHINGTON — President Biden’s executive order asking three federal agencies to review the “public charge” rule drew plaudits from several health policy experts, while others decried the move as a step in the wrong direction.

The public charge rule, part of the Immigration and Nationality Act, was issued in October 2020 by the Department of Homeland Security. It states that immigrants who are applying for a permanent residency “green card” or for citizenship will be negatively affected on their applications if they have used public programs such as the Supplemental Nutrition Assistance Program (SNAP), Medicaid, or Temporary Assistance to Needy Families for more than 12 months in a 3-year period prior to applying.

Several states sued over the rule, claiming it was unfair, and two courts issued injunctions preventing its implementation; both were eventually lifted by the Supreme Court, although the suits themselves remain active in the lower courts.

Biden Signs Executive Order

On Tuesday, President Biden signed an executive order directing the Justice, State, and Homeland Security departments to “review all agency actions related to implementation of the public charge ground of inadmissibility” and consult with other departments, including Health and Human Services, when considering the rule.

According to the order, the review should “consider and evaluate the current effects of these agency actions and the implications of their continued implementation,” identify appropriate actions to take, and recommend ways to “clearly communicate current public charge policies and proposed changes, if any, to reduce fear and confusion among impacted communities.”

“I’m not making new law; I’m eliminating bad policy,” Biden said. President Trump, he continued, “issued executive orders I felt were very counterproductive to our security, counterproductive to who we are as a country, particularly in — in the area of immigration. This is about how America is safer, stronger, more prosperous when we have a fair, orderly, and humane, and legal immigration system.”

Abner Mason, founder and CEO of ConsejoSano, a tech startup specializing in health equity and multicultural patient outreach for Medicaid plans, predicted that Medicaid will see an uptick in enrollment following Biden’s order, and that providers will get more Medicaid patients. Many immigrants seeking permanent residency or citizenship are thought to have avoided signing up for Medicaid, for fear of jeopardizing their applications.

But he noted that states are temporarily barred from screening Medicaid enrollees carefully during the pandemic. Those new enrollees may eventually face a different jeopardy, once states are again allowed to restrict eligibility. States may need to tighten their fiscal belts and their Medicaid rolls could be an inviting target for cuts.

Immigrants and the Fiscal Burden

Robert Rector, senior research fellow for domestic policy at the Heritage Foundation, a right-leaning think tank here, expressed disappointment with Biden’s order. “The general idea of the rule was a good idea,” even though it’s often misrepresented, he said in a phone interview. “The general thrust of that rule — although the bureaucracy made it exorbitantly complicated — is that as a society we want to be bringing in immigrants who aren’t going to be a fiscal burden for the U.S. taxpayer.”

“What people really don’t understand is that the U.S. has a very large government and it gives a lot of benefits and services; the average household gets over $30,000 a year in benefits and services from the government, including Social Security and Medicare and education costs, routine services like highways and sewers, and means-tested welfare” programs like Medicaid, the Children’s Health Insurance Program, and food stamps. “The sum of those expenditures is over $1 trillion a year,” Rector said.

“Libertarians don’t like me because I don’t want to destroy this welfare system — I believe there is purpose to supporting lower-income people and disadvantaged people to try to help them succeed in society,” he added. “But you can’t do that for huge inflows of people from abroad…. If you have a finite number of people that you want to let in, why would you not want to let in educated people who are going to be fiscal contributors?”

There aren’t a lot of numbers on how many people declined to enroll in programs such as Medicaid or food stamps due to the rule, Rector added. “I don’t think it had an operational effect because it wasn’t around very long … and they managed to make it very complicated.”

But what evidence that did appear suggested the rule may have had some effect, according to Shelby Gonzales, director of immigration policy at the Center on Budget and Policy Priorities, a left-leaning think tank here.

“There is a lot of anecdotal evidence that suggests that people have gone without Medicaid and other important supports out of fear that enrolling would harm their loved ones,” she wrote in an email. “The Urban Institute found that 31.5% of adults with low incomes in families that include children and at least one immigrant reported that they, or someone in their family, avoided participating in a benefit program in 2019 because of concerns about how benefit receipt would affect immigration status.”

Gonzales lauded the executive order as “an important first step to address the fears people have,” but added that “a lot more work will need to be done to address the damage of this rule.” Among other actions, “the federal government should launch a comprehensive outreach campaign aimed at addressing the concerns people have and letting them know it’s safe for them to access benefit programs for which they are eligible,” she said.

