Tag: Finance

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Georgia in line to recover $500 million in Medicaid overpayments

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GA is completing its effort to recover managed care funds not spent during 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.

 
 

 
 

Georgia is in line to recover $500 million from state Medicaid insurers for overpayments in 2020 and 2021, according to an insurance industry official who represents the companies.

Special Photo: Georgia Health News

ATLANTA — Georgia is in line to recover $500 million from state Medicaid insurers for overpayments in 2020 and 2021, according to an insurance industry official who represents the companies.

The half-billion-dollar payout will come from two separate Medicaid recoveries, Jesse Weathington, the executive director of the Georgia Quality Healthcare Association, said. Due to the federal role in financing Medicaid, much of the returned money would likely go to the U.S. government.

The insurers were told the reduction was due to many Medicaid patients skipping medical care during the COVID-19 pandemic, along with other adjustments, Weathington said.

“It was surprising in terms of timing and the amount,” Weathington said. He added that the three Medicaid insurers were not given detailed breakdowns of how the state actuary arrived at the numbers.

The Georgia Medicaid insurers – Peach State, Amerigroup and CareSource – are paid a per-member, per-month rate to care for Medicaid members. These insurers continued to receive those payments from Medicaid while there was a drop-off in patient visits.

The repayments are known as clawbacks: When an organization believes it has overpaid for services, it takes steps to get the money back.

“Clawbacks mean people did not get health care,” Laura Colbert, executive director of Georgians for a Healthy Future, a consumer advocacy group, said. “Essentially, people may have missed services they needed last year. That’s no fault of the [Medicaid insurers] because we saw that happen across the board, regardless of the type of insurance. The state still has a right to address that based on their contract.”

The Department of Community Health, which runs Medicaid in the state, did not respond to GHN’s requests for comment.

The $202 million retrospective rate adjustment for 2020 is now awaiting approval from the federal Centers for Medicare & Medicaid Services, Weathington said. Another $300 million mid-year adjustment for 2021 is currently under negotiation, he added.

Medicaid, jointly financed by the federal government and individual state governments, covers low-income and disabled residents. Georgia pays the Medicaid insurers more than $4 billion each year to provide care to low-income children and other vulnerable populations. The state covers about one-third of those costs, with the feds funding the rest.

It’s unclear how much of the recovered funds will go to the feds and how much to Georgia’s coffers. But if it’s split by the normal funding formula, the state would gain more than $165 million.

The projected $500 million recovery comes after Medicaid insurers posted big profits during 2020, according to the Center for Children and Families at Georgetown University.

Before the pandemic, many states had measures in place to limit the profits that state Medicaid insurers could make on their contracts and ensure taxpayer dollars went to patient care. Georgia was not one of those states, according to the Center on Budget and Policy Priorities.

Other states have adopted or bolstered measures to recover taxpayer dollars that went to Medicaid programs while patients stayed home during the pandemic. There are different ways states can do this.

For example, Virginia directed state Medicaid insurers to increase payments to medical providers.

 
 

Two of the Georgia insurers – Peach State and Amerigroup – are owned by publicly traded, for-profit corporations, Centene and Anthem, respectively. Centene last year acquired WellCare, another Medicaid insurer, and closed down its WellCare Medicaid operations in May.

A third Medicaid insurer, CareSource, is a nonprofit company based in Ohio.

Clipped from: https://www.news-daily.com/news/georgia-in-line-to-recover-500-million-in-medicaid-overpayments/article_a660e200-f871-5353-8685-507aebfef43b.html

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Massachusetts Scores 10% Medicaid Rate Hike Through American Rescue Plan Act Funding

 
 

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DME providers will be getting some of the 10% ARP money that MA has requested from CMS.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

BOSTON (July 22, 2021)—The MassHealth Medicaid program is implementing a 10% rate increase for durable medical equipment (DME) claims with dates of service effective July 1, 2021. The broad-based relief applies a 10% increase for all DME and augmentative and alternative communications codes and a 50% increase for labor code K0739, which covers repair or nonroutine service for DME other than oxygen equipment requiring a skilled technician.

