Tag: Enrollment

Posted on by

Up to 18 million people could lose Medicaid coverage after COVID-19 PHE

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 new sky is falling number hides the punchline that 10M will go back to getting insurance from their employer, and more than 1M will get heavily-subsidized marketplace coverage. And that all of this is due to the fact that Medicaid will be returning to normal eligibility rules.

 
 

Clipped from: https://www.healthcarefinancenews.com/news/18-million-people-could-lose-medicaid-coverage-after-covid-19-phe

Findings suggest the result could see the largest changes in coverage since the ACA came into force more than a decade ago.

 
 

Photo: Image Source/Getty Images

Upwards of 18 million people could lose Medicaid coverage, and four million people could become uninsured entirely when the COVID-19 public health emergency expires next year, according to a recently published analysis from the Urban Institute.

This could result in the biggest changes in coverage since the Affordable Care Act was implemented more than a decade ago, findings suggested.

The most recent data shows that enrollment jumped by more than 18 million people from February 2020 to June 2022. This increased enrollment largely owes to the continuous coverage requirement of the Families First Coronavirus Response Act, which has prevented state Medicaid agencies from disenrolling people during the PHE unless they specifically request it.

Using the latest available administrative data on Medicaid enrollment, recent household survey data on health coverage, and the Urban Institute’s Health Insurance Policy Simulation Model, analysts estimated that about 3.2 million children are estimated to transition from Medicaid to separate Children’s Health Insurance Programs, so total Medicaid and CHIP enrollment will decline by 14.8 million people.

About 3.8 million people will become uninsured, data showed, while about 9.5 million people will either newly enroll in employer-sponsored insurance after losing Medicaid, or transition to employer-sponsored insurance as their only source of coverage after being enrolled in both employer-sponsored insurance and Medicaid sometime during the PHE.

On top of that, more than one million people will enroll in the nongroup market, most of whom will be eligible for premium tax credits in the marketplace.

Further extensions of the PHE are possible, according to the Urban Institute. If it’s extended for an additional 90 days, the number of people losing Medicaid will likely rise to nearly 19 million.

WHAT’S THE IMPACT?

The largest share of people losing Medicaid, 9.5 million, will end up with employer-sponsored insurance (ESI), the report found. Nationally, unemployment has nearly returned to pre-pandemic levels, and many people will lose Medicaid eligibility precisely because they gained new employment during the PHE. An unknown number of those transitioning from Medicaid to ESI only was enrolled in both types of coverage during the PHE; the number of people newly enrolling in ESI after the PHE will likely be considerably lower than 9.5 million.

The end of the PHE is still uncertain. If it is extended for 90 more days, about one million more people will lose Medicaid after its expiration. The Biden administration has promised to give 60 days’ notice before the end of the PHE but has resisted requests by many states for more notice.

While nearly four million people are likely to become uninsured, people transitioning from Medicaid to private coverage will pay more in premiums and out-of-pocket health costs. It is possible that more people losing Medicaid, particularly those without access to ESI, may experience a temporary interruption in health coverage before enrolling in alternative coverage.

State policy decisions during the transition following the PHE expiration will affect how many people lose coverage, how rapidly they lose coverage, and how many people will enroll in other coverage, according to the Urban Institute.

Medicaid enrollment during the PHE may have other lasting effects, such as raising awareness of churning in health insurance coverage, and possibly changing perceptions of Medicaid, authors said. The experience may also inform the debate around other issues related to churn and continuity of coverage, such as 12-month continuous eligibility in Medicaid and better coordination between Medicaid and the marketplaces.

THE LARGER TREND

The public health emergency will be extended past its current deadline of January 11. The new deadline will be in April if it’s extended for another 90 days.

The PHE keeps waivers and policies in place for Medicaid coverage, telehealth coverage, and add-on payments to hospitals and physicians. Telehealth waivers will expire 151 days after the end of PHE.
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com

Posted on by

TECH- Google rolls out search features for Medicaid, Medicare patients

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]: Google seeks to replace your local Medicaid eligibility state employee.

 
 

Clipped from: https://www.fiercehealthcare.com/health-tech/google-rolls-out-search-features-aim-make-it-easier-sign-medicaid-medicare

 
 

LAS VEGAS—When many people are looking to enroll in health benefits, they turn to Google as a source of key information on eligibility, the application process and in-network providers.

In this spirit, the Google Search team has quietly rolled out multiple features for its search engine that aim to make it easier for users to access key information about obtaining Medicaid and Medicare benefits, as well as which doctors locally accept those types of coverage.


(Google)

If someone submits a search query for Medicaid in their state, for example, the top of the results will populate with multiple buttons that direct them to key results on eligibility requirements, how to apply and where they can log in to their accounts. Searching for Medicare generates similar buttons, as well as an option to pull up news about the program.

Hema Budaraju, senior director of product for health and social impact at Google Search, told Fierce Healthcare that access to information is a social determinant of health, and addressing that challenge is a key part of how the tech giant is thinking about equity.

“It’s equity by design in the product,” Budaraju said in an interview at the HLTH conference, “and we’re very proud of being part of the journey.”

Helping people secure coverage is one piece, better enabling them to use it effectively is another. Another recent addition to Google’s search allows people to seek out local physicians and the results will include if those doctors accept Medicare and Medicaid.

