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]: The Good Guvnr is taking another run at it, and instead of kicking able-bodied members off if they don’t work, they get moved into crappy fee for service. Who stands to lose in this? It rhymes with banaged flare schmorganizations.

 
 

Clipped from: https://www.arkansasonline.com/news/2023/feb/16/sanders-announces-proposed-work-requirement-for/

 
 

The state Department of Human Services is seeking federal approval to require participants in Arkansas’ Medicaid expansion program to work, volunteer or enroll in training or classes, Gov. Sarah Huckabee Sanders announced Wednesday.

The new requirement would apply to recipients of the Arkansas Health and Opportunity for Me program, or ARHOME, an expansion that uses Medicaid dollars to buy private health insurance for participants, Sanders said during a news conference.

Unlike the state’s previous Medicaid work requirement, ARHOME recipients would not lose Medicaid coverage if they failed to meet the requirement outlined in Sanders’ proposal. Instead, their coverage would revert to traditional Medicaid fee-for-service coverage.

“Arkansas is still too far behind in making sure able-bodied citizens are working,” the Republican governor said. “We need a clear path for Arkansans to move from government dependency to financial independence.”

More than 300,000 adults are enrolled in the ARHOME program. The Medicaid expansion offers coverage to Arkansans with incomes below 138% of the federal poverty level, which corresponds to an annual income of $18,000 for a one-person family, said Kristi Putnam, secretary of the Department of Human Services.

The Department of Human Services plans to publish a draft Medicaid waiver amendment April 23 that would remain open for a 30-day public comment period. On June 1, the state expects to submit the waiver amendment to the federal Centers for Medicare and Medicaid Services. State officials are proposing Jan. 1, 2024, as the effective date for the new requirement, Putnam said.

Arkansas became the first state to implement work requirements for a Medicaid expansion in June 2018. More than 18,000 people lost their health coverage while the requirement was in place over nine months. A federal judge blocked the requirement in a 2019 ruling. At the time, the state’s Medicaid expansion program was known as Arkansas Works.

Under former President Donald Trump, 13 states received approved work requirements for Medicaid programs. Arkansas was the only state that enacted its requirement and took action against recipients who failed to comply. Other states began instituting requirements but did not cut Medicaid coverage for recipients due the coronavirus pandemic and litigation.

The Centers for Medicare and Medicaid Services under President Joe Biden has finalized the withdraw of waivers from all states that approved work requirements under the previous administration, according to the nonprofit Kaiser Family Foundation.

Sanders said she expects federal officials to approve the state’s request. She said the measure was “fully compliant with previous court rulings” and reiterated that it differed from previous work requirements in that it would not lead to Arkansans losing Medicaid coverage.

While several states have instituted various forms of work requirements tied to Medicaid, Department of Human Services spokesman Gavin Lesnick said none has taken the same approach that Sanders has outlined.

When asked about what would incentivize ARHOME participants to fulfill the work requirement, Putnam said the state expansion provides enhanced benefits compared to traditional Medicaid coverage, including additional health and social supports.

Since there is currently no work requirement in effect, state officials are not tracking the number of ARHOME recipients who aren’t working, volunteering or taking classes, said Lesnick.

State law wouldn’t have to change for officials to institute the work requirement. Statutes allow the department to use qualified health plan enrollment “as an incentive to foster economic independence,” said Putnam.

Rep. Lee Johnson, who chairs the House Committee on Public Health, Welfare and Labor, voiced support for the work requirement, saying that boosting the state’s labor force was a top priority for officials.

“Anything we can do to address the workforce shortage we’re having right now in Arkansas is important. I think it’s arguably the most important economic thing we can do,” said Johnson, a Republican from Greenwood. “A strategy like this seems to be something that can help alleviate some of those concerns.”

Jodiane Tritt, executive vice president of the Arkansas Hospital Association, said her organization was happy to see Arkansans wouldn’t lose Medicaid coverage under the proposed work requirement.

“We most definitely approve of the fee-for-service safety net,” she said during an interview Wednesday. “We feel that having coverage in this requirement is much better than the previous work requirement.”

Tritt noted that most hospital types see lower reimbursement rates for patients with traditional fee-for-service Medicaid than for patients with qualified health plans like those offered by the ARHOME program. The impact of patients shifting to fee-for-service coverage would vary between hospitals according to their patient mix, Tritt said.

Will Watson, director of strategy for the Democratic Party of Arkansas, called the work requirement “a mean-spirited tactic already rejected by a federal judge” in a statement Wednesday.

Senate minority leader Greg Leding, D-Fayetteville, said that while work requirements for Medicaid programs may be politically popular, he doesn’t believe they are effective. A better approach to growing the workforce, he said, would be for state officials to focus on providing Arkansans access to better transportation, stable housing and social support networks.