“This is a big win when we needed it most,” said Jason Morin, president and CEO of the Home Medical Equipment and Services Association of New England (HOMES). “Between the pandemic impacts and the recent respiratory recall, providers are reeling and struggling to find ways to continue to absorb these rising costs. This action provides much-needed direct relief to the providers of Massachusetts and also shows us that the state’s Medicaid leadership is listening.”

In June, HOMES requested that DME suppliers receive a share of the health care focused relief funds granted to Massachusetts through the American Rescue Plan Act. This request, coupled with HOMES’ long-term efforts to build strong relationships with MassHealth leaders and other healthcare officials, gives suppliers serving Medicaid beneficiaries in the state a better footing to deal with higher product and operational costs related to the pandemic.

“It took a long time to develop, but we currently have an excellent relationship with the state Medicaid program. As a result, they have not only come to understand the value that our industry brings to their beneficiaries but also became provider advocates on a number of issues,” added Morin. “I also can’t overstate how instrumental Laura Williard, David Chandler, and the AAHomecare team have been in helping us to develop materials and resources and provide a national perspective in many of our meetings.”

AAHomecare has worked closely with state and regional association leaders to develop sample letters to request that DME suppliers receive a share of the $195 billion allocated to states to mitigate the fiscal effects of the COVID-19 pandemic on health care providers as well as a temporary 10% increase in federal matching funds for home and community-based services (HCBS). We will share more details on these efforts in an upcoming edition of Payer Relations in Focus.

“DME suppliers deserve a share of this support, and we’re committed to helping state leaders make the strongest possible case for being included in state-directed relief,” said Laura Williard, AAHomecare vice president of payer relations. “Now that the first state has explicitly approved our industry to share in this relief, we have an opportunity to let Medicaid officials in other states know about the precedent Massachusetts has set.”

Read the Massachusetts HHS announcement here.

Clipped from: https://www.homecaremag.com/news/massachusetts-scores-10-medicaid-rate-hike-through-american-rescue-plan-act-funding

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$3 million Medicaid reimbursement bump a ‘lifesaver’ for some assisted living providers

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NJ long term care providers will get a temporary 25% rate increase to help with increased costs during COVID.

 
 

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.

 
 

Gov. Phil Murphy

A temporary 25% Medicaid reimbursement rate bump is being called a “lifesaver” for some assisted living providers, according to New Jersey senior living associations.

“We are very thankful the legislature has recognized that our assisted living buildings have had additional expenses,” Kathy Fiery, Health Care Association of New Jersey vice president of assisted living, told McKnight’s Senior Living. “For our Medicaid buildings, this was a difficult year. This is, at least, an acknowledgement that high-occupancy Medicaid buildings are deserving of some additional dollars.”

Garden State Gov. Phil Murphy signed legislation that makes a fiscal year 2021 supplemental appropriation of $3 million to the Department of Human Services for a temporary 25% increase to assisted living residences and facilities, as well as comprehensive personal care homes, that participate in the Medicaid program. Communities can use the dollars to help increase wages or supplemental pay for certified nurse aides providing direct care, as well as for COVID-19 preparedness and response. 

HCANJ Vice President John Indyk said that assisted living communities had a $3-above-minimum-wage increase go into effect this year, along with other COVID-19-related expenses. The wage increase, he added, was particularly difficult for buildings with high Medicaid populations. Although nursing homes were reimbursed for the increased wage expense, assisted living providers did not receive any financial assistance, Indyk said.

“I think for high Medicaid occupancy facilities in urban areas, they were struggling to pay $3 above the minimum wage. This is much needed relief for them,” he said, adding that additional legislation is being developed to continue the funding into the future.

HCANJ is thankful for the additional funding, Fiery said, adding that except for a few weeks worth of funding for COVID-19 testing, assisted living providers have not received any other financial relief.

LeadingAge New Jersey and Delaware also supported passage of the legislation.

“Many mission-driven assisted living providers who make it a point to serve Medicaid and low-income populations do so at a per-client revenue loss, which is not sustainable,” LeadingAge NJ & DE Vice President Meagan Glaser told McKnight’s Senior Living. “As a result of this new legislation, assisted living residences will now be able to expand, rather than limit, their Medicaid client base.”