When a user clicks into a specific physician, they can also further investigate their options using a “check insurance info” option that allows them to filter by specific Medicare and Medicaid carriers and plans.

Budaraju said the goal was to offer these details in “an easily consumable manner” that enables them to make “timely” decisions about their care and coverage. She added that these tools are not limited to Medicare and Medicaid, and that Google has rolled out similar functionality for the Children’s Health Insurance Program, Supplemental Nutrition Assistance Program and electronic benefit transfer (EBT) programs as well.

The journey in accessing data on these social programs is “nonlinear,” Budaraju said, and often requires people to sift through multiple webpages and sites to find the details they need. That’s why Google saw an opportunity to streamline the experience.

She said the Search team also sees an opportunity to use this framework as a baseline for other scenarios, such as economic security, crisis response or in extreme weather. The focus on equity and easing the user experience is replicable in other areas, she said.

“There is a beauty to understanding, ‘What is the journey?'” Budaraju said.

Posted on by

Possible end of emergency spurs debate on Medicaid

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]: Legislators in states that have expanded are saying that ending the PHE will impact minorities in states that have not expanded. TL/DR Congresspersons from CA are trying to speak for constituents in say, Alabama. Weird.

 
 

Clipped from: https://rollcall.com/2022/11/07/possible-end-of-emergency-spurs-debate-on-medicaid/

Some estimates predict between 5 million and 14 million people will lose Medicaid coverage at the end of the COVID-19 public health emergency

 
 

California Rep. Judy Chu is among the lawmakers who has expressed concern about the end of the public health emergency, saying it could hurt minority populations in states that have not expanded Medicaid. (Bill Clark/CQ Roll Call file photo)

The potential end of the COVID-19 public health emergency has reinvigorated debate over the merits and costs of expanding Medicaid.

A provision of a 2020 COVID-19 relief bill required that states keep people continuously enrolled in Medicaid through the end of the month in which the COVID-19 public health emergency ends in exchange for more federal funding. 

The provision contributed to a 25 percent enrollment surge during the pandemic, but will end when the public health emergency does, prompting a year-long unwinding during which time the Kaiser Family Foundation estimates between 5 million and 14 million people will lose Medicaid coverage.

The Biden administration projected in August that of those impacted, 383,000 would be in the 12 states that declined to expand Medicaid since the passage of the 2010 health care law. That figure changed on Tuesday, when South Dakotans voted to expand the program via ballot measure – a move that will likely prevent 42,500 individuals from losing coverage, according to state officials.

Those who do lose coverage will fall into the Medicaid “coverage gap” – they’re part of a group of 2.2 million people living in non-expansion states who make too much to qualify for Medicaid but too little to qualify for subsidized marketplace coverage under the 2010 law.

The Supreme Court ruled in 2012 that Medicaid expansion was optional, but 39 states and Washington, D.C., have capitalized on significant federal financial incentives and expanded their programs. Now, with the end of the public health emergency looming, advocates in the remaining states argue that expansion is a moral imperative with significant financial incentives. 

“There are going to be a lot of low-income folks in the coverage gap after the public health emergency ends,” said Jane Adams, campaign director at the Cover Alabama Coalition, a group advocating for expansion in Alabama. “And it doesn’t have to be this way… It’s just bad governance not to expand.”

Opposition remains stiff. 

“It’s about the state having autonomy over its money,” said Justin Bogie, senior director of fiscal policy at the Alabama Policy Institute, a conservative Birmingham-based think tank that opposes expansion. “It’s really the federalism principle – having that division of power, letting states choose how they allocate their resources without strings attached.”

The scope of loss

It’s not immediately clear when the unwinding will begin, though it could be as soon as mid-January. The Biden administration has promised to give 60 days notice before ending the public health emergency, which means they would likely alert the public by mid-November about their plans. Worries about a winter COVID-19 surge could spur the administration to renew the public health emergency.

But when the emergency does end, the Department of Health and Human Services projects nearly 7 million people will lose Medicaid coverage despite still being eligible, in what’s known as “administrative churn” — the temporary loss of Medicaid coverage when enrollees disenroll then re-enroll during a short period of time for a variety of reasons, including renewal processes and short-term changes in income that make them temporarily ineligible.

Eight million others will be disenrolled because they no longer qualify for Medicaid and will need to seek coverage elsewhere, likely on health care marketplaces. Roughly 2.8 million of those people live in states that did not expand Medicaid.

Some will be covered by expanded health care law subsidies, which were extended through 2025 as part of the Democrats’ climate, health care and tax law. But others, many of whom will be from vulnerable minority groups, will lose coverage.  

“Yes, some people will be okay,” said Rep. Robin Kelly, D-Ill., a member of the Congressional Black Caucus. “But there will still be too many people that won’t be.”

Debate around Medicaid expansion is largely partisan. Republicans control the state legislatures in each of the 11 states that have opposed expanding Medicaid, though many Republican-led states have expanded.

With Tuesday’s vote, South Dakota – where former President Donald Trump won with more than 60 percent of the vote in 2016 and 2020 – became the sixth Republican-led state to expand via ballot initiative.

North Carolina’s Republican-led state House and Senate each passed bills this year in favor of expansion. Neither was adopted before the end of the 2022 legislation session, but the votes signal a potential ideological shift in a state long opposed to expansion.

 
 

‘That ship has done sailed’

The Public Affairs Research Council of Alabama estimates that expansion would cost the state an average of $225 million per year through 2027, but would result in more than $1 billion in savings during the same time period.

 
 

Despite the potential savings, conservatives argue the $225 million cost is steep in a place like Alabama, which has a general fund budget of roughly $2.7 billion. Alabama Gov. Kay Ivey, a Republican, has consistently expressed concern about the long-term costs of the program. Ivey did not respond to multiple requests for comment. 

Bogie, of the Alabama Policy Institute, argued it’s unfair to future generations of taxpayers as federal investment in the program balloons. Federal Medicaid spending was $462 billion in 2022 and projected to rise by 2032, according to the Congressional Budget Office. 

Bogie said Alabama Republicans also worry expansion could negatively impact the state’s workforce participation, which is among the lowest in the country, by removing the incentive to obtain employer-provided insurance.

The Biden administration has opposed efforts in several states to impose work requirements. Alabama in 2021 withdrew a proposal to establish work requirements for its traditional Medicaid population.

Even the Supreme Court’s June overturning of Roe v. Wade didn’t move the needle in Alabama, Bogie said. Concerns about uninsured mothers forced to carry their babies to term were mostly quelled when the state legislature allocated $4 million to extend postpartum coverage for Medicaid beneficiaries from 60 days to 12 months.

“I think that ship has done sailed,” said Republican state Sen. David Sessions, when asked on local radio in October about the prospect of expansion.

 
 

The cliff

Expansion advocates, however, contend opponents may be forced to reconsider once the public health emergency ends and coverage loss becomes reality.

“When you don’t have families losing their coverage immediately, that makes it easier to not deal with the policy issue,” said Adam Searing, an associate professor at the Georgetown University School of Public Policy’s Center for Children and Families.

Members of the Congressional Black, Hispanic and Asian Pacific American caucuses raised concerns in an April letter to the Biden administration that Americans of color could suffer disproportionately.

More than half of Medicaid’s 73 million beneficiaries identify as Black, Hispanic, Asian American or another non-white race or ethnicity, according to the Medicaid and CHIP Payment and Access Commission, a nonpartisan legislative branch agency that provides policy and data analysis to Congress.

“The end of the public health emergency represents a cliff at which millions of AAPIs (Asian American Pacific Islanders) could find themselves without coverage,” Rep. Judy Chu, D-Calif., chair of the Congressional Asian Pacific American Caucus, told CQ Roll Call. “I am especially concerned about AAPIs in states which have not expanded Medicaid, leaving a coverage gap of up to 2 million people without access to affordable coverage.”

Congress has little recourse to address coverage loss, though they could pass legislation to extend pandemic-era levels of Medicaid funding for the duration of the unwinding period to ease administrative burden. But there is currently no proposal to do so.

 
 

The simplest, most effective response to ward off coverage loss is to expand Medicaid in the remaining non-expansion states, said Searing. 

 
 

In Alabama, popular support for expansion is strong, according to a February 2022 poll conducted by Alabama Arise, a group affiliated with the Cover Alabama Coalition. 

The group found that more than 70 percent of Alabama residents (65.8 percent of whom were registered Republicans) favor expanding Medicaid when given arguments in support of expansion. 

Adams said the Cover Alabama Coalition hopes to build on those results and make another push for expansion after the November election. A key facet of the initiative will be meeting individually with Republican lawmakers to educate them on the potential benefits of Medicaid expansion and address any lingering ideological opposition to the 2010 health care law, Adams said.

“I’m optimistic,” Adams said. “We have a really strong coalition and we are going to be doing our due diligence to educate not only the public, but lawmakers, that the Obamacare they were scared about 10 years ago is not the same Obamacare today.”

 
 

From <https://rollcall.com/2022/11/07/possible-end-of-emergency-spurs-debate-on-medicaid/>

Posted on by

PHE/ AR- How Arkansas is boosting Medicaid outreach ahead of PHE expiration

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]: Groups can apply for $500 and $5,000 grants to help explain the wind-down process to members in their communities.

 
 

 
 

Clipped from: https://www.beckerspayer.com/payer/how-arkansas-is-boosting-medicaid-outreach-ahead-of-phe-expiration.html

The Arkansas Department of Human Services has launched a grant program for community-based organizations to assist the state’s Medicaid beneficiary outreach efforts ahead of the eventual end of the COVID-19 public health emergency. 

The public health emergency runs through at least Jan. 11. When the emergency ends, Arkansas Medicaid will redetermine eligibility for beneficiaries whose eligibility was extended solely due to the emergency, according to a Nov. 8 department news release. Arkansas Medicaid will also begin closing cases for ineligible individuals and for individuals who do not respond to requests to renew or provide information. 

Ahead of that ending, the department is seeking community-based organizations to help with outreach and engagement of their local constituencies, according to the release. The organizations will also help with the renewal process in some circumstances. 

Organizations with a proven track record for serving low-income children and adults, those with low incomes in rural communities, and low-income pregnant or postpartum women will be given priority for grants, according to the release.

 
 

What: Mini-grant program to assist the Arkansas Department of Human Services with important outreach and engagement efforts in advance of the eventual unwinding and ultimate end of the ongoing Public Health Emergency (PHE) related to the COVID-19 pandemic.