“People aren’t just choosing not to work,” Leding said Wednesday.

Harvard researchers in a 2020 analysis found that Arkansas’ previous work requirement did not increase employment among 30-to-49 year-olds — the demographic targeted by the policy — when compared to states without work requirements.

When asked about studies that showed work requirements were ineffective, Sanders said “the goal always has to be to encourage people to get into the workforce and not be fully dependent on the government.

“Any time we can offer pathways and incentives we’re going to look for that.”

The number of hours an ARHOME participant would have to work, volunteer or take classes per month under the requirement has yet to be determined. State officials will address specifics of the program as they develop the draft amendment for public comment, Lesnick said in an email Wednesday.

Continuous coverage requirements for states’ Medicaid programs are set to phase out starting April 1 under the federal public health emergency. Recipients who are no longer eligible or do not respond to renewals may start losing coverage then even if the federal emergency is continued.

“We estimate between 15 and 30 percent of Medicaid recipients who have had their coverage extended because of the Public Health Emergency (PHE) and who are in categories outside of the Long Term Services and Supports (LTSS) populations may be disenrolled,” Lesnick said.

The department, however, won’t know precisely how many Arkansans will be impacted until it completes the unwinding process and redetermines eligibility for the affected recipients. This process will be completed within six months of April 1.

The total enrollment in Medicaid at the end of 2022 was 1,143,219, Lesnick said.

 
 

  
 

 
 

 Gov. Sarah Huckabee Sanders listens Wednesday at the state Capitol as Kristi Putnam, secretary of the state Department of Human Services, discusses plans for ARHOME recipients. Putnam said statutes allow the department to use qualified health plan enrollment “as an incentive to foster economic independence.” (Arkansas Democrat-Gazette/Thomas Metthe)
  

 
 

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]: The fight to trim the SNAP/Medicaid spending in Iowa now has a Senate bill version.

 
 

 
 

Clipped from: https://iowacapitaldispatch.com/2023/02/15/bill-could-make-iowans-with-cars-savings-ineligible-for-snap-medicaid/

 
 

The Salvation Army of Ames stocks shelves with food donations from community members as well as corporate contributions. (Photo by Kate Kealey for Iowa Capital Dispatch)

Having a car or modest savings could disqualify families for some public assistance under a bill lawmakers are considering in the Iowa Senate.

Senate Study Bill 1105 would require an asset test for Iowans applying for SNAP and Medicaid assistance. The Senate bill does not include changes proposed in the House legislation that restrict the use of SNAP to purchase certain foods, including soda and candy.

A subcommittee on Wednesday recommended moving the bill forward with amendment to the Senate Health and Human Services Committee.

The asset limit would match the federal asset test guidelines, which would mean families could have a maximum of between $2,750 and $4,250 in assets, depending on the disability status of household members, to remain eligible for the public assistance programs. The test would apply to both savings and property like cars and land.

Speakers and legislators questioned Wednesday whether the bill’s asset limit tests would kick off kids from program benefits if their parents were found ineligible when factoring in their assets’ value.

Following the pandemic and supply chain problems, even used cars skyrocketed in value, lobbyists speaking against the bill said. That would automatically disqualify many legitimately needy Iowans from accessing assistance. It also could mean if a household with children exceeds these value limitations, the kids’ coverage in these program could be affected.

Sen. Jeff Edler, R-State Center, said he would check with Iowa HHS staff on children’s qualifications, but still stood in support of some form of asset test. He said families with snowmobiles or $5 million worth of land in Nebraska should not be receiving taxpayer money in Iowa.

“I think we need to work together to try and figure out how do we truly get help to these folks,” he said, and asked for suggestions of what asset level would be appropriate.

Representatives of Iowa food banks and hunger assistance programs said many Iowa residents who face food insecurity already do not qualify for the Supplemental Nutrition Assistance Program, SNAP, under state law. Even though SNAP use is at a 14-year low, Iowans are coming at record-high numbers to get assistance from food banks, Luke Elzinga with the Des Moines Area Religious Council Food Pantry Network and the Iowa Hunger Coalition said.

It’s unrealistic to expect rural Iowans to live without cars, Elzinga said, and not being able to save money could keep those people from exiting poverty long term.

“This tells me that the state should be looking at ways to expand access to the program,” Elzinga said.  “Investing in things like Double Up Food Bucks, looking at raising the income eligibility for SNAP. This really feels like a step in the wrong direction for our state.”

Other changes include a requirement for single parents to work with the state on child support payment enforcement to stay eligible, and for new documentation requirements.

These new stipulations will make it harder for people in need to access food or health care, Laura Hessburg with Iowa Coalition Against Domestic Violence said. Victims leaving an abusive home often do not have time to grab the IDs or documents they would need under the legislation to prove their eligibility. Additionally, it would be dangerous to force domestic abuse survivors to contact their abuser about child support to qualify for benefits, she said.

Additionally, speakers opposed to this bill repeatedly brought up Pennsylvania, where the state’s asset test was reversed within three years of implementation because a study showed its high cost to the state.

But lobbyists with conservative groups like Americans for Prosperity and the Opportunity Solutions Project spoke in support of the legislation, saying lawmakers have an obligation to serve as responsible stewards of taxpayer funds. Asset tests are not meant to keep people in need off of assistance programs, but instead make sure the money isn’t going to people who shouldn’t receive it.

Scott Centorino with the Opportunity Solutions Project said it’s important to remember Pennsylvania is not the only state that has  implemented asset tests. He said other states have “gotten ahead” of Iowa on welfare accountability measures.

“For every Pennsylvania, there’s a Missouri or a South Dakota or a Kansas,” Centorino said. “Those states have not turned back.”

The legislation will next be discussed by the full Senate Health and Human Services Committee.

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]: More on the push to convert CMS into USDA.

 
 

 
 

Clipped from: https://www.usatoday.com/story/money/personalfinance/2023/02/15/food-medicaid-programs-explained/11258161002/

“Food as medicine” may be coming to a health plan near you.

More states are testing Medicaid programs that’ll provide more people with healthy foods and, potentially, lower healthcare costs. 

Medicaid typically only covers medical expenses, but Arkansas, Oregon and Massachusetts received approval from the Centers for Medicare & Medicaid Services (CMS) last year to use a portion of their Medicaid funds to pay for food programs, including medically tailored meals, groceries and produce prescriptions (fruit and vegetable prescriptions or vouchers provided by medical professionals for people with diet-related diseases or food insecurity). California already was running a food program under a different CMS approval. The aim is to see whether providing people with nutritious foods can effectively prevent, manage, and treat diet-related diseases.  

“A lot of what ails our health care system is overutilization because we’ve never changed the lifestyles that take us into the health care system in the first place, and that starts with your diet,” said Indiana Senator Mike Braun at a hearing in December. 

Eradicating hunger:New push to cut hunger, improve Americans’ diets touted at White House conference

How does ‘food as medicine’ work? 

Though different processes will be tested, Massachusetts and California allow medical professionals to refer struggling patients to a local food assistance organization to determine their needs. That could result in grocery store gift cards, kitchen supplies, cooking classes, nutrition counseling or a service that will deliver “medically tailored meals” to patients. In Massachusetts, patients are checked on every three months. 

In November, the U.S. Department of Agriculture (USDA) invested $59.4 million partly to support so-called “produce prescriptions” from a health care provider for fresh fruits and vegetables. 

Does food as medicine work? 

“The relationship between what we eat and how it affects our health and mortality is clear,” said Dan Glickman, co-chair of the Task Force on Hunger, Nutrition, and Health, at a hearing in December. 

A study published last fall estimated that if all patients in the U.S. with mobility challenges and diet-related diseases received medically tailored meals, 1.6 million hospitalizations would be avoided, with a net savings of $13.6 billion annually. 

Another study in 2019 found that over the course of about a year, the meals resulted in 49% fewer inpatient admissions and a 16% cut in health care costs compared with a control group of patients who did not receive the meals. 

Priorities:Biden has lofty plan to ‘end hunger.’ But president must address Americans’ urgent needs.

Fighting diabetes:Diabetes care gets major update: More aggressive approach to weight loss, cholesterol, disparities recommended

What’s next? 

There is more work to be done to determine if this idea can flourish and the best ways to implement it.

This spring, the American Heart Association and Rockefeller Foundation will launch a $250 million “Food is Medicine” Research Initiative to determine if such programs can be developed cost-efficiently enough to merit benefit coverage and reimbursement for patients, said Kevin Volpp, director at the University of Pennsylvania’s Center for Health Incentives and Behavioral Economics and leader of the initiative. 

CMS requires such programs to be neutral to the federal budget and capped at 3% of the state’s total Medicaid spend, according to Madeline Guth, senior policy analyst with KFF’s Program on Medicaid and the Uninsured.

Superiority questioned:Are superfoods really superior to other foods?

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Other issues include finding food suppliers, defining what’s “nutritious,” and who would ultimately qualify. Because there are strict guidelines now, only a very small percentage of Medicaid recipients are eligible in these pilots, Guth said.

“CMS is indicating what it approved for those states is setting the stage for what it’s willing to approve and looking to approve for other states,” Guth said. “There could be more coming, but these states will be the model and what we’ll be watching over the next year or so.” 

Medora Lee is a money, markets, and personal finance reporter at USA TODAY. You can reach her at mjlee@usatoday.com and subscribe to our free Daily Money newsletter for personal finance tips and business news every Monday through Friday morning.