Glaser said that assisted living program providers will be able to continue providing services within subsidized senior housing buildings, where residents primarily have low incomes and are Medicaid-eligible. Without this reimbursement increase, she said, many assisted living providers were at risk of closing, which would have forced residents to move into higher-cost nursing homes.

“With the recent closures of several non-profit long-term care facilities, it’s more critical than ever that New Jersey look for ways to ensure the stability and sustainability of mission-driven long-term care providers,” she said. 

 
 

Clipped from: https://www.mcknightsseniorliving.com/home/news/3-million-medicaid-reimbursement-bump-a-lifesaver-for-some-assisted-living-providers/

 
 

 
 

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Libertarian group sues government over information on $143 billion in improper Medicaid payments

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CMS has been sued for not providing information about what its doing to reduce improper payments in accordance with FOIA timelines.

 
 

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 libertarian organization Americans for Prosperity Foundation is suing the Centers for Medicare and Medicaid Services to find out what it is doing about $143 billion in improper payments made by Medicaid.

The complaint asks for records on CMS’s efforts to recover improper Medicaid payments and for data showing improper payment rates by states. According to CMS, improper Medicaid payments totaled $143 billion in 2019 and 2020, rising from 14.9% of all payments in 2019 to 21.4% in 2020. Medicaid is a joint federal-state healthcare program for the poor.

“Failing to recover $143 billion in improper Medicaid payments is an affront to hardworking American taxpayers and a threat to Medicaid’s long-term fiscal stability,” said Dean Clancy, a senior health fellow at Americans for Prosperity Foundation. “More transparency and accountability is needed to ensure that CMS manages Medicaid responsibly.”

The $143 billion in improper payments is about 11% of the roughly $1.3 trillion spent by Medicaid from 2019 to 2020. By contrast, Medicare, the federal healthcare program for seniors and the disabled, had about $55 billion in improper payments in 2019 and 2020. Additionally, Medicare’s improper payments declined from almost $29 billion in 2019 to just under $26 billion in 2020.

Federal law requires CMS to recover any improper payments over the amount of 3%.

SENATE DEMOCRATS PLAN END RUN AROUND STATE THAT HAVEN’T EXPANDED MEDICAID UNDER OBAMACARE

Americans for Prosperity Foundation requested CMS supply the information on improper payments under a Freedom of Information Act request it filed on May 5, 2021. Under federal law, an agency has 20 days to respond to a FOIA request or 30 days under unusual circumstances. When CMS did not comply, Americans for Prosperity Foundation filed suit in federal court.

An improper payment occurs when a recipient receives an incorrect amount of funds or uses the funds in an improper way or when the recipient is ineligible to receive the funds in the first place. Medicaid enrollees cannot receive benefits when they earn more income than is allowed under the program or when they fail to meet residency requirements. The Americans for Prosperity Foundation complaint notes that state governments often do not ensure compliance with federal Medicaid requirements.

CMS did not immediately respond to a request for comment.

CLICK HERE TO READ MORE FROM THE WASHINGTON EXAMINER

Democrats in Congress are trying to expand Medicaid. Georgia Sens. Raphael Warnock and Jon Ossoff and Wisconsin Sen. Tammy Baldwin are trying to establish a Medicaid-like coverage plan run by the federal government. It would cover people who live in the 12 states that have not yet expanded Medicaid under Obamacare. The federal government would fully fund the plan. States would not have to provide matching funds.

 
 

Clipped from: https://www.washingtonexaminer.com/news/group-files-suit-over-medicaid-improper-payments

 
 

 
 

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Florida asks for more time on potential Medicaid boost

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Florida is interested in the extra HCBS money, but needs more time to consider the implications.

 
 

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.

 
 

 
 

TALLAHASSEE, Fla. – Gov. Ron DeSantis’ administration is asking the federal government for additional time “to consider the potential impacts” of drawing down hundreds of millions of dollars in additional federal Medicaid money for home- and community-based services.

In an email to the federal Centers for Medicare & Medicaid Services, Karen Williams of the state Medicaid office said Florida wants a 30-day extension, which would give the state until July 12 to submit a plan to the federal government.