More Details: When the PHE ends, Arkansas Medicaid will redetermine eligibility for all Arkansas Medicaid clients whose eligibility has been extended solely due to the PHE. Arkansas Medicaid will also begin closing cases for ineligible individuals and for individuals who do not respond to requests to renew or provide information. 

DHS is seeking to partner with community-based organizations (CBOs) to assist with outreach and engagement of their local constituencies and, in some cases, helping with the renewal application process. DHS, with support from the Arkansas Foundation for Medical Care (AFMC), will identify eligible Arkansas 501c3 nonprofits for recruitment. These CBOs will then be asked to complete the application process and confirm they meet eligibility criteria for the grant opportunity. The goal is to serve all 75 counties. Applications will be reviewed in the order received and priority will be given to organizations which have a proven track record for serving low-income children and adults, those which serve low-income Arkansans in rural communities, and those which serve low-income pregnant or post-partum women. Partnerships in larger counties will be limited to at least one CBO Basic Outreach Partner per 75,000 residents and one CBO Enhanced Outreach Partner per 75,000 residents.  

Eligible CBOs will be required to complete a mini-grant application created by DHS. DHS may limit the number of CBOs who can participate in each county based on the county’s population and the number of partners already approved in the county. CBOs will identify their participation level as either a Basic Outreach Partner or an Enhanced Outreach Partner.

Basic Outreach Partners may be eligible for a one-time $500 stipend and Enhanced Outreach Partners may be eligible for a one-time $5,000 stipend for participation.

Program details and the application can be found at www.afmc.org/cbo. Please submit applications with required documents to cboinfo@afmc.org by December 16, 2022, at 5 p.m. Applications submitted after this date or are incomplete will not be considered for the first round of grant funding. 

 
 

From <https://humanservices.arkansas.gov/news/dhs-launches-mini-grant-program-to-assist-with-outreach-to-medicaid-clients-ahead-of-public-health-emergency-ending/>

 
 

 
 

Posted on by

OR- Oregon is guaranteeing kids won’t get kicked off Medicaid until at least age 6

 
 

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]: Kiddos will stay on Medicaid until age six, no exceptions. Even if momma and daddy win the lottery and become millionaires on their 3rd birthday.

A newsletter briefing on the health-care policy debate in Washington.

 
 

 
 

A newsletter briefing on the health-care policy debate in Washington.

Good morning to everyone, especially these brown bears eating pounds and pounds of salmon to prepare for winter. Send your favorites to rachel.roubein@washpost.com. 

Today’s edition: The Centers for Disease Control and Prevention is officially expanding eligibility for the monkeypox vaccine. House Republicans are probing biosafety practices overseen by two key federal agencies. But first … 

Oregon wants to keep kids covered during their critical, early-stage development

A child receives the Pfizer-BioNTech coronavirus vaccine at the Fairfax County Government Center. (Chip Somodevilla/Getty Images)

Oregon is testing out a new concept in Medicaid: Keep children continuously enrolled in the safety net program until they turn 6 years old. 

The first-of-its-kind idea, to be piloted over five years, is designed to stop children from getting kicked off their health coverage during years crucial to their development. Federal health officials signed off yesterday on the program, which more states could emulate in the coming months. 

Story continues below advertisement

“We have near universal health insurance coverage for senior citizens in this country,” said Bruce Lesley, the president of the First Focus on Children, an advocacy group. “Where we really would like to get with kids is that the public programs should basically assume coverage unless someone says, ‘No, I have private coverage.'”

Oregon’s pilot program comes at a critical moment for safety net coverage. Millions of children are at risk of losing their Medicaid coverage when the public health emergency for the coronavirus ends. Such a notion is already fueling a push in Congress to include policies in a year-end deal that would further maintain coverage for kids.

Joan Alker, the executive director of Georgetown’s Center for Children and Families:

The Biden Administration has approved Oregon’s transformative Section 1115 Medicaid request which will provide a major new support for young families. pic.twitter.com/ufBAKTkm8Z

— Joan Alker (@JoanAlker1) September 28, 2022

The details

The idea of continuous enrollment for kids isn’t new — it’s one advocates and some Democrats have been pushing for years. Over half of states have a requirement that kids can’t be kicked off their coverage for 12 months, even if a family’s income changes. 

Story continues below advertisement

The point is to avoid a temporary loss of health coverage, known as churn.
It occurs frequently in Medicaid and the Children’s Health Insurance Program, and is essentially when people cycle on and off the programs in a short period of time, and can happen when a person’s income fluctuates, for instance.

  • Roughly 11.2 percent of children with full benefits are disenrolled and then subsequently re-enrolled within one year, according to the Kaiser Family Foundation. 

Now, Oregon is pioneering a new approach. The state will soon allow children to remain on Medicaid until their sixth birthday. After that, children 6 years old and older, as well as adults, can stay enrolled for two years at a time, regardless of changes in their finances or other family circumstances.

Will other states follow suit? Joan Alker, the executive director of Georgetown’s Center for Children and Families, said she’s “cautiously optimistic,” and some states have already begun to propose such policies.

Story continues below advertisement

  • Washington state asked the federal Medicaid agency this summer for permission to cover children with Medicaid for the first six years of their lives.
  • New Mexico has drafted an application that would also provide continuous Medicaid enrollment up to age 6.
  • California lawmakers asked state officials to seek sign-off from the federal government to continuously cover children with Medi-Cal until they turn 5.
Challenges loom

Amid the coronavirus pandemic, Congress offered states a deal. They could get enhanced funding for their Medicaid programs from the federal government if they pledged not to remove anyone from the program’s rolls until the public health emergency ended.

States are already bracing for the complex process of determining who is still eligible for the programs whenever the public health emergency is over. Children and young adults are expected to be disproportionately impacted, with the Department of Health and Human Services predicting that 5.3 million could lose their Medicaid or CHIP coverage.

That’s already spurring advocates to push Congress to pass policies to keep kids covered in a year-end spending deal. A requirement that children can’t lose their coverage for a continuous 12 months was originally included in Democrats’ sweeping social spending bill but was ultimately left on the cutting room floor when the legislation was narrowed. And such a policy is a top priority for key party leaders, such as House Energy and Commerce Chair Frank Pallone Jr. (D-N.J.).

Story continues below advertisement

  • “We’re hoping that people recognize that when the public health emergency ends, there’s going to be a lot of kids kicked off,” Lesley said. “Having 12-month continuous [coverage] would really help — not completely eliminate that — but it would help mitigate the loss of coverage for lots of kids.”

 
 

 
 

Clipped from: https://www.washingtonpost.com/politics/2022/09/29/oregon-is-guaranteeing-kids-wont-get-kicked-off-medicaid-until-least-age-6/

Posted on by

Proposed CMS rule would streamline Medicaid, CHIP enrollment

MM Curator summary

[MM Curator Summary]: New rules could standardize Medicaid eligibility and enrollment processes nationwide, but it would come at the cost of making it more difficult for states to right-size the rolls more than 1x a year.

 
 

 
 

 
 

An article from

 
 

 
 

The exterior of the U.S. Department of Health and Human Service in Washington, DC. Alex Wong via Getty Images

This audio is auto-generated. Please let us know if you have feedback.

Dive Brief:

  • The CMS on Wednesday issued a proposed rule aimed at reducing coverage gaps by streamlining the application and renewal process for Medicaid enrollees and other programs like the Children’s Health Insurance Program.
  • Among other things, the proposed rule aims to make CHIP and Medicaid enrollment easier for children, older adults and those with lower incomes by limiting renewals to once a year, establishing standardized statewide renewal processes and giving applicants 30 days to respond to information requests.
  • The proposed rule comes as states begin to notify Medicaid beneficiaries about potential losses of coverage due to the impending end of the COVID-19 public health emergency.

Dive Insight:

The COVID-19 PHE created a continuous coverage requirement for Medicaid enrollees in states that accepted matching rates for Medicaid payments, allowing those with Medicaid coverage to forgo renewing for eligibility and retain their coverage.

Enrollment in CHIP and Medicaid programs jumped 24% during the PHE, making it the largest source of health coverage in the U.S. Estimates on how many could get kicked off coverage once the PHE ends range between 5 million and 14 million beneficiaries.

The proposed rule would make it easier to enroll and retain Medicaid coverage as some states begin notifying Medicaid beneficiaries that they may lose coverage when the COVID-19 public health emergency ends.

In addition to standardizing procedural enrollment and renewal processes for states, the proposed rule also attempts to lower coverage disruptions and churning, which can occur when people lose coverage and re-enroll quickly by simplifying the enrollment process and maintaining continuity of coverage for those eligible.

It initiates applications for Medicare Savings Programs, allowing those who use low-income subsidies to be eligible for MSP coverage “to the maximum extent possible.” Currently, there are no regulations that ensure efficient enrollment processes for MSPs, resulting in “millions” of eligible individuals to miss out on potential savings, according to the CMS.

“This proposed rule will ensure that these individuals and families, often from underserved communities, can access the health care and coverage to which they are entitled — a foundational principle of health equity,” CMS Administrator Chiquita Brooks-LaSure said in a news release.

People over 65 and with blindness or a disability, who are excluded from enrollment simplifications, would also have access to an easier enrollment process in the proposed rule. Renewals would occur no more than once a year, with the rule also proposing to eliminate in-person interviews and provide a minimum 90-day reconsideration period after termination for “failure to return information needed to redetermine eligibility.”

In the proposed rule, states would also see more federal oversight for their enrollment and renewal processes by establishing guidelines to check available data prior to determining eligibility if a beneficiary can’t be reached by mail and providing timelines for when renewals must be completed.

Other changes include:

  • Automatic enrolling, with some exceptions, for Supplemental Security Income recipients into Qualified Medicare Beneficiary groups.
  • Allowing projected and predictable medical expenses to be deducted from an applicant’s income when determining financial eligibility, including home care and prescription drugs.
  • Eliminating the requirement to apply for other benefits as a condition of Medicaid eligibility to reduce administrative hurdles.
  • Requiring states to keep Medicaid and CHIP records and case documentation from the time the case is active plus three years thereafter.
  • Establishing a clear process to prevent eligible termination for beneficiaries who should be transitioned between Medicaid and CHIP when their income changes or when the beneficiary appears to be eligible for the other program, even if the beneficiary fails to respond to requests for information.

 
 

Clipped from: https://www.healthcaredive.com/news/proposed-cms-rule-streamline-medicaid-chip-enrollment/631019/

Posted on by

MO- Missouri officials vow progress as Medicaid applicant wait time remains at 100 days

MM Curator summary

[MM Curator Summary]: In a rare move, CMS gets directly involved to fix things.

 
 

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.

 
 

If the state can’t reduce the Medicaid backlog, it could put federal funding at risk

 
 

Kim Evans, right, director of family services at the Department of Social Services, testified before the Missouri House Budget Committee on Feb. 16, 2022 (photo courtesy Missouri House Communications).

State health officials faced tough questions Wednesday from the board overseeing Missouri’s Medicaid program — with a focus on the persistently long wait times for applicants and heightened federal scrutiny of the program.

Kim Evans, director of the Department of Social Services’ family support division, told the MO HealthNet Oversight Committee that Missouri is “well on our way” to getting wait times for applicants below 45 days by Sept. 30.

That deadline was established in a mitigation plan approved last month by the federal agency Centers for Medicare and Medicaid Services, in response to wait times violating federal standards for nearly a year.

Some members of the committee were skeptical the state will meet its deadline. As of Wednesday the average processing time for an application remained around 100 days. 

“I’m really concerned about the people who are waiting over three months to figure out if they have been accepted into the program,” said state Sen. Jill Schupp, a Democrat who serves on the oversight committee.

Board members also expressed concern that if the state can’t get wait times under the 45 day limit, the federal government could impose financial sanctions. 

“We don’t want sanctions, ” Schupp said, “we don’t want to lose money because we’re not able to fulfill the applications in the 45 day period.”

Evans said that before any financial penalties, the federal government would first implement more stringent compliance measures in a corrective action plan to try to help the state comply. 

“Our plan is never to get to the corrective action plan,” Evans said. “Our staff are working very hard right now.”

Federal scrutiny intensifies 

Wednesday was the first oversight meeting since the state began operating under a federal mitigation plan to curb Missouri’s delays and backlog.

The federal government formally requested the state produce a mitigation plan in May, after identifying “multiple issues related to Missouri’s timely processing of applications,” according to the letter obtained Wednesday by The Independent.

CMS had begun working with the state in early 2022 to identify strategies the state could adopt to address the backlog. But by May, the federal government wasn’t satisfied with Missouri’s progress. 

In the May letter, CMS said Missouri will “need to do more” to achieve compliance, and to avoid erroneously stripping applicants of coverage in the longer-term.

Right now, under the federal public health emergency, the state is not allowed to remove anyone from its rolls. Experts worry that once the state has to begin recertifications again, possibly early next year, the process could strain an already overburdened system. 

“We have communicated our concerns to the state on multiple calls,” the May letter says, adding that if wait times don’t get down under federal standards Missouri may have to submit a corrective action plan. 

If the state continues to fall short, federal financial participation in the program “may be at risk,” the letter says.

Evans, asked about those repercussions in the meeting, said the state is doing all it can to avoid them, including “throwing as many staff at this as we can” at processing applications.

The mitigation plan, designed to help the state process applications more quickly, includes temporary measures such as enrolling parents based on children’s verified eligibility, allowing the agency to use verified income from applicants already enrolled in federal food benefits, and allowing the agency to accept verification from the federal marketplace. 

Waiting over three months 

According to numbers Evans presented to the committee Wednesday, the current wait time is around 100 days — down from 115 days in June but still double what is federally allowed. 

The backlog of applications also has dropped to 34,060 from close to 50,000 in late June. 

At the last meeting, Evans predicted they’d be at 30 days by late August, Schupp pointed out. 

“Obviously, we’re not there,” Schupp added.

Medicaid isn’t the only benefits program struggling with delays. 

Evans testified Wednesday that Missourians are also facing long hold times waiting for required interviews to receive federal food assistance through the Supplemental Nutrition Assistance Program, or SNAP.

“The same staff that process Medicaid also process SNAP,” Evans said, explaining that DSS moves staff around depending on need. 

Lately, Evans said there has been an influx in SNAP applicants that she attributed in part to the worsening economy.  

“I know it has crept up to a couple of hours the last couple weeks,” Evans said about the average SNAP call wait time. 

Missouri’s SNAP call times are the subject of a federal lawsuit. 

Last month a judge said just one hour, which was the state’s May average, is “still unacceptably long and particularly burdensome for financially struggling Missouri citizens in need of SNAP benefits.”

‘You just leave a person in limbo’

For the Missourians with pending applications, each additional day waiting is a day worrying about prescription prices, delaying needed care, and, often, devoting hours they can’t spare to try to navigate the system, experts say. 

Melanie Jefferson, a 59 year old in St. Louis, said she applied on April 15 for Medicaid.  

As of this week, she still hadn’t heard back. 

Jefferson is a Type II diabetic and without Medicaid has to pay almost $100 for each Epipen. She is delaying other care, including visiting the neurologist and dentist. When she recently went to the optometrist for her annual eye exam, they told her it’d cost $400 without insurance. She walked out of the office without an exam. 

As the weeks stretched on without hearing back about her application, Jefferson felt completely in the dark. 

“I never got any information: nothing in the mail, no email, nothing to keep up with the status of my application,” Jefferson said, later adding “You just leave a person in limbo and it’s kind of crazy to me.”

When she called the Medicaid call center in late June, a staff member initially had trouble locating her in the system, Jefferson said. When they located her application, the staff member told Jefferson her information hadn’t been appearing because no one had begun processing the application yet. 

“I have enough going on,” said Jefferson. “This is unnecessary stuff.”

 
 

Clipped from: https://missouriindependent.com/2022/08/10/missouri-officials-vow-progress-as-medicaid-applicant-wait-time-remains-at-100-days/

Posted on by

PHE- MACPAC: Only 3% gained exchange coverage after leaving Medicaid

MM Curator summary

[MM Curator Summary]: Pivoting to the exchanges during the wind-down may not be a great plan.

 
 

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 paltry 3% of people got Affordable Care Act exchange coverage within a year after leaving Medicaid or the Children’s Health Insurance Program, a new study found. 

The study published last month by the Medicaid and CHIP Payment and Access Commission (MACPAC) comes as states are pondering how to transition scores of people from Medicaid to the exchanges once pandemic emergencies unwind. 

“We found that most individuals who moved from Medicaid to the exchange had a gap in coverage; these gaps were longer for racial and ethnic minorities,” wrote MACPAC, a panel that advises Congress on Medicaid and CHIP issues.

Researchers looked at enrollment data on CHIP, Medicaid and the ACA marketplaces from 2017 through 2019.

“Overall, we found that most beneficiaries who disenrolled from Medicaid or CHIP in 2018 returned to the same program within 12 months (a phenomenon referred to as churn) or did not enroll in another insurance affordability program,” the study said.

It found that 3% of beneficiaries who dropped off Medicaid or CHIP in 2018 got coverage on the exchanges in 12 months. Of the people who got ACA coverage, 3.9% were enrolled in Medicaid and 3.3% in CHIP. A beneficiary who moved from Medicaid or CHIP to ACA was much more likely to have a gap in their coverage. 

“For example, less than one quarter of children moving between Medicaid and CHIP experienced a gap in coverage, but more than 70% of adults and children moving from Medicaid to exchange coverage had gaps,” the study stated. 

On average the coverage gap from going to Medicaid or CHIP was three months, but was longer for Black, Hispanic and Indian Alaskan Native beneficiaries, MACPAC said. Non-Hispanic adults, for example, had a coverage gap of 73 days while Black and non-Hispanic adults didn’t have coverage for 105 days. 

The study results take on pressing relevance as states are preparing for the COVID-19 public health emergency to expire sometime this year or in 2023. 

At the start of the pandemic, Congress gave states the chance to get a 6.2% increase in their federal matching rate for Medicaid. However, states that took the extra funds were prohibited from dropping anyone from Medicaid or CHIP coverage for the duration of the PHE. 

The Department of Health and Human Services has extended the PHE through October. A report from Politico said that the PHE will be extended again for another 90 days, and HHS has promised stakeholders a 60-day heads up for when the PHE won’t be extended again.

States and the federal government have been preparing for the eventual expiration of the emergency, including how to handle coverage for those who are no longer eligible for Medicaid or CHIP. All states have 14 months after the PHE ends to redetermine Medicaid eligibility.

“Although many individuals who lose Medicaid coverage are expected to be potentially eligible for exchange coverage, the analyses in this memo suggest that many eligible individuals may not enroll,” the study said. “Administratively, states are required to transfer applications from Medicaid to the exchange if individuals are potentially eligible, but in practice, these account transfers do not always work as intended.”

As the PHE expiration looms, the Centers for Medicare and Medicaid Services has given states guidance on the unwinding. The agency has helped states to improve notices and is aiding community-based organizations on gathering the additional information needed for completing an exchange application. 

Congress may be helping with the transition. MACPAC cited potentially higher premiums on the exchanges as a barrier to getting coverage for those who transition from Medicaid or CHIP.

However, the Senate passed the Inflation Reduction Act on Sunday, which extends boosted subsidies on the exchanges through 2025. The House is expected to vote on Friday on the package, which also includes drug pricing reforms. 

 
 

Clipped from: https://www.fiercehealthcare.com/payers/macpac-only-3-get-exchange-coverage-after-leaving-medicaid-chip-2018

Posted on by

PHE- Medicaid/CHIP enrollment rose 23.9% during the pandemic, KFF report shows

MM Curator summary

[MM Curator Summary]: Medicaid has now ballooned to 88M people. Medicaid enrollment grew 26%; CHIP by 5%.

 
 

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 increases in enrollment are likely because of changes in the economy, policy changes like Medicaid expansion in the Affordable Care Act and the temporary continuous enrollment requirement from the Family First Coronavirus Response Act, the report said. 

 
 

Preliminary data for April 2022 show that total Medicaid/Children’s Health Insurance Program enrollment has grown by 23.9% since February 2020, an August 3 report by Kaiser Family Foundation shows. This represents an increase of 17 million people, reaching 88.3 million total people enrolled. 

KFF’s report analyzed the Centers for Medicare and Medicaid Services’ Performance Indicator Project Data. It comes after the Department of Health and Human Services’ announced that the national uninsured rate reached a record low of 8% in early 2022.

The increases in enrollment are likely because of changes in the economy, policy changes like Medicaid expansion in the Affordable Care Act and the temporary continuous enrollment requirement from the Family First Coronavirus Response Act, the report said. 

The continuous enrollment requirement prohibits states from disenrolling Medicaid enrollees during the pandemic emergency period. States in return receive a temporary increase in the federal Medicaid match rates. Continuous enrollment has paused “churning” in Medicaid, meaning when people temporarily lose coverage when they disenroll and then have to re-enroll.

All states saw a growth in total Medicaid/CHIP enrollment from 2020 to 2022. Oklahoma, which expanded Medicaid in July 2021, experienced the largest growth at 64.5% and Connecticut had the lowest at 14.8%. Utah, Idaho, Nebraska and Missouri also expanded Medicaid in the last two years.

Most of the increases in enrollment from 2020 to 2022 are from Medicaid, which rose by 25.9%, or 16.7 million enrollees. CHIP, meanwhile, has only increased by 5%, or 336,000 enrollees, and 15 states saw declines in enrollment. This is likely because of changes in family income, leading children to move from CHIP to Medicaid coverage, KFF found.

Adult enrollment has increased by 33.1% from 2020 to 2022, or 11.3 million adults. Child enrollment increased at a slower pace: 14.7%, or 5.2 million children.

After the ACA Medicaid expansion was implemented in 2014, there were major increases in Medicaid and CHIP enrollment. The trend reversed from 2017 to 2019, going from 73.4 million enrolled to 71.2 million, representing a 3% decrease. The decrease was due to a robust economy, but in some cases people who were eligible for coverage had challenges in the enrollment and renewal process, the report said.

It’s possible the trend could switch course again soon. Although there has been a continuous increase in Medicaid enrollment in the past two years, the increases seem to be slowing, KFF found. Additionally, when the public health emergency ends and continuous enrollment expires, many could lose coverage. Currently this is set for mid-October, but the Biden administration may extend it for another 90 days, the report said.

When the continuous enrollment requirement ends, states have up to 14 months to return to normal operations. During this period, states will disenroll people who no longer qualify for coverage. KFF estimates that between 5.3 million to 14.2 million could be disenrolled when this happens.

“How states manage the large volume of redeterminations during the ‘unwinding’ of the continuous enrollment requirement, as well as how states engage with enrollees and other stakeholders, will impact the continuity of coverage for millions of Medicaid enrollees,” the report said.

Photo: designer491, Getty Images

 
 

Clipped from: https://medcitynews.com/2022/08/medicaid-chip-enrollment-rose-23-9-during-the-pandemic-kff-report-shows/

Posted on by

HHS putting $49 million toward increased healthcare coverage for children

MM Curator summary

[MM Curator Summary]: The money will be doled out in $1.5M grants to entities working to increase Medicaid enrollment outreach efforts.

 
 

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.

 
 

Grantees will provide enrollment and renewal assistance to children and their families, as well as expectant parents.

 
 

Photo: FS Productions/Getty Images

The administration made a push to expand healthcare coverage for young people this week when the U.S. Department of Health and Human Services, through the Centers for Medicare and Medicaid Services, awarded $49 million to organizations trying to reduce uninsured rates among children, parents and families.

The agency said it’s looking to invest in outreach and enrollment through Medicaid’s Connecting Kids to Coverage program. Grantees were funded through the Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act of 2017 (HEALTHY KIDS Act). The HEALTHY KIDS Act provides continued funding for outreach and enrollment to reduce the number of children eligible for, but not enrolled in, Medicaid and CHIP.

Grantees will provide enrollment and renewal assistance to children and their families, as well as expectant parents, to promote improved maternal and infant health outcomes. 

CMS issued 36 cooperative agreements in 20 states through the Connecting Kids to Coverage program. Grantees – including state and local governments, tribal organizations, federal health safety net organizations, nonprofits and schools – will each receive up to $1.5 million over three years to advance Medicaid and CHIP enrollment and retention.

WHAT’S THE IMPACT

Grantees will participate in the Connecting Kids to Coverage National Campaign efforts, including the national back-to-school initiative, the year-round enrollment initiative, and new initiatives focused on retaining individuals in Medicaid and CHIP.

CMS said this work will be key as states prepare to resume normal Medicaid and CHIP
operations once the COVID-19 public health emergency ends.

The grantees will also work on several unique activities of their own. They may: engage schools and other programs serving young people; bridge demographic health disparities by targeting communities with low coverage; use social media to conduct virtual outreach and enrollment assistance; and use parent mentors and community health workers to assist families with enrolling in Medicaid and CHIP, retaining coverage, and addressing social determinants of health.

THE LARGER TREND

According to CMS, of America’s 4 million uninsured children, 2.3 million are eligible for Medicaid and CHIP – though  many families don’t know they’re eligible or struggle with enrollment.

There are also pronounced disparities. American Indian and Alaska Native children have the highest uninsured rates (11.8%), followed by those who are Hispanic (11.4%) and non-Hispanic Black (5.9%). 

Targeting new and expectant parents can also lead to increased child enrollment, since infants born to people on Medicaid and CHIP are automatically deemed eligible for one year, CMS said.

ON THE RECORD

“At HHS, it is a top priority to make high-quality health care accessible and affordable for every American,” said HHS Secretary Xavier Becerra. “This past year, through unprecedented investments in outreach and enrollment efforts, a record-breaking 14.5 million people signed up for health care coverage through the ACA Marketplace. With today’s historic investment for children and parents, we will redouble our efforts to get families covered – and give them the peace of mind that comes with it.”
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com

 
 

Clipped from: https://www.healthcarefinancenews.com/news/hhs-putting-49-million-toward-increased-healthcare-coverage-children