Tag: Enrollment

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Guidance Released on Medicaid and Children’s Health Insurance Program

 
 

MM Curator summary

[MM Curator Summary]: CMS has now provided detailed guidance on how states should deal with eligibility determinations once the PHE is declared over.

 
 

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.

 
 

 
 

 
 

During the COVID-19 Public Health Emergency (PHE), insurers, health technologies, and certain FDA-regulated products were provided various flexibilities in their offering of care. Now the Biden administration is beginning a “return to normal operations” with the release of state guidance that provides up to 12 months to ensure eligibility and renewal reviews of individuals who remained covered under Medicaid during the pandemic. Without appropriate planning, this could result in a disruption of coverage as states begin to verify and renew individuals covered under Medicaid and the Children’s Health Insurance Program (CHIP).

During the pandemic, states were provided incentive payments to maintain continuous enrollment for all individuals enrolled in Medicaid. It is estimated that over 40 million children were enrolled in Medicaid or CHIP during the pandemic. It is also estimated that up to 15 million people, including 6 million children, may be at risk of losing this coverage when eligibility determinations are back in place.

This new guidance sets some specific criteria for states to plan and implement a smooth transition to ensure that individuals enrolled in Medicaid are in fact eligible. The following are key issues established in this guidance for states – that could affect individuals, providers, and plans:

  1. States have been receiving a temporary 6.2% increase in Federal Medical Assistance – and a major condition of receiving that increase was a requirement to maintain continuous enrollment.
  2. When this condition ends, states will have up to 12 months to restart the normal enrollment process.
  3. This will include Medicaid, CHIP, and the Basic Health Program (BHP).

The Centers for Medicare & Medicaid Services (CMS) has established a tool for states to plan a return to the standard process for new and existing enrollees. States will be expected to submit data showing their completion of pending applications and reviewing renewals for those who are currently enrolled. CMS will be monitoring errors, timelines, and data submission by states and may require states to provide additional reporting on a more frequent basis.

Key Issues for States in the Toolkit to Ensure Compliance

  1. When the PHE ends, states will again renew eligibility requirements every 12 months for individuals enrolled in Medicaid and CHIP based on eligibility criteria. For individuals no longer eligible for the program they are enrolled in, states must consider other insurance affordability programs prior to terminating Medicaid and CHIP coverage.
  2. Applications must be handled promptly and may not exceed 90 days for a Medicaid applicant on the basis of disability, or 45 days for all others.
  3. States are encouraged to plan to comply with these requirements by considering staffing and organizational needs, prioritizing work, and determining mitigation strategies.
  4. The first step is to assess the processing of renewals to conduct post-enrollment verification and redeterminations of eligibility due to changes in the enrollee circumstances. While states will be required to initiate renewals for all individuals enrolled within 12 months, the month it begins may vary by state. States will have to evaluate the number of renewals, length of time pending, which populations may be stable (children, dually eligible individuals); populations that are vulnerable and other populations.
  5. Application processing is expected to be timely—CMS expects states to expeditiously process applications beginning immediately. States may use a phased-in approach to complete applications, such as two months after the month in which the PHE ends. States should complete eligibility determinations for those age 65 and older; three months after PHE ends, states should complete eligibility determinations for all pending disability-related applications; four months after the PHE ends, states should resume timely processing of all applications.
  6. CMS expects states will begin processing fair hearing requests timely after the PHE ends. The approach should be customized by each state depending on the volume, types of requests, and staffing.
  7. States should develop an outreach and communications plan, and in doing so, should consider the core audiences and key messages.
  8. States should have a month-to-month plan for completing eligibility determinations; timely application processing; initiating renewals by 12 months after the state begins its unwinding period; and completing all pending actions. This will require a detailed effort to communicate with existing populations of eligible individuals as well as those who have been covered previously.

CMS has identified additional guidance and resources for states in this transition to ensure a review of individuals enrolled in Medicaid and CHIP and assist them through the 12 month cycle with planning tools. Plans, providers, and other health care entities should monitor each state’s efforts carefully and assist in providing accurate information on the potential changes in coverage that may occur during this transition.

 
 

Clipped from: https://www.natlawreview.com/article/public-health-emergency-guidance-released-medicaid-and-children-s-health-insurance

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End of Public Health Emergency Triggers End to Medicare, Medicaid Flexibilities

MM Curator summary

[MM Curator Summary]: The end of the PHE will not only impact the surged Medicaid enrollment, but also will return Medicare Advantage governance back to its normal model.

 
 

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.

 
 

During an AHIP webinar, Mark Hamelburg, senior vice president of federal programs at AHIP, explained the shifts coming to Medicare and Medicaid when the public health emergency finally ends.

While the country looks forward to the end of the COVID-19 pandemic to get back to a sense of normalcy, there are concerns that the end of the public health emergency (PHE) will trigger the end of waivers and regulations in Medicare and Medicaid that could significantly impact patients, explained Mark Hamelburg, senior vice president of federal programs at AHIP, during an AHIP webinar on the state of the industry in 2022.

Hamelburg was joined by fellow AHIP experts Kate Berry, senior vice president of clinical innovation; Danielle Lloyd, senior vice president of private market innovations and quality initiatives; and AHIP CEO and President Matt Eyles.

Eyles kicked off the webinar to highlight some of AHIP’s priorities in 2022:

  • Ensuring access to affordable coverage and care by addressing the underlying cost drivers of care
  • Ending pharmaceutical monopolies and patent gaming that let companies raise drug prices, shut out competition from generics and biosimilars, and undermine the ability to negotiate for lower drug prices
  • Improving health equity so everyone has an equal opportunity to achieve their best health
  • Developing a clear vision of a postpandemic world that maintains coverage gains and marketplace subsidies that have made health insurance coverage affordable

 
 

  • Supporting a competitive, free market, which had ensured early access to COVID-19 testing and treatment without a cost barrier

“We are champions of care in 2022 and beyond, and our focus is squarely going to be on the health and well-being of Americans,” Eyles said. “It is top of mind for us at AHIP here every single day.”

As the pandemic and PHE come to an end, there are going to be important shifts for people who qualify for Medicare and Medicaid, Hamelburg explained. At the start of the pandemic, the government implemented COVID-19 relief laws and regulatory flexibility that will end with the PHE.

In Medicare, enrollees have paid no cost sharing for their COVID-19 testing and related services, as well as monoclonal antibody infusions for COVID-19 treatment, he said. In Medicare Advantage (MA) and Part D, regulations enacted during the PHE have allowed enrollees to access out-of-network coverage at in-network cost-sharing levels.

Other provisions that will end with the PHE include flexibilities for MA plan sponsors to waive or reduce premiums and make mid-year benefit enhancements during the PHE, Hamelburg said.

Medicaid also has a requirement tied to the PHE around ensuring all states provide coverage without cost sharing for COVID-19 vaccines, testing, and treatment. There are also a number of operational waivers that states received to run their Medicaid programs during the PHE.

“Maybe one of the most significant impacts that we’ll have—potential shifts across different programs and products—relates to eligibility in Medicaid,” Hamelburg said.

At the beginning of the PHE, states were given an increase in their federal Medicaid matching funds as long as states agreed to maintain their Medicaid eligibility for beneficiaries through the end of the PHE. This means states have not been doing regular eligibility reviews and rolling people off when they no longer qualify.

“So, now we’ve gone through almost 2 years [of the PHE], and incomes and other conditions have changed, and some people are no longer going to be eligible,” Hamelburg explained. “In fact, we now have more than 80 million people on Medicaid and CHIP. And there have been estimates that millions could end up losing coverage when this process kicks in.”

A major concern is that people who lose coverage, or even those who remain eligible, could run into issues because of processing delays. States may not have their updated addresses and people could lose coverage even though they are still eligible.

“That’s something that we are tremendously focused on and is going to be one of the big issues once the PHE ends,” he said.

Separate from the pandemic, Hamelburg highlighted the success of the MA program. At this point, there are almost 29 million people in MA, which is roughly 45% of all Medicare beneficiaries. He also noted that the enrollees in MA are more racially and ethnically diverse, as well as being more satisfied with their coverage than enrollees in traditional Medicare.

According to Hamelburg, MA gives enrollees more financial security at a more affordable price and research has shown that there are positive clinical outcomes for people in MA vs traditional Medicare. MA enrollees may be getting Part D drug coverage or dental, vision, and hearing benefits without paying an extra monthly premium. MA also has a cap on annual out-of-pocket costs that is not in the original Medicare program.

“So, people enroll in the program, they’re satisfied with it, they talk to others, and that’s really generating the incredible growth we’ve seen,” he said.

 
 

Clipped from: https://www.ajmc.com/view/end-of-public-health-emergency-triggers-end-to-medicare-medicaid-flexibilities

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Healthcare groups want advance notice on the end of PHE and Medicaid provisions

MM Curator summary

[MM Curator Summary]: Medicaid industry associations are asking for 90-120 days’ notice for when the PHE ends to help with planning for the eligibility redetermination process.

 
 

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.

 
 

There could be “dangerous and unnecessary gaps in coverage and care,” groups tell Congress.

 
 

Photo: SDI Productions/Getty Images

 
 

Payer groups are asking Congress for a 90-day notice prior to the end of the public health emergency because of what it means for current Medicaid enrollees who could lose coverage.

Also, Medicaid Health Plans of America and seven other groups want a 120-day notice before the end of federal matching provisions for Medicaid and Children’s Health Insurance Program beneficiaries in the Families First Coronavirus Response Act, which is also related to the end of the PHE.

They sent a letter to Senate and House leaders on February 17 urging Congress to proceed with caution if considering a wind down of the enhanced Federal Matching Assistance Percentage and Maintenance of Effort continuous eligibility provisions. These and other provisions represent significant safeguards that protect Medicaid beneficiaries during the COVID-19 pandemic, the letter said.

If dropped, there could be “dangerous and unnecessary gaps in coverage and care” as states, in coordination with Medicaid health plans, conduct redeterminations on coverage, the groups said.

WHY THIS MATTERS

Medicaid beneficiaries are at risk of losing coverage once the public health emergency ends.

States are required to keep people enrolled in Medicaid throughout the public health emergency as a condition of receiving a temporary increase in the federal share of Medicaid costs, according to The Commonwealth Fund. When the PHE ends, the enhanced federal funding will end and states will resume administering renewals for Medicaid eligibility. 

Medicaid beneficiaries will have their eligibility redetermined, triggering a high risk of coverage losses that is almost certain to fall disproportionately on Black and Latinx individuals who have experienced significant harm and  dislocation during the pandemic, the report said.

Medicaid Health Plans of America said that, throughout the pandemic, Medicaid has provided healthcare coverage and services to more than 80 million low-income, vulnerable people who would otherwise not be able to afford insurance.
 
“However, we recognize that as the pandemic wears on, the strain placed on the Medicaid program has been building,” the letter said. 

The current public health emergency ends on April 16 and could be extended again by the Secretary of Health and Human Services. It could be allowed to expire at the end of the 90-day period or terminated early if deemed appropriate.

A public health emergency has existed since January 27, 2020. The PHE was renewed four times by former HHS Secretary Alex Azar and has been renewed four times by current Secretary Xavier Becerra.

THE LARGER TREND

In an announcement made on February 17, the Centers for Medicare and Medicaid Services said it would seek a Request for Information to develop a more comprehensive access strategy in its Medicaid and CHIP programs.

CMS wants feedback on topics related to healthcare access, such as enrolling in and maintaining coverage, accessing healthcare services and supports and ensuring adequate provider payment rates to encourage provider availability and quality. 

Evidence shows that while Medicaid and CHIP generally provide comprehensive coverage for healthcare services, some enrollees still experience challenges accessing providers and medical services despite statutory access protections in Medicaid, CMS said. 
 
Interested parties may access the RFI questions and provide comment on Medicaid.gov. The RFI is open for a 60-day public comment period that began February 17.
 
ON THE RECORD

“We want to hear directly from stakeholders so we can strengthen our programs for the more than 80 million Americans with Medicaid or CHIP health insurance. Together, by advancing health equity, we can ensure quality healthcare is within reach for everyone who needs it,” Becerra said.
 
“Medicaid and CHIP provide essential health coverage for over 80 million individuals and families,” said CMS Administrator Chiquita Brooks-LaSure. “Ensuring every eligible person can access the coverage and care to which they are entitled is a foundational principle of health equity and our work at CMS. We invite interested stakeholders and individuals with lived experience to join us in this mission, starting by responding to the request for information.”

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org

 
 

Clipped from: https://www.healthcarefinancenews.com/news/healthcare-groups-want-advance-notice-end-phe-and-medicaid-provisions

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OR- Oregon lawmakers consider bill to head off Medicaid disenrollments

MM Curator summary

[MM Curator Summary]: The state is planning for the task of determining whether the 300k+ members added to the rolls during the pandemic are still eligible.

 
 

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.

 
 

 
 

Aaron Kunkler | Feb 15, 2022 | Oregon

Lawmakers in the Oregon legislature are examining ways to head off a massive Medicaid disenrollment once the COVID public health emergency is lifted.

One bill attempting to do this, HB 4035, would require the Oregon Health Authority and the Department of Human Services to develop a process for conducting medical assistance program redeterminations following the end of the public health emergency declared on March 8, 2020.

 
 

The federal Family First coronavirus Recovery Act mandated that people who were enrolled in Medicaid during the public health emergency could not be disenrolled until the emergency order was lifted. After the lifting of the order, states will have a year to redetermine eligibility of their Medicaid enrollees.

According to the Oregon Health Authority, at the end of January 2022, there were more than 1.38 million members enrolled in the Oregon Health Plan, the state’s Medicaid program. It’s an increase of roughly 302,000 members since March 2020 when the emergency was declared. Federal law generally requires people on Medicaid to have their eligibility redetermined annually.

The Oregon Health Authority estimates that nearly all of the 302,000 enrollees will lose Medicaid coverage after the public health emergency is lifted. Health authorities in Washington are struggling with similar questions.

HB 4035 would do a number of things, including submitting a report to the legislature by the end of this May on their progress. It also requires the health authority to maintain continuous enrollment for the medical assistance program, and give the state some flexibility until the end of 2023 to maintain coverage for Oregonians and minimize the risk of disruptions in coverage or care for high-risk populations or people at risk of becoming uninsured.

It also allows temporary limit waivers on disclosure of enrollee information to promote greater information sharing and community partners assisting individuals who are reapplying for or seeking to maintain eligibility in the medical assistance program who are moving from Medicaid to plans under the health insurance exchange.

It also creates a task force to develop a bridge program to provide affordable health insurance coverage and improve coverage for people who regularly enroll and disenroll.

The bill was approved by the House Committee on Health Care with a do pass recommendation on Feb. 14 and referred to Rules. It cleared on a 9 – 1 vote, with Rep. Raquel Moore-Green casting the sole vote against it.

Clipped from: https://stateofreform.com/news/oregon/2022/02/oregon-lawmakers-consider-bill-to-head-off-medicaid-disenrollments/

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Next big health crisis: 15M people could lose Medicaid when pandemic ends

MM Curator summary

[MM Curator Summary]: The general press oversimplifies post-PHE enrollment issues.

 
 

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.

 
 

State audits could lead to as many as 15 million people, including 6 million children, losing their health insurance, according to one analysis.

 
 

The Biden administration recently extended the public health emergency another three months, through April 15, but the White House is likely to allow it to expire once Covid-19 cases wane and vaccinations increase.

Congress could help, they say, if it decouples the requirement to keep people on state Medicaid rolls from the public health emergency and sets a date for when the pandemic-era policy will end. State officials are also asking federal lawmakers for more money and eyeing additional requirements for the unwinding effort, which some say could safeguard against pressures from state lawmakers to expedite the process in order to save money and remove people from welfare rolls as soon as possible.

People typically lose Medicaid coverage because their income increases above the eligibility threshold, or they fail to submit the proper paperwork to prove they qualify. But when the pandemic began, Congress, in exchange for additional federal funding, barred states from kicking people off Medicaid. Enrollment surged nearly 20 percent over the next 16 months to 76.7 million, according to the Centers for Medicare and Medicaid Services, an all-time high.

Now, states fear that unwinding the expanded social safety net could prove messy — as many of the millions removed from the rolls may not know they’ve lost their health insurance or which options are available for new coverage. It’s a problem not just for states but for the Biden administration, which might be forced to grapple with rising uninsured rates in an election year.

“Most of us go to sleep at night thinking about this and what we can do the next day around this,” said Daniel Tsai, director of the Center for Medicaid and CHIP Services, describing the level of engagement across HHS and CMS on this issue as “unprecedented.”

“We are pulling out all the stops,” Tsai said.

Utah, which undertook a similar effort last year for its Children’s Health Insurance Program, offers a preview of what the rest of the country could experience. More than 41 percent of the 15,000 kids enrolled in Utah’s program lost their health insurance during the redetermination process — despite the state’s efforts to reach out to people, update addresses and send out notifications in advance.

“So maybe, just maybe, we are a canary in the coal mine, or maybe, just maybe, we are a cautionary tale for some other states on what needs to happen,” Nelson told the Medicaid and CHIP Payment and Access Commission last week.

State health officials say a firm date would allow them to hire and train additional staff amid an ongoing workforce shortage, build out call center capacity to limit wait times and conduct outreach campaigns with local community organizations to ensure enrollees know they need to provide certain information to the state to keep their coverage.

“That’s really one of the big risks, that people will be eligible but become unenrolled just because they don’t get the message and don’t know how to continue their coverage and are just out of the habit, quite honestly, of doing renewals and redeterminations after almost two years,” said Suzanne Bierman, administrator of Nevada’s Medicaid program.

Start the process too early, and states worry they’ll be paying for resources they don’t yet need and wasting what might be the one shot they have to communicate with a vulnerable population. Start too late, and states might not have the infrastructure in place to help hundreds of thousands of residents re-enroll in Medicaid or transition to coverage on state health insurance exchanges.

While states are accustomed to some level of uncertainty from the federal government, Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation, said this is a unique situation.

“Just not knowing how much longer this will be in place is creating significant challenges,” Tolbert said. “The pressures are heightened and the uncertainty is even greater.”

Without a firm date, state health officials say they are doing what they can, including asking enrollees to update their contact information — like addresses, phone numbers and emails — so the state will be able to find them once the actual redetermination process starts.

In Pennsylvania, state Medicaid and exchange officials are shoring up the data transfer process to make it easier for people to sign up for an Obamacare plan if they lose their Medicaid coverage.

In Massachusetts, the state invested $5 million in a community-based Medicaid redetermination and vaccination outreach campaign to communities hit hardest by the pandemic.

And in New York, Gov. Kathy Hochul’s budget included an additional $69 million to the state health department’s budget, some of which the agency says will be used to facilitate the unwinding of the public health emergency.

“We have a big job ahead of us. We know that already,” New York Health Commissioner Mary Bassett told reporters last week. “Our goal is to make it orderly and keep people insured.”

State health officials credited the Biden administration with offering some help, pointing to assurances early last year that the public health emergency would run at least through the end of 2021, and that states would have 60 days’ notice before it ended. CMS also released guidance last summer that answered some of states’ most pressing questions and a best practices list in November as states prepare for the end of the continuous enrollment requirement. There are also calls at least twice a month between state and federal officials.

“We are highly cognizant that states kind of need to know an end date to get things moving,” Tsai said. “Our message has been, ‘We should just plan for that coming as soon as possible.’ Not to say it will be … but the answer is, ‘Do not sit and wait.'”

Jennifer Wagner, director of Medicaid eligibility and enrollment for the Center on Budget and Policy Priorities, a left-leaning think tank, worries that some states may welcome the chance to purge their welfare rolls and do little to help people prove their eligibility or find new coverage.

“What we have seen historically is that so many eligible people get caught up in the chaos of this, of states not doing good ex parte [renewals], of not updating addresses, not leveraging SNAP information for addresses or income or other things, relying on paper-based mail instead of any effort to phone calls or text messages or other things,” she said.

Medicaid experts point to Ohio — where the state has contracted with an outside vendor that will automate eligibility redeterminations in exchange for a cut of state Medicaid savings and plans to process redeterminations in 90 days — as a particularly concerning case. The Ohio Department of Medicaid declined to comment.

Medicaid advocates are also concerned that states may have a financial incentive to clear their rolls as quickly as possible. The additional federal matching funds that Congress provided to help pay for the swelling Medicaid rolls will be cut at the end of the quarter in which the public health emergency ends, giving states a reason to rush through the process instead of taking the full 12 months the Biden administration has said it will allow.

Democrats proposed extending those additional federal payments as part of their social spending package, but the effort is stalled in Congress.

Medicaid advocates caution that the faster states rush through the process, the greater the chance eligible individuals could lose coverage for not filling out the right paperwork. Kicking people off state Medicaid rolls who are eligible stands to not only disrupt patient care — meaning less management of underlying conditions at doctor’s offices and more utilization of higher-cost care in hospitals — but also could cost states down the road in staff time to reprocess those individuals if and when they reapply for Medicaid.

It’s also likely to have a disproportionate impact on low-income communities of color, given that more than half of Medicaid recipients identify as Black, Hispanic, Asian American, or another non-white race or ethnicity, according to MACPAC.

Tricia Brooks, a research professor at the Georgetown University McCourt School of Public Policy, warned that states trying to complete redeterminations over a short time period could see call centers quickly overwhelmed — reminiscent of the strain state unemployment systems came under at the beginning of the pandemic.

“When you have an hour wait time at a call center, you can’t expect the consumers are getting the information that they need and you need to be able to hit the pause button,” Brooks said. “I worry that we’re not going to be able to hit the pause button before too much damage is done.”
 

Clipped from: https://www.politico.com/news/2022/02/02/medicaid-states-pandemic-loss-00004153

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Texas cut Medicaid staffing during the pandemic. Millions are now at risk of being dropped from the program.

MM Curator summary

[MM Curator Summary]: Many in the state are concerned that staffing levels needed to process benefits programs applications are not sufficient to deal with the PHE wind down.

 
 

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.

 
 

 
 

More than 1 million Texans were added to Medicaid coverage during the pandemic, many of them children, thanks to emergency federal funding that deters states from dropping recipients during the health crisis.

But those gains could soon be erased, according to patient advocates, who worry that state health officials are not prepared for the influx of new and returning Medicaid applications that could pour in as early as this spring, when the Biden administration is scheduled to lift the emergency declaration.

The state health agency has already shown signs it may not be ready, falling behind last summer in processing food assistance sign-ups, which uses the same employees as Medicaid. That backlog followed a round of staffing cuts the agency was ordered to make in 2020 as part of an early pandemic response by Republican state leaders.

“We had said this will be an issue, and it’s now coming to a full head,” said Melissa McChesney, a health policy adviser at UnidosUS, a Latino advocacy group.

 

From January to October, the state’s timeliness rate for processing food assistance applications fell from over 90 percent to 66 percent, even though the total number of people signing up remained nearly the same. That means a third of all people seeking help were unable to get it within 30 days.

 
 

“It’s not that they weren’t eligible, it’s that the case was never even determined if they were eligible,” said Rachel Cooper, a senior policy analyst at the left-leaning think tank Every Texan.

 
 

Now add to the uncertainty millions of Medicaid recipients who will need to be quickly cleared to gain or continue their medical coverage.

The agency cut the equivalent of just over 700 eligibility jobs last fiscal year, much of it through a hiring freeze; as of the fall, it was down by what would amount to about a thousand positions from the end of 2019 — a 15-percent cut for an agency that had roughly 7,000 eligibility workers in 2019.

 
 

A spokesperson said the Health and Human Services Commission is working with health plans and other contractors to prepare for the renewals and will automate the process as much as possible, cross-checking details on recipients with available wage and Social Security data. The agency is urging Medicaid recipients to update their contact information by going to YourTexasBenefits.com.

 
 

Missed deadlines, coverage gaps

 
 

Since the pandemic began, Medicaid enrollment in Texas has grown by more than 1.2 million people, to just over 5 million total recipients as of October. That includes nearly 1 million children and more than 200,000 low-income women who are pregnant or gave birth during the health emergency.

 
 

The growth has been a blessing for many families whose children have been frequently bumped from the program because of missed deadlines or other procedural errors, only to later reapply and be accepted back into Medicaid. That ricochet can leave eligible children without coverage for months at a time.

 
 

The state Legislature recently reduced the number of spot checks to twice annually, down from four times. Critics say the automated process can be rife with old data and misrepresent a family’s actual income. Once a family is flagged as no longer eligible for Medicaid, it has only less than two weeks to respond from when the state mails a request for documentation.

 
 

In 2019, 40 percent of children who were bumped from the program re-enrolled within six months, suggesting they had been wrongly dropped.

 

Texas is also one of a dozen states that has refused to expand Medicaid to adults who make too little to qualify for subsidized insurance through the Affordable Care Act. Republican leaders have publicly avoided the issue in recent years, but previously argued that Medicaid was inefficient and pointed to other problems like the high costs of certain medical care.

“Having reliable access to care is sometimes more than just having a clinic available to you,” said Andrea Caracostis, a doctor who heads a federally qualified health clinic in Houston. “It has to do with your ability to pay for it, and if they have assistive Medicaid, that’s one less thing they have to worry about.”

For new mothers who may end up losing Medicaid coverage, there are other programs they can move into that provide some access to basic services like health screenings and contraceptives, and potentially private insurance if they can afford it. But it will fall largely on local health providers to help them navigate what can be a confusing maze of applications.

 
 

The bigger concern, advocates say, is thousands of eligible children suddenly losing coverage because of an overwhelmed system. That’s what happened in Utah in mid-2020 when the state restarted renewals of its Children’s Health Insurance Program. More than 6,000 children, or 41 percent of all recipients in the program, lost their coverage and had to reapply, according to news reports.

 
 

Missouri saw a smaller but still significant drop in 2018 and 2019 when it restarted renewals with an overhauled eligibility system.

 
 

“I can only imagine it’s going to take a hit on us as well,” Caracostis said. “All the revenue we were counting on for X amount of Medicaid patients we may not have later on.”

 
 

Last week the Biden administration extended the health emergency for three more months amid the latest COVID wave. If it is the last extension, states could begin processing renewals as early as May 1.

 
 

https://www.houstonchronicle.com/politics/texas/article/Texas-cut-Medicaid-staffing-during-the-pandemic-16803350.php

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NY/ Expansion- ‘Medicaid for All’ is rapidly becoming a reality in New York

MM Curator summary

[ MM Curator Summary]: Half the people in NY are on Medicaid now.

 
 

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.

 
 

 
 

Gotham enrolls an even higher share of its residents in Medicaid: more than 4 million people, or nearly half of the city’s 8.8 million people. Shutterstock

In New York, it looks like the Democrats’ dream of “Medicare for All” is rapidly becoming a reality. Or at least “Medicaid for All.”

Since COVID struck, enrollment in the government-funded health-insurance program has shot up by 1.5 million people, as The Post reported this week. And the numbers were soaring even before that: By January 2020, 6.1 million of the state’s 19.8 million residents were enrolled; now, health officials estimate 7.6 million people will be getting benefits by March. That’s nearly 40 percent of the state’s population.

Add in other state health programs, from Child Health Plus to the Essential Plan, and it comes to 8.4 million New Yorkers, or 42 percent of the population, getting aid, the Empire Center reports.

And this is supposed to be a backstop program for just the poorest New Yorkers.

Gotham enrolls an even higher share of its residents in Medicaid: more than 4 million people, or nearly half of the city’s 8.8 million people.

New York has long been a national leader, both in terms of the number of enrollees and how much it spends on them — around $75 billion last year, including federal, state and local funds. And as the Empire Center also notes, more New Yorkers above the poverty line qualify for Medicaid than those under it. Even as New York’s poverty rate declined, its Medicaid rolls grew by 1.4 million from 2010 to 2019.

Clearly, the state needs to better screen applicants. But it also needs to rethink how this program “for the poor” works. Because soon, the state won’t be able to afford anything else but this.

 
 

Clipped from: https://nypost.com/2021/12/27/medicaid-for-all-is-rapidly-becoming-a-reality-in-new-york/

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Backlog of Medicaid applications spurs Arkansas lawmakers to concur with hiring contract help for $29M

 
 

MM Curator summary

[ MM Curator Summary]: Maximus will get $29M to help Arkansas with its current eligibility processing backlog.

 
 

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.

 
 

Arkansas lawmakers endorsed a $29 million contract Tuesday that aims to address the state’s backlog of Medicaid applications.

M

  • Morning

About 50,000 Medicaid eligibility applications were backlogged as of mid-November, according to state Department of Human Services spokeswoman Amy Webb. Webb said that number is not unprecedented, but the main causes of the backlog are the coronavirus pandemic, which has resulted in worker quarantines and temporary office closures because of positive cases, and staff turnover that has led to vacancies the department is having difficulty filling.

“We are short-staffed as most public [and] private employers are right now, and we’ve got a backlog of applications to process,” Mark White, chief of staff for the Department of Human Services, told the Review Subcommittee of the Arkansas Legislative Council.


White said the backlog is primarily affecting long-term care facilities, which means nursing homes and assisted living facilities have to operate without payment.

“The issues that most affect the beneficiaries have been our long-term care, where we have seen applications taking a little longer to process,” he said after the meeting. “We know that’s a strain on nursing homes, so we’re working to address that.”

The Department of Human Services plans to hire the Reston, Va.,-based company Maximus Human Services Inc. to help with processing Medicaid applications as well as changes related to Medicaid eligibility, White said.

The company will bring in staff to help the department work through the backlog as well as “provide some ongoing surge capacity” by allowing the state to access the company’s capacity to augment its own staff to deal with an influx of patients, he added.

Maximus will recruit, hire and train contracted eligibility specialists, according to information about the contract provided to the committee. The Department of Human Services inked a larger contract with Maximus for staffing several years ago, Webb said.

When the contract goes before the Arkansas Legislative Council for approval on Friday, the department will present its full plan, at the request of Rep. Jeff Wardlaw, R-Hermitage, White said.

Wardlaw, along with fellow Legislative Council co-chairman Sen. Terry Rice, R-Waldron, said in interviews Tuesday they are concerned about the impact of the delayed payments on rural nursing homes.

Wardlaw said his area lost two assisted living facilities two years ago as a result of Medicaid reimbursement issues and that other legislators from rural areas share those concerns.

“Every time we lose one of these facilities, we can’t get them back,” he said.

Rice said the backlog issue has been going on for some time and, at one point, reimbursements were taking four to five months when they should take 45 days or less. It’s something he has been discussing with the Department of Human Services officials for a number of months, he said.

He added that nursing homes have already been struggling financially as a result of the pandemic and that some have taken out personal loans to stay afloat.

“There’s been some strain on that industry anyway,” he said. “DHS needs to get these people placed and get those back payments.”

Rice said the pandemic and staffing shortages are legitimate excuses, but said he expects the government to hold itself accountable like a private business would.

“When you’re talking about some of these homes going out of business, they will not be back, and I keep preaching that to them,” he said.

Webb said in an email that the contract, in addition to addressing the backlog, allows the department to “staff up and provide support” as it prepares to deal with the end of the public health emergency.

The federal government’s public health emergency declaration is set to expire at the end of March, but it could be extended.

Under that declaration, there are limited circumstances by which the Department of Human Services can remove someone from the Medicaid programs, such as death, Webb said, so there will be lot of casework and eligibility re-determinations once the public health emergency ends.

“Obviously, we don’t have to do it overnight or all at once. We would have six months to redetermine eligibility once it ends,” she said.

The Department of Human Services also recently launched a new eligibility system, which it piloted in a few counties in December 2020 and launched statewide in April 2021. Webb said the system is working well, and the department launched a pilot to include Supplemental Nutrition Assistance Program, or food stamps, cases in some counties in the new system.

There were 330,421 people enrolled in Arkansas Works, the state’s Medicaid expansion, as of November 2021. More than 1 million adults and children were enrolled in Medicaid programs overall. At the beginning of March 2020, prior to the onset of the coronavirus pandemic, Arkansas Works enrollment was 250,233 and overall enrollment was just over 903,000.

Clipped from: https://www.arkansasonline.com/news/2021/dec/15/backlog-of-medicaid-applications-spurs-arkansas/

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Delaware- State auditor presses for Medicaid information

 
 

 
 

MM Curator summary

 
 

The state auditor is being refused data needed to confirm the state has followed Medicaid eligibility determination laws.

 
 

 
 

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.

 
 

 
 

State Auditor Kathy McGuiness is seeking Medicaid information for a performance audit after the Department of Health and Social Services went to court to quash her request. FILE PHOTO

State Auditor Kathy McGuiness took on the Department of Health and Human Services Nov. 2 in her months-long attempt to audit Delaware’s Medicaid program.

“We have been doing performance audits for decades,” McGuiness said during a hearing in Superior Court in opposition to DHSS’s attempt to avoid a Medicaid audit. “By limiting information, it hinders the auditor’s ability to do the job.”

In May, McGuiness began seeking information from DHSS to determine the eligibility of people who are receiving Medicaid. DHSS has pushed back, saying the auditor has no right to personal identifiable information, and it went to court to quash the auditor’s request.

McGuiness appealed the motion to quash, and both sides were heard by Superior Court Judge Jan Jurden.

Deputy Attorney General Annie Cordo said McGuiness is seeking to do an audit that is beyond the realm of her duties, even though McGuiness said previous auditors have conducted performance audits.

“Just because something happened once and one state administrator permitted it to happen does not necessarily mean it falls legally within the authority of what the auditor is permitted to do,” Cordo said. “We need to look at what is in the Delaware Code, which is a post audit of financial transactions, not a performance audit of how the program is in fact run, looking for efficiencies and weaknesses.”

McGuiness said her office is not seeking the entire Medicaid database, but income information would be needed to determine the eligibility of Medicaid recipients.

In a June 30 audit conducted by independent auditor CliftonLarsonAllen, the audit found DHSS’s Medicaid program did not consistently follow procedures to determine and monitor provider eligibility. The audit also found the program is unable to support provider eligibility, which may result in un-allowed costs.

Jurden will decide whether the state auditor can proceed with a performance audit with access to Medicaid information.

 
 

Clipped from: https://www.capegazette.com/article/state-auditor-presses-medicaid-information/229980

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Florida prepares for Medicaid disenrollment as end of PHE remains unclear

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Florida is in the planning phases of dealing with the more than 1M members who joined its rolls as part of the pandemic.

 
 

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.

 
 

 
 

Nicole Pasia | Nov 2, 2021 | Florida

Over one million Floridians have enrolled in Medicaid over the course of the pandemic. However, this large influx of beneficiaries may shift as the federal public health emergency (PHE) declaration — and the accompanying Medicaid disenrollment freeze — could end as early as mid to late January 2022.

 
 

The latest enrollment numbers from the Agency for Health Care Administration (AHCA) show an overall increase of 32.3% across the state since March 20, 2020. The only program with a significant drop in enrollment is the Florida Healthy Kids program. Audrey Brown, president and CEO of the Florida Association of Health Plans (FAHP), said that the drop reflected a transfer of those beneficiaries to Medicaid.

 
 


Image: Agency for Health Care Administration

 
 

Floridians under Medicaid are currently protected from being disenrolled due to the Families First Coronavirus Response Act. However, once the PHE ends, the Department of Children and Families (DCF) will need to redetermine each member’s eligibility. Conditions that lead to ineligibility for Medicaid include turning 65 and needing to transfer to Medicare, pregnant people reaching the end of the postpartum coverage period, and changes in circumstances, such as increased income.

The Centers for Medicare and Medicaid Services (CMS) have released guidance for states as they begin the redetermination process, but have not announced exactly when the PHE will end. The most recent PHE renewal will expire on Jan. 16, 2022.

Brown said that state Medicaid agencies will receive a 60-day notice prior to the end of the PHE declaration. Until then, the best they can do is coordinate with other state agencies to prepare for the redetermination process.

“I think the agency, with our health plans as partners, have been as transparent as they can possibly be. But obviously, the unknown is when that state of emergency at the federal level will be ending. And so for all of our purposes, we just continue the dialogue. We talk regularly with AHCA and the DCF to find out from them if they’ve heard anything new, and I know that the agencies are prepared to reach [the determinations] as quickly as possible.” 

Once the agencies inform the health plans of a member’s change in eligibility, the plans (FAHP has 18 member health plans across the state) will notify them in advance of the end of their services, as well as other options for health coverage. Florida is one of 14 states that has not yet expanded Medicaid since it became available in 2014. Because of this, people may go on the state exchange to look for coverage from private plans. 

Brown says that the exchange is still an affordable option for Floridians.

“We have a very competitive, large group of health plans that participate on the exchange, [which is] heavily federally-subsidized. Even though people may not be qualified for Medicaid because of their financial eligibility, there are a lot of people that will pick an exchange policy and will even be up to 100% federally subsidized.”

Florida led the nation with the highest number of newly enrolled members in the state marketplace during the summer Special Enrollment Period (SEP). A CMS report stated over 487,000 Floridians participated in the SEP.

The 2022 open enrollment for the federal health insurance marketplace kicked off Nov. 1, and will continue until Jan. 15, 2022, the day before the PHE declaration expires. Participants who sign up by Dec. 15, 2021 will have coverage take effect on Jan. 1, 2022. 

 
 

Clipped from: https://stateofreform.com/news/florida/2021/11/florida-prepares-for-medicaid-disenrollment-as-end-of-phe-remains-unclear/