“Please consider this email as the state of Florida’s formal request for the 30-day extension. This additional time will allow the state of Florida to continue coordinating with all impacted stakeholders to consider the potential impacts of this increase,” Williams wrote in the email late Friday afternoon.

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The American Rescue Plan Act, a stimulus package signed in March by President Joe Biden, included provisions that allow states to tap into additional federal Medicaid funding for a number of different groups and services, some of which Florida has taken advantage of, and others not.

For instance, the federal law provided incentives for 12 states, including Florida, to expand Medicaid to low-income childless adults. The law, at least in part, offers states a 5 percentage- point increase in their regular federal Medicaid matching rates for two years after expansion would take effect. But as they have done for years, Florida Republican leaders shunned the idea of expanding Medicaid during this spring’s legislative session.

The American Rescue Plan Act also allows states to tap into additional funds to extend by 10 months the length of time that postpartum women can qualify for Medicaid. Florida is taking advantage of that provision, with House Speaker Rep. Chris Sprowls, R-Palm Harbor, leading the charge.

The federal law also provided states with an opportunity to draw down a 10 percentage-point increase in federal Medicaid funds for home- and community-based services, such as services provided in Florida’s “iBudget” program for people with developmental and intellectual disabilities.

Tom Rice, a program manager with the state Agency for Persons with Disabilities, told members of the Florida Developmental Disabilities Council last month that the state was putting together plans to access the enhanced Medicaid funding. But advocates for people with disabilities grew worried that the state wouldn’t submit a plan to the federal government — or request an extension — by a Sunday deadline.

With the request for an extension filed Friday, Jim DeBeaugrine, a lobbyist and former director of the Agency for Persons with Disabilities, said he remains hopeful that Florida can tap into the additional federal money.

DeBeaugrine, also a former staff member of the House Appropriations Committee, estimated that Florida could tap into an additional $450 million in Medicaid funds for services provided through the iBudget program.

“I am cautiously optimistic that we can work with AHCA (the state Agency for Health Care Administration) and APD and hopefully come up with a good plan to use the dollars, at least associated with our population,” DeBeaugrine said.

While the 10 percentage-point increase has been a focus of providers that care for people with developmental and intellectual disabilities, the increased funding would be available for all home- and community-based services.

According to guidance issued by the Centers for Medicare & Medicaid Services, states could use the increased funds for a number of other services such as medical or remedial services recommended by physicians, including mental health and substance-use disorder services; private duty nursing services; and programs for all-inclusive care for the elderly, what is known as PACE.

“This is potentially a lot bigger than the population I am concerned with,” said DeBeaugrine, referring to people with disabilities.

Clipped from: https://www.clickorlando.com/news/2021/06/15/florida-asks-for-more-time-on-potential-medicaid-boost/

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Parson says budget cuts are coming next month if deal on Medicaid tax renewal is not reached

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The Governor notifies the legislature that there will be program cuts if the provider-tax funding device is not able to be passed.

 
 

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.

 
 

By Jeanne Kuang | The Kansas City Star (TNS)

JEFFERSON CITY — Medicaid budget cuts are coming next month unless lawmakers strike a deal to renew a critical medical provider tax that underwrites a major portion of the state’s health coverage program for low-income residents, Missouri Gov. Mike Parson warns.

Lawmakers did not renew the tax, which expires Sept. 30, before they ended their session May 14. At issue was a fight led by Republican Sens. Paul Wieland, of Imperial, and Bob Onder, of Lake St. Louis, to insert language banning Medicaid coverage of certain birth control methods.

The tax collected from hospitals, nursing homes and pharmacies generates roughly $1.6 billion a year. That allows the state to bring in $3 billion in federal funds that is returned to the facilities for treating low-income elderly and disabled residents enrolled in the state’s $12 billion Medicaid program.

“The clock’s ticking on us,” Parson told reporters Monday. “If there’s not some sort of agreement where we have a solution, and it doesn’t happen before July 1, there’s not going to be choices. We’re going to have to start withholding [from the budget] July 1.”

 
 

Gov. Mike Parson signs prescription drug monitoring program bill on Monday, June 8, 2021. (Handout photo/governor’s office)

The $35 billion state budget sitting on Parson’s desk for the fiscal year that starts July 1 includes increased funding for homes for the developmentally disabled, higher Medicaid payments to nursing homes and expanded mental health services.

 
 

Clipped from: https://www.stltoday.com/news/local/govt-and-politics/parson-says-budget-cuts-are-coming-next-month-if-deal-on-medicaid-tax-renewal-is/article_9dbd8dc2-0cda-557c-8953-57dc73fd4319.html

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Guam officials eye Medicaid cliff

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Guam’s FMAP will go from 89% to 55% for FY 2022.

 
 

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.

 
 

 
 

HAGÅTÑA (The Guam Daily Post) — Local health officials are keeping a keen eye on the expiration of expanded Medicaid assistance as they map out their budgetary needs for the next fiscal year.

The federal government covers a certain share of Medicaid expenses based on the Federal Medical Assistance Percentage for the state or territory.

The FMAP for Guam has fluctuated recently but has been 55% in the past, meaning the local government needed to put up a 45% share to get the federal government to cover the rest.

In fiscal year 2019, Congress raised the FMAP to 100%. In fiscal 2020 and 2021, the FMAP was set to 83% and then to about 89%, due to the Covid-19 pandemic. Moreover, the island’s Medicaid cap was lifted to about $130 million for fiscal year 2020 and 2021.

About $122 million of federal funding was spent out of Medicaid in fiscal 2020, while Guam spent only $12 million.

But these expansions last up to the end of this fiscal year, and as Department of Public Health and Social Services Director Arthur San Agustin stated Thursday, the U.S. Congress has not set any additional funding after fiscal year 2021.

This means that for fiscal 2022, Guam is expected to revert to a prior Medicaid cap of about $19 million to $20 million, and a match of 55% for Guam’s 45%.

“An ongoing fiscal challenge of this program is to determine the amount needed to match Medicaid federal funds without knowing the percent of Guam’s required match. Unlike other programs, their match levels have remained constant for years, which allows for better fiscal planning and decision-making,” San Agustin said, referring to the uncertainty about where numbers will ultimately land.

This is just as much a concern for the Guam Memorial Hospital Authority.

“We’re also kind of concerned that, come Sept. 30, if the Medicaid FMAP goes back to the 55%/45%, that’s really going to have a significant impact on our Medicaid reimbursements,” GMHA Administrator Lillian Perez-Posadas told lawmakers Thursday. “So I hope you’re all paying attention to that situation and maybe we can find a way to collectively make sure that doesn’t happen.”

DPHSS noted a drastic decrease in federal funding for its Division of Public Welfare within its fiscal 2022 budget. According to Tess Arcangel, the division director, this was due to lower anticipated Medicaid funding. Arcangel said there is a federal proposal to remove the Medicaid cap but it doesn’t include the FMAP.

She didn’t name the proposal, but may have been referring to the Insular Area Medicaid Parity Act, of which Guam Delegate Michael San Nicolas is a co-sponsor.

San Nicolas did not comment about any specific bills but stated that he and his colleagues are working closely “to secure full and permanent inclusion of Guam and all territories in Medicaid, and are confident that we will achieve that in this 117th Congress.”

When asked if he foresaw at least an interim solution before the Medicaid expansions expire, San Nicolas said an interim solution is “very likely” but so is a permanent one.

Because of concerns caused by temporary fixes to Medicaid issues for the territories, San Nicolas and other territorial representatives have called for a permanent solution.

Meanwhile, a positive note for Guam has been the inclusion of citizens of Freely Associated States in Medicaid, as part of the $900 billion federal relief package signed into law in December. There is no Medicaid cap on residents under the Compacts of Free Association, although the match may still revert to 55%/45%, according to Arcangel.

Currently, DPHSS has about 8,000 COFA migrants under the local Medically Indigent Program. The department submitted a statement amendment to shift them to Medicaid effective Jan. 1, but has not received approval from the Centers for Medicare and Medicaid Services, Arcangel said.

If the transfer occurs, then funding intended for MIP could be used as a local match for Medicaid, she said.

 
 

Clipped from: https://mvariety.com/news/guam-officials-eye-medicaid-cliff/article_8e55d268-bc9b-11eb-9027-2bc01af6fc55.html

 
 

 
 

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Hospitals question fee increase to help pay for Medicaid expansion

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OK hospitals are not happy about a proposed 1.5% increase on the “taxes” they pay to get more federal draw down funds.

 
 

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.

 
 

OKLAHOMA CITY — Despite an influx of hundreds of millions of federal dollars earmarked to help pay for Medicaid expansion, lawmakers are proposing increasing fees paid by hospitals with the money to be used for the same purpose.

“While we’re not opposed to doing our part to increase access to care, we are disappointed that the Legislature chose not to use the hospital fee as a backstop considering that we have federal funds available for the next eight quarters,” said Patti Davis, president of the Oklahoma Hospital Association.

She said the state’s hospitals are still in “recovery mode” from the pandemic, and they would prefer legislators would first use the hundreds of millions in additional federal funding before increasing their assessment rate.

The state’s Supplemental Hospital Offset Payment Program, or SHOPP fee, is a self-assessment that allows hospitals to maximize federal Medicaid matching funds by supplementing state Medicaid funding.

Senate Bill 1045, which already cleared the state Senate this week, would increase that assessment rate from 2.5% to 3% for calendar year 2022, then raise it to 3.5% in 2023 and finally to 4% in 2024.

Currently, 68 hospitals are obligated to pay the fee out of their annual operating budget, including those in Duncan, Claremore, Chickasha, Enid, McAlester, Stilwell, Ada, Norman, Tahlequah, Muskogee, Oklahoma City, Tulsa and Stillwater.

In a bid to help states, Davis said the federal American Rescue Plan Act earmarked specific funds to states to cover costs of Medicaid expansion. Oklahoma received more than enough to cover its expansion for the first two years, she said.

“While we understand it’s one-time funds, we were certainly hoping that that might provide a little bit more gap for hospitals,” she said.

Davis also said she hasn’t gotten any clarity from the Health Care Authority or the Legislature just how exactly they’re going to use that supplemental federal funding.

Melissa Richey, a spokeswoman for the Oklahoma Health Care Authority, said there is no explicit directive from the federal government over how those American Rescue Plan and Families First Coronavirus Response Act funds are to be used.

The state agency has received only $240 million in enhanced federal funds to date, she said. The benefit is received over time and not as a lump sum.

State Rep. Kyle Hilbert, R-Bristow, the House author, said the federal coronavirus funds went toward Medicaid expansion, which freed up $164 million in state money to be put into a rate preservation savings account. That brings the fund’s balance up to about $197 million.

In 2019, the Legislature created the fund to save a portion of the match the state receives on its federal dollars when its reimbursement rate is high. The amount the state receives from the federal government fluctuates based on the health of the state’s economy, Hilbert said.

Because Oklahoma’s economy is thriving and its budget has seen a $1 billion surplus, lawmakers are bracing for a steep drop in the reimbursement rate in the next three years.

In the past those drops resulted in provider rate cuts, but the new rate preservation fund is designed to prevent cuts across the board, Hilbert said. The state’s current match rate is 68%, but could drop as low as 50% depending on the health of the economy, he said.

Every 1% drop in federal matching funds will cost taxpayers about $54 million, he said.

The new SHOPP fee is expected to generate $37 million in the first year, and will help offset some of the $164 million price tag to pay for Medicaid expansion, he said. Lawmakers expect an additional 200,000 people to be eligible for the program.

Hilbert said it’s irresponsible to pay for ongoing expansion expenses with one-time revenue sources.

“It’s just like drawing down your retirement fund to start making payments on your mortgage,” he said. “Eventually you’re going to run out of retirement money. You’ve got to have some revenue source to help fund your ongoing expenditures, and that’s why the increase in SHOPP is necessary to fulfill the will of the Oklahoma voters and funding Medicaid expansion.”

Janelle Stecklein covers the Oklahoma Statehouse for CNHI’s newspapers and websites. Reach her at jstecklein@cnhinews.com.


Clipped from: