Category: MM Curator

 
 

MM Curator summary

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.

 
 

[MM Curator Summary]: Let’s try this maybe in a way that doesn’t rely on CMS or SCOTUS.

 
 

 
 

Clipped from: https://www.washingtonpost.com/business/2023/04/11/gop-medicaid-food-stamps-work/

The demand from House Speaker Kevin McCarthy comes as the White House rejects talks on policies that could cut benefits to low-income Americans

House Speaker Kevin McCarthy (R-Calif.) at a bill-signing ceremony in March. GOP leaders are looking at proposals to require recipients of some federal aid to work. (Jabin Botsford/The Washington Post)

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House Republicans are eyeing new work requirements for millions of low-income Americans who receive health insurance, money to buy food and other financial aid from the federal government, reprising the party’s historic crusade against welfare as some lawmakers seek new ways to slash spending.

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In recent weeks, the GOP has focused its attention on two anti-poverty programs: Medicaid, which enrolls the poorest families in health insurance, and food stamps, which provide grocery benefits to those in need. Top lawmakers including House Speaker Kevin McCarthy (R-Calif.) have publicly endorsed rules that could force some enrollees to find a job and work longer hours — or risk losing the government’s help entirely.

The demands largely come in the context of a brewing fight over the federal budget. Many Republicans have said that federal aid programs offer a way for policymakers to boost U.S. workforce participation while saving Washington money — a stance that infuriates Democrats, aid workers and others, who say such changes could harm vulnerable families still reeling since the coronavirus pandemic.

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The debate in some ways resembles the Republican-led campaign against so-called welfare queens in the 1990s, when a politically resurgent GOP — then under the leadership of House Speaker Newt Gingrich — secured a dramatic restructuring of the government’s social safety net. The resulting overhaul, enacted by President Bill Clinton, slashed cash benefits for millions of Americans in ways that GOP leaders now cite as a model.

“I don’t think hard-working Americans should be paying for all the social services for people who could make a broader contribution and instead are couch potatoes,” Rep. Matt Gaetz (R-Fla.), a member of the far-right House Freedom Caucus, said at a news conference last month.

At the center of the standoff is the debt ceiling, the statutory limit on how much the U.S. government can borrow to pay its bills. Lawmakers must raise that cap as soon as June or risk a federal default — an economic calamity that GOP leaders have tried to exploit in hopes of advancing their agenda.

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In a letter published late last month, McCarthy called on President Biden to negotiate and spelled out his party’s latest demands. That included steep spending cuts and new policies “strengthening work requirements for those without dependents” — a reference to children — citing the fact that Biden supported the welfare-to-work approach adopted under Clinton in the ’90s.

Biden has refused to haggle over the debt ceiling and instead demands that Republicans raise it and preserve the country’s credit without conditions. The president has expressed a willingness to discuss broader fiscal issues with McCarthy, but White House aides have outright rejected any changes to food stamps and Medicaid that reduce enrollment.

“The President has been clear that he will oppose policies that push Americans into poverty or cause them to lose health care,” White House spokesman Michael Kikukawa said in a statement. “That’s why he opposes Republican proposals that would take food assistance and Medicaid away from millions of people by adding burdensome, bureaucratic requirements.”

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Still, top Republicans have unveiled a battery of proposals, including one targeting Medicaid, hoping to deliver on a long-sought conservative goal to add work requirements to the insurance program.

In February, Gaetz released legislation that would deny benefits to able-bodied adults unless they work for 120 hours per month, volunteer or participate in a work program for 80 hours, or participate in a combination of those activities. The congressman did not respond to a request for comment.

It is unclear whether other Republicans would support that approach. Gaetz’s bill does not yet appear to have any co-sponsors, but the hard-right bloc to which he belongs, the House Freedom Caucus, generally endorsed work requirements in its own demand letter last month. The group didn’t specify any programs, but Rep. Scott Perry (R-Pa.), the caucus’s chairman, later told The Washington Post that he wants nationwide work requirements for Medicaid.

The new conservative push is especially potent because Republicans’ razor-thin House majority gives its hard-right faction powerful leverage. It also arrives at a tumultuous time for Medicaid, which saw enrollment balloon by about 30 percent at the height of the pandemic.

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During the crisis, lawmakers enacted temporary rules that essentially prevented states from culling their Medicaid rolls. But those prohibitions expired on April 1, opening the door for state health officials to begin reevaluating eligibility. Approximately 15 million low-income Americans are ultimately expected to lose their coverage as a result, including 6.8 million who still qualify for the program, according to federal estimates in August.

At the White House, Biden has leaned into health care as a campaign message ahead of a potential 2024 reelection bid. In an interview last month, his Medicaid chief criticized work requirements.

“On work requirements, I think the administration’s position is really clear about being very much concerned about putting up barriers to people getting coverage,” said Chiquita Brooks-LaSure, the administrator of the Centers for Medicare and Medicaid Services. “It’s critical that we have coverage in this country … and there are other ways to really address making sure that people are able to find employment.”

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The two parties have previously battled over work requirements in the safety net program. In 2018, the Trump administration issued optional guidance for states to implement work rules in Medicaid for the first time, contending it would incentivize healthy people to find employment. Democrats seized on the issue, arguing the policy would hurt vulnerable Americans and was designed to curtail Medicaid enrollment.

Thirteen states adopted such rules under President Donald Trump. Once Biden took office, however, his Medicaid agency quietly began to send letters rescinding states’ Medicaid work requirements, which already faced a flurry of legal challenges and weren’t in effect. Only one state, Arkansas, imposed a work requirement for a significant period. Over more than nine months, about 18,000 adults lost coverage for failing to comply with the rules, and only about 1,900 re-enrolled in the program before a federal judge blocked the work rules.

Since then, the state’s new governor, Sarah Huckabee Sanders (R), has said she will try again under different rules — while a work requirement in Georgia is slated to begin this summer. Nationally, Republicans have argued that such mandates could increase labor force participation, even as the unemployment rate remains low.

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“This is the perfect time to have work requirements because people are needed, they’re wanted,” said Rep. Brett Guthrie (R-Ky.), chairman of the House Energy and Commerce health subcommittee. “Wages are rising because there’s a shortage of workers, so it’s a good opportunity for people to better themselves moving forward.”

For some Republicans, though, the push doubles as an opportunity to reduce the federal debt, which exceeds $31 trillion. At a House hearing in early April, Rep. Darin LaHood (R-Ill.), the new chairman of the House Ways and Means subcommittee on work and welfare, stressed that lawmakers had to ensure more “accountability for federal taxpayer dollars.”

In doing so, Republicans have signaled their focus could be broad in scope, potentially including the benefits the government provides for housing, child care and other key services.

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“We should be exploring every possibility to get our fellow Americans back into the labor force, including strengthening work requirements across all government programs,” added Rep. Jason T. Smith (R-Mo.), the leader of the House Ways and Means Committee.

Tasked to prepare a spending blueprint for the 2024 fiscal year, the House Budget Committee last week specifically called attention to what it described as a “culture of government dependency,” citing an uptick in spending in Medicaid and other federal programs, including food stamps, unemployment insurance, disability benefits and tax credits for low-income parents with children.

The panel’s chairman, Rep. Jodey Arrington (R-Tex.), said in a previous interview that Republicans are “going to look at health care” with the goal of reducing costs, stressing that decisions “haven’t been made” about what to propose on Medicaid. Broadly, though, Arrington long has endorsed work requirements on aid programs, especially in the case of food stamps.

Formally known in Washington as the Supplemental Nutrition Assistance Program, or SNAP, food stamps provide lower-income households with an average of more than $230 each month for groceries, often paid through a debit card. Approximately 41 million people are currently enrolled in the program, according to the government.

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Under existing law, SNAP already requires many adults without children to seek employment and training. But GOP leaders argue that the rules are too lax, exempt too many beneficiaries from work and open the door for states to make too many exceptions.

One key bill from Rep. Dusty Johnson (R-S.D.), a top ally of McCarthy, would rewrite some of the program’s rules, chiefly by subjecting Americans without children between the ages of 49 and 65 to SNAP work requirements. (Current rules for these adults only apply up to 49.) The proposal, which has more than three dozen GOP co-sponsors, also would limit states’ ability to waive some of those rules.

“This is not about balancing the budget on the backs of anyone,” Johnson said in an interview, adding that there is “no reliable pathway out of poverty” that doesn’t involve work, education and training.

But the changes could force more than 10 million people off food stamps, according to the left-leaning Center on Budget and Policy Priorities, which estimates the cut would affect 1 in 4 SNAP recipients. Even those who retained monthly food aid could face additional hardship, because they could be forced to work longer hours in ways that affect their ability to care for their children, CBPP found.

Johnson disputed that analysis. Still, it could be the second blow to SNAP recipients in recent months, after Congress allowed a pandemic benefit program to expire in March, slashing millions of families food benefits by an average $82, according to the Food Research and Action Center. Some Republicans still have signaled discomfort over targeting SNAP in the ongoing budget debate.

Democrats, meanwhile, have pledged to oppose any such changes, setting up a clash that could come to head even if the GOP does not pursue changes in talks around the debt ceiling. Lawmakers also must act by Oct. 1 to approve legislation known as the Farm Bill, which authorizes a bevy of federal farm and nutrition-related programs.

 
 

 
 

MM Curator summary

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.

 
 

[MM Curator Summary]: Who knew what when?

 
 

 
 

Clipped from: https://oversight.house.gov/release/comer-requests-gao-review-improper-payments-in-medicaid-program/

WASHINGTON—House Committee on Oversight and Accountability Chairman James Comer (R-Ky.) is requesting U.S. Government Accountability Office (GAO) Comptroller General Gene L. Dodaro initiate a review of the high number of improper payments in the Medicaid program. Chairman Comer is also requesting GAO review actions the Centers for Medicare and Medicaid Service (CMS) can take to coordinate with state auditors and improve Medicaid program integrity.

“We are writing to request the Government Accountability Office (GAO) initiate a review of improper payments in the Medicaid program. GAO has previously made more than 750 recommendations and designated Medicare and Medicaid programs as a ‘high risk area’ since 1990 due to high rates of improper payments. The size and complexity of the Medicaid program make it vulnerable to improper payments. Improper payments totaled an estimated $98.7 billion in fiscal year 2021, meaning more than one of every five Medicaid expenditures were improper. The Committee is continuing our larger oversight of CMS due to unresolved concerns about billions of dollars in wasted taxpayer funds each year,” wrote Chairman Comer.

GAO has produced multiple reports identifying weaknesses in the processes Medicaid agencies use to identify improper payments and identified necessary steps to strengthen program integrity, yet CMS has failed to take necessary action. Pandemic-era changes to Medicaid eligibility determinations drastically increased the rate of improper payments. The Oversight Committee is seeking information to ensure that GAO and CMS coordinate to take necessary steps to reduce waste, fraud, and abuse in Medicaid programs and recoup improper payments.

“During the COVID-19 pandemic, the Medicaid program suspended enforcement of eligibility reviews, resulting in millions of people receiving Medicaid benefits for which they were not eligible. While the suspension was important to ensure state’s ability to respond to the COVID-19 pandemic, according to GAO, the lack of eligibility determination audits will likely increase improper payments due to the lack of oversight. Suspending eligibility verifications prevented states from removing ineligible enrollees, compounding existing improper payment abuses,” Chairman Comer continued.

Read the letter to GAO Comptroller General Gene L. Dodaro here.

READ MORE: Comer & Oversight Republicans Press CMS on Medicaid Redeterminations to Reduce Improper Payments

MM Curator summary

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.

 
 

[MM Curator Summary]: Directed payments is Latin for “yet another opaque way to siphon taxpayer money to providers- this time thru MCOs”.

 
 

 
 

 
 

Clipped from: https://www.route-fifty.com/health-human-services/2023/04/special-medicaid-funds-help-most-states-prompt-oversight-concerns/385000/

 
 

Grady Memorial Hospital in Atlanta. Frank Mullen via Getty Images

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This story was first published by Kaiser Health News. Read the original article here. 

Emanuel Medical Center in rural Georgia racks up more than $350,000 a month in losses providing health care for low-income and uninsured patients. But a new state funding proposal could significantly reduce those deficits, not just for the 66-bed Swainsboro facility but for most rural hospitals in Georgia, according to state Medicaid officials.

It’s not Medicaid expansion, which Georgia Republican leaders have rejected. Instead, the state Department of Community Health is using an under-the-radar Medicaid funding opportunity that has been rapidly taken up by more than 35 states— including most of the states that have expanded the government insurance program.

The extra federal money comes through an obscure, complicated mechanism called “directed payments“—available only for states that hire health insurers to deliver services for Medicaid.

In 2020, these special funding streams, which are approved by federal health officials, sent more than $25 billion to states, according to the Medicaid and CHIP Payment and Access Commission (MACPAC), which advises Congress.

The Centers for Medicare & Medicaid Services, when asked for an updated total, referred KHN to individual states for their spending figures. “CMS has not publicly published total spending related to state directed payments,” said agency spokesperson Bruce Alexander.

But the Government Accountability Office, Congress’ watchdog agency, and MACPAC say federal health officials should do more to monitor directed payments and evaluate whether states meet the program’s goals, which include improved access and quality of care. More transparency is needed, these agencies said.

A MACPAC report last year found that fewer than 25% of directed payment plans running for at least a year had evaluations available for review.

Federal health officials “are getting a lot of questions” on directed payments from GAO and MACPAC, said Debra Lipson, a senior fellow at consulting firm Mathematica, which has studied the issue. “It’s a lot of money.”

CMS hasn’t yet released reports on quality metrics for the program, Lipson added.

Alexander, the CMS spokesperson, said the agency “takes our role in oversight and transparency seriously, and we are working collaboratively with our federal and state partners to improve our oversight and transparency” of directed payments.

Medicaid is the government health insurance program for low-income and disabled patients. It’s jointly financed by the states and the federal government.

CMS launched the directed payments program in 2016. Georgia officials estimated the state will net $1 billion in federal funds this fiscal year for hospitals and other medical providers through its directed payment programs.

California estimates it brought in more than $6 billion just last year in new federal funds through directed payments. Arizona received $4.3 billion between 2018 and 2022. Florida netted more than $1 billion over a 12-month period ending in September.

This special Medicaid funding may indirectly help patients by strengthening financial stability for hospitals, along with offering the potential for capital improvements from the added cash infusions.

But patient advocates and Democratic lawmakers in Georgia said providing insurance coverage for the medical needs of the uninsured by adopting Medicaid expansion is more urgent. Hospitals, like Emanuel Medical Center, would benefit from Medicaid reimbursements for patients who now often rack up unpaid bills for care.

The uninsured “are not going to get preventive care, and that drives up health care costs,” said state Sen. Elena Parent, an Atlanta-area Democrat. “The state should have expanded Medicaid.”

That expansion is not going to happen in Georgia in the short run, as Republican Gov. Brian Kemp is set to launch new limits on Medicaid enrollment for low-income adults, with work requirements attached.

Under directed payments, added funding for hospitals and other Medicaid medical providers flows through different avenues, including minimum fees for services, a general reimbursement increase, and pay hikes based on quality of care.

Payments are based on the volume of services delivered. If one hospital served more Medicaid patients than another, its reimbursements would be higher, Lipson said.

“CMS initially was surprised by the volume of states’ directed payment proposals,” said Lipson. Some states have 25 or more, she added. They must be renewed annually. Often states finance their portion through hospital assessments or money transferred from public funds, such as hospital authorities, county governments, and state agencies.

Georgia has five such directed payment plans. Their goals include boosting Medicaid pay for hospitals and doctors, strengthening the health care workforce, and improving health outcomes and equity, said Caylee Noggle, commissioner of the state Department of Community Health, which runs Medicaid in Georgia.

Grady Memorial Hospital in Atlanta, a large safety-net provider, said it expects to gain $139 million across four of the Georgia programs.

“It’s a tremendous benefit for us,” said Ryan Loke, Grady’s chief health policy officer. “Without this money, Grady would be in a lot worse position.”

Grady is seeing more Medicaid and uninsured patients who formerly used nearby Atlanta Medical Center, which closed last year.

State Sen. Ben Watson, a physician and Savannah-area Republican, pointed out that such safety-net hospitals, which serve a large portion of people who lack health coverage, are getting higher pay through Medicaid directed payments, thus helping them cover some losses.

Georgia plans to use these funding streams as a base for extending extra help to rural hospitals.

With the extra payments, Grady and other hospitals will approach or reach their normal funding limit for hospitals that serve a “disproportionate share” of indigent patients. The state would take about $100 million of this excess money and send it to rural hospitals.

The Georgia Hospital Association said the directed payment money is helpful but won’t cover costs of charity care for the uninsured.

“They’re not looking at [hospitals’] bad debt,” said Anna Adams, an executive with the group. “An insured patient is a healthier patient. We’d love to see as many people covered as possible.”

Officials at rural hospitals in Georgia, meanwhile, are looking forward to the projected boost in Medicaid funds.

“It’s going to put cash in the coffers of rural hospitals that are struggling,” said Jimmy Lewis, CEO of HomeTown Health, an association of rural hospitals in the state.

Damien Scott, CEO of Emanuel Medical Center, said he’s “cautiously optimistic” about the coming allocation. On his wish list: attracting a pediatrician to his county — it has none currently — and gaining the space to move the hospital’s lone MRI machine from a truck into the hospital building.

As it is, he said, “we struggle every month for our survival.”

This story can be republished for free (details).

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Subscribe to KHN’s free Morning Briefing.

 
 

MM Curator summary

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.

 
 

[MM Curator Summary]: A tiny fraction of Medicaid members get residential treatment for opioid use disorder- but it the difficulty in getting non-residential treatments (ie MAT) is probably a bigger problem.

 
 

 
 

Clipped from: https://www.upi.com/Health_News/2023/04/12/rehab-opioid-addition/9341681306196/

 
 

The United States is in the middle of an opioid crisis, yet new research shows that only about 7% of Americans on Medicaid who have opioid use disorder receive residential treatment.

This means that many people who could potentially benefit from what is more commonly known as “rehab” aren’t getting the care they need to help them with their addiction.

“We know residential care is important when it’s done right … and when it’s evidence-based. We know it’s incredibly important to engaging people in their recovery from opioid use disorder,” said study corresponding author Lindsay Allen. She is a health economist and assistant professor of emergency medicine at Northwestern University Feinberg School of Medicine, in Chicago.

“And Medicaid is a major payer. It’s the biggest payer of opioid use disorder treatment nationally because so many individuals with OUD [opioid use disorder] are covered by Medicaid,” Allen continued.

Making direct comparisons of access to residential OUD treatment can be difficult because states code or define programs differently.

But the researchers used a research network that standardized data for nine states that represent about 14.9 million people, including 20% of all Medicaid enrollees.

Using an apples-to-apples comparisons of data, the investigators discovered that usage of residential treatment for OUD varied widely, depending on the state.

RELATED Overdose deaths among seniors soar over past 2 decades, UCLA study finds

While some states provided residential treatment for up to 14.6% of Medicaid enrollees with OUD, others only allowed 0.3% to access rehab.

Allen said the differences were disconcerting.

Among the benefits of having standardized data is providing information about where and what policies need to be targeted, she said.

RELATED Anti-addiction drug buprenorphine may cut risk of fatal overdose

The states that were part of the study were Delaware, Kentucky, Maryland, Michigan, North Carolina, Ohio, Pennsylvania, Virginia and West Virginia. Dr. Sarah Wakeman, medical director for substance use disorder at Mass General Brigham, in Boston.

Yet, there isn’t convincing evidence that residential treatment is best for treating OUD, she said, noting that many residential programs don’t offer medication to treat OUD, or even prohibit them.

What is best is treating a patient with an opioid agonist, such as methadone and buprenorphine, Wakeman said, comparing this to providing insulin to someone with diabetes. The medications are misunderstood and deeply stigmatized, she said.

“They restore normal functioning. They allow a person to feel well again, to not experience cravings or an urge to want to use opioids, to not experience withdrawal and to just get on with their life,” Wakeman said. “And they’ve been shown in literally hundreds of studies over decades to reduce the recurrence of opioid use disorder and reduce both overdose-specific mortality and all-cause mortality.”

Residential treatment may be helpful for someone who has experienced significant consequences from their opioid disorder, who has not successfully stabilized in an outpatient treatment setting or who is also addicted to other substances, said Dr. Larissa Mooney, director in the division of addiction psychiatry at UCLA’s David Geffen School of Medicine in Los Angeles.

However, even in residential treatment, medication for OUD needs to be offered, Mooney said.

“The most robust treatments for opioid use disorder are FDA-approved medications, which include buprenorphine, methadone and extended-release naltrexone,” Mooney said.

Managing co-occurring psychiatric disorders, such as depression or anxiety, is also an important part of addiction recovery, she said.

“With support and access to medication treatment, many people can achieve remission from opioid use disorder. Individual paths to recovery vary widely, so we need to ensure access to as many treatment options as possible,” Mooney said.

More information

The U.S. Department of Health and Human Services has more on the opioid crisis in the United States.