Rachel Garfield, PhD, co-director of the Program on Medicaid and the Uninsured at the Kaiser Family Foundation here, noted in an email that “in recent years we have seen increases in the uninsured rate among the Hispanic population, which could reflect the effects of the public charge rule. In terms of how the change in administration will change these recent trends, it remains to be seen, but we do know that word of mouth and informal information networks are important source of information among this population, so it will somewhat depend on how messaging about a shift in direction occurs.”

Ripple Effects

Kelly Whitener, JD, associate professor of the practice at the Georgetown University Center on Children and Families, agreed that the rule influenced more people than those directly targeted. “For example, children’s use of Medicaid/CHIP is not counted in a public charge determination if that child were to later apply for a green card, nor is it counted in the parent’s application, and yet, we saw declines in Medicaid/CHIP participation among children in immigrant families,” she said in an email.

While the Biden order “is a very meaningful and important step in the right direction, it will take a long time to undo the damage that has been done over the last 4 years,” Whitener said. “The public charge rule changes made by the Trump administration are still in effect and will remain in effect until new rules replace them, which will take months if not years.”

In the meantime, the rule continues to be tied up in court, explained Sonya Schwartz, JD, a consultant with Protecting Immigrant Families, a campaign composed of several organizations working on immigrant rights issues. A total of 11 lawsuits — including those in which the injunctions were issued — have been brought against the rule, and the Supreme Court may eventually take up one or more. “Yesterday, a district court in Illinois asked for the Department of Justice to come in” and explain its plans in a case there, “and on Feb. 19th, we’ll know a little more about what the department plans to do.”

One possibility is for the department to drop its earlier requests for Supreme Court review of lower court rulings against the Trump administration rule. Or the Supreme Court — which is having its next case conference on that same date, Feb. 19 — could simply decide not to hear them, she said.

Another option is that the Department of Homeland Security could issue an interim final rule on the subject “due to the pandemic and all the fear, and how this rule threatens to undermine our vaccine efforts and making sure people get tested and treated for COVID,” said Schwartz. “So I think there are a lot of options where we could get policy change a little bit faster, either through the courts or the agency acting quickly, but we just don’t know yet.”

  •  

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/91058

 
 

 
 

 
 

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Department of Human Services Provides Updates on Work Supports System for Medicaid Recipients

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Pennsylvania continues the rollout of its program to connect Medicaid members who want to work to jobs and skills building programs.

 
 

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.

 
 

Harrisburg, PA – Department of Human Services (DHS) Secretary Teresa Miller today outlined the Medicaid Work Supports system, a program designed to connect people whose health care is covered through Medicaid to local employment and training resources, with a goal of supporting people in finding long-term employment and achieving financial independence. As Pennsylvania continues to experience economic challenges from the COVID-19 pandemic, DHS hopes this program can be a bridge to employment for people affected by job or income loss.

Medicaid provides critical access to health care for people who would not otherwise have access to essential services like preventative visits, screenings, and medications – things we all need to stay healthy and lead an enriched, fulfilling life. Many people on Medicaid are over the age of 65 or have a chronic illness or long-term disability. Medicaid also supports people ages 19-64 with incomes at or below 133 percent of the federal poverty income guidelines. Medicaid connects more than 3.1 million Pennsylvanians to basic and life-saving health care, and enrollment in this program has grown by 300,000 people since February 2020, likely due to the economic insecurity created by COVID-19.

Prior to February 2020, most Medicaid recipients did not have a targeted connection to employment resources and support.

“One of the DHS’ top priorities remains increasing employment opportunities for those we serve. We know that many people who use safety-net programs want to work and reach their potential in jobs that lead to independence,” said Secretary Miller. “We recognized an opportunity to offer more support to people who need it in a meaningful way that meets people where they are. The Medicaid Work Supports program – a proactive, direct referral to employment and training resources – is an opportunity to fix disparities and help all people served by this system take a step forward in life.”

DHS worked with partners across the state – including the Department of Labor & Industry, Physical Health Managed Care Organizations (MCOs), Local Workforce Development Boards, and more – to implement a systematic identification and connection framework to increase workforce participation and long-term employment outcomes.

Now, when someone enrolls in Medicaid for the first time or transfers Medicaid plans, they are asked if they are interested in learning about employment resources. If they respond “yes,” they receive one of the following three outreach strategies depending on their circumstances:

  1. A letter that explains the services available at their local PA CareerLink™ office. PA CareerLink™ provides services including help with searching and applying for a job, providing a list of local job openings, and counseling to explore career interests. Some participants may also be eligible to receive support for new training and education opportunities.
  2. If the individual is a recipient of other benefits such as the Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF), the recipient’s County Assistance Office (CAO) will reach out to discuss the person’s interest in a DHS-approved employment and training program. The CAO will help with the referral and supports as needed.
  3. If the person is not in either of the previous groups, they will receive outreach from their selected MCO, which oversees a range of their health care services. Several MCOs have in-house programs ranging from GED support to general employability skills workshops to trainings for positions within their own healthcare systems.

These outreach and referral efforts are tracked by DHS to ensure that Medicaid beneficiaries receive the supports and information they requested.  DHS is also working with the PA Department of Labor & Industry to collect data on the program’s long-term outcomes for individuals who participate, such as time employed and wage gains. DHS will use this information to inform future decisions regarding Medicaid Work Supports programming.

Since the launch of Medicaid Work Supports in late February 2020, more than 38,000 people have indicated an interest in learning more about local employment resources, averaging about 800 people per week. Early reviews indicate that these efforts are creating space to discuss not only employment, but a range of other complex situations individuals experience, all of which contribute to stability and economic independence. In the future, use of the Resource Information and Services EnterpriseOpens In A New Window (RISE) PA tool will further support these efforts to address social determinants of health as part of the whole-person approach.

The Medicaid Work Supports program is not a work requirement, which as a policy functionally jeopardizes individuals’ access to health care and undermines efforts to help people achieve long-term employment. This program was designed to help people, especially communities that experience greater barriers to finding and retaining employment, move out of poverty.

Through person-centered services and a commitment to reform, DHS’s workforce-focused efforts aim to confront the impact of systemic racism and the inequities that racism has created over many decades. About 25 percent of Medicaid beneficiaries are Black despite being 13 percent of Pennsylvania’s general population. Poverty is not a personal or moral failure, but it is often a consequence of systemic racism and limited resources in particular communities or neighborhoods, which can often be tracked back to segregation-era policies. DHS is focused on uprooting systemic racismOpens In A New Window and promoting economic justice, particularly for all communities and individuals who use public assistance programs.

“As we look to recover from the economic crisis created by COVID-19, we hope that this focus on equity and opportunity for all people will allow us to help people who may not have been reached or meaningfully served by similar efforts previously. Economic recovery for all Pennsylvanians helps all of us, and the Medicaid Work Supports program gives us a way to help people in this journey. If there are individuals who have fallen on difficult circumstances because of the crises and collective trauma we are all facing, help is available,” said Secretary Miller.

Applications for Medicaid and other public assistance programs can be submitted online at www.compass.state.pa.usOpens In A New Window. Those who prefer to submit paper documentation can pick up an application at their local CAOOpens In A New Window, where social distancing protocols are in place, or they can print from the website or request an application by phone at 1-800-692-7462.They can then mail it to their local CAO or place it in a CAO’s secure drop box, if available. You do not need to know your own eligibility in order to apply. While CAOs remain closed, work processing applications, determining eligibility, and issuing benefits continues. Clients should use COMPASS or the MyCOMPASS PA mobile app to submit necessary updates to their case files while CAOs are closed.

For more information on DHS’ E&T Programs visit www.dhs.pa.govOpens In A New Window.

MEDIA CONTACT: Erin James – ra-pwdhspressoffice@pa.gov

# # #

 
 

Clipped from: https://www.media.pa.gov/pages/DHS_details.aspx?newsid=654

 
 

 
 

 
 

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State leaders react to Medicaid bill funded by medical marijuana

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Kansas Governor Kelly is proposing to fund Medicaid expansion with marijuana taxes.

 
 

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.

 
 

(Dakota News Now)

TOPEKA, Kan. (WIBW) – State leaders are backing Governor Laura Kelly’s Medicaid expansion bill that will be funded by medical marijuana.

Governor Laura Kelly announced legislation on Monday to expand Medicaid and provide health insurance for 165,000 Kansans. She said the legislation would also establish a regulatory framework to make Kansas the 48th state to legalize medical marijuana.

Kansas leaders have been speaking of the announcement ever since. Many think the Medicaid overhaul is much needed and will result in a healthier and more productive workforce.

“Making health care available to thousands of low-income, uninsured Kansans would help working Kansans and their families, resulting in a healthier, more productive workforce and benefit employers across the state,” said Tracey Osborne Oltjen, President and CEO of the Overland Park Chamber of Commerce. “We know that people who have health coverage are generally healthier and more productive at work. From a business perspective, that’s why Medicaid expansion is so important. Until we expand Medicaid in Kansas, we risk falling further behind our neighbors. We should not stand as an island on this issue, creating expensive challenges for our residents and our businesses.”

The Kansas Hospital Association says currently, 38 states have implemented or are moving toward Medicaid expansion. It said all of the states that border Kansas have taken steps to expand Medicaid and it is important that Kansas have a serious discussion about it. It said kanCare expansion will help every community in Kansas.

“The Kansas Hospital Association continues to support KanCare Expansion and the benefits it will bring to Kansas,” said the KHA. “Expansion improves the health of Kansans by improving access to tens of thousands of hardworking Kansans who cannot afford to wait another year for affordable health care coverage. We must have a Kansas-based solution – a solution that brings hundreds of millions of our federal tax dollars back home to Kansas – creating jobs, boosting our economy and improving the health of Kansans.”

According to Kansas Appleseed Center for Law and Justice, the COVID-19 pandemic has further exacerbated the Medicaid issue. It said legislators are allowing Kansans to fall through the cracks and expansion of Medicaid will allow the state to mitigate further inequities in Kansas’ healthcare system.

“Accessible, truly affordable healthcare is critical to achieving a more thriving, inclusive and just Kansas. In each corner of our state, COVID-19 has magnified the invaluable role healthcare plays in keeping our loved ones and our communities safe,” said Kansas Appleseed. “Prior to the co-occurring health and economic crisis brought on by the pandemic, nearly 90,000 Kansas fell within the coverage gap, rendering our state ill-prepared to meet the needs of those who would be impacted. Refusing to expand Medicaid has also had disparate impacts on Black, Indigenous, and communities of color, compounding the already-existing disparities created by institutional and systemic racism and oppression dating back to our country’s founding.”

Lt. Governor David Toland said the state’s economic recovery may even depend on the new bill.

“Our economic recovery depends heavily on our ability to attract and retain businesses throughout the state,” said Toland. “Kansas has no business giving companies even one reason to look elsewhere — and I can say, unequivocally, that the availability of healthcare and well-being of all Kansans matters a great deal to companies considering places to locate and grow.”

Many in the Kansas House of Representatives took to Twitter to show support for the bill.

Gov. Kelly said the bill would designate the Kansas Department of Health and Environment to be responsible for the oversight of patients and their use of medical marijuana, KDOR would be responsible for licensure and fee collections as well as regulation of producers and the Board of Healing Arts would be responsible for certifying prescribing doctors. She said it would also establish a bipartisan medical marijuana advisory committee with appointments made by Gov. Kelly, legislative leadership and chaired by the Secretary of Health and Environment.

Clipped from: https://www.wibw.com/2021/02/02/state-leaders-react-to-medicaid-bill-funded-by-medical-marijuana/

 
 

 
 

 
 

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Judge blocks Texas effort to remove Planned Parenthood from Medicaid

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The Texas effort to block state funds to the abortion chain is working its way through the courts.

 
 

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://thehill.com/regulation/court-battles/537467-judge-blocks-texass-efforts-to-remove-planned-parenthood-from?rl=1

 
 

A district court judge in Texas moved late Wednesday evening to temporarily halt the state’s effort to remove Planned Parenthood from its Medicaid program just hours before the state was set to do so.

A state district judge in Travis County, Maya Guerra Gamble, granted three Planned Parenthood affiliates operating in Texas a temporary restraining order while setting a hearing for Feb. 17.

“It appears from the specific facts set forth in the verified Application for Temporary Restraining Order, and the evidence submitted to the Court, if any, that immediate and irreparable harm will result to Providers before notice can be served on the OIG and HHSC and a hearing can be held on Providers’ request for a temporary restraining order unless the OIG and HHSC are restrained as requested,” Gamble wrote, referring to the Texas Health and Human Services Commission and its Office of Inspector General.

Texas officials had sent a notice to Planned Parenthood providers in late January stating they would be kicked out of Medicaid, the state-federal health program for the poor. 

The organization is seeking to continue to receive Medicaid funding to provide non-abortion services, and filed an emergency lawsuit asking courts to institute a temporary restraining order Wednesday alleging that Texas failed to issue a “proper termination notice” under state law governing which providers are covered by Medicaid.

“For now, if courts don’t immediately step in to block [Texas Gov. Greg] Abbott’s harmful order, 8,000 Texans with low incomes could lose access to critical, life-saving health care, including cancer screenings, STI testing and treatment, and birth control,” Planned Parenthood said in a decision ahead of the judge’s order. The organization’s Texas affiliates did not immediately return requests for comment Thursday evening.

“Texas’s Medicaid ‘defunding’ offers a clear example of how critical it is for the Biden-Harris administration to stop attacks that target the reproductive health care of people with low incomes, women, and people of color,” the organization continued.

Their efforts could end up setting off a battle with the Biden administration, which signaled Thursday that it would enforce federal Medicaid guidelines governing which organizations receive funding.

“Well the president’s views are clear and consistent on this issue,” White House press secretary Jen Psaki

 
 

Jen PsakiCable news could learn something from Psaki and Cronkite
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MORE said during her daily news briefing. “Just last week in an executive order he reissued guidance specifying that states cannot refuse Medicaid funding for Planned Parenthood and other providers. HHS would certainly have more specific details but they have stated they are committed to protecting and strengthening the Medicaid program as is the President consistent with the Executive Order we released last week.”

Updated 10:30 p.m.

 
 

 
 

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The Health 202: Biden narrows picks to lead Medicare and Medicaid down to two choices

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A Manatt consultant and former Bacerra associate is being heralded as the next head of 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.

 
 

with Alexandra Ellerbeck

The Biden administration has narrowed its search for Centers for Medicare and Medicaid Services administrator to two people – former Obama administration appointee Chiquita Brooks-LaSure and North Carolina Health Secretary Mandy Cohen, five people with connections to the administration tell me. 

 
 

The eventual pick to lead the federal agency that oversees the government’s major health insurance programs will play a central role in reshaping how the government manages safety-net programs that provide tens of millions of Americans with health coverage, after some controversial and unprecedented reconfigurations by the previous administration. CMS is a trillion-dollar agency that oversees Medicare, Medicaid and the Affordable Care Act. 

 
 

Cohen, as chief operating officer and chief of staff, and Brooks-LaSure as deputy director in the office that oversees the ACA’s insurance marketplaces and regulations. Brooks-LaSure is currently a managing director at consulting firm Manatt. In the years immediately after 2010 law was passed, Brooks-LaSure worked as director of coverage policy in the Office of Health Reform at the Department of Health and Human Services.

“They would both be great, and they are both really well-liked,” said a person with close ties to the administration who spoke on the condition of anonymity to discuss the personnel matter.

Brooks-LaSure is now favored for the spot, three of the sources said. 

She was more involved in Biden’s campaign and headed up his HHS transition team. That could put her in a better spot to immediately start working with civil servants within CMS.

“She is very calm and very measured,” said Dan Mendelson, whose firm Avalere Health employed Brooks-LaSure from 2003 to 2007. “She doesn’t react too quickly and I think that kind of thoughtfulness will be really useful given the range of issues they have to deal with right now.”

There’s another potential benefit to picking Brooks-LaSure: she has previously worked alongside California Attorney Xavier Becerra, who is Biden’s nominee for HHS secretary. She served as a staffer on the House Ways and Means Committee while Becerra was a member of that committee.

The well-documented acrimony between former HHS secretary Alex Azar and former CMS administrator Seema Verma under the Trump administration serves as a recent warning of the dysfunction that can occur when these two influential appointees don’t work harmoniously.

The White House declined to comment on the status of the CMS nomination. Neither Brooks-LaSure nor Cohen responded to emailed questions.

The next CMS director will have a lot on their plate.

Top on the agenda will be unraveling changes the Trump administration made to the Obamacare marketplaces and the Medicaid program. 

As we’ve reported, the new administration is likely to crack down on short-term plans that can offer skimpy benefits and tighten up rules around the insurance products that are sold on HealthCare.gov and the state-run exchanges. Officials will also be looking at ways to walk back what amount to permission slips the previous administration gave states to enact new requirements for Medicaid enrollment.

At the same time, the part of Medicare that covers hospital costs for seniors is running dangerously short on funds. It’s projected to become insolvent by 2024, two years earlier than expected. That’s closest to insolvency Medicare has been since 1971, when its trustees projected a two-year insolvency window.

But picking a CMS leader isn’t the administration’s top priority at the moment.

Becerra is still awaiting Senate confirmation, a process which has been delayed as Senate leaders fought over how to divide party control of the 50-50 Senate.

Confirmation hearings for Becerra aren’t expected to start until the week of Feb. 15 and could be pushed even later. 

And the CMS position isn’t the only top health-care slot Biden has yet to fill. He hasn’t yet named a nominee to lead the Food and Drug Administration, or nominees for more than a dozen other key posts at HHS.

Clipped from: https://www.washingtonpost.com/politics/2021/02/05/health-202-biden-narrows-picks-lead-medicare-medicaid-down-two-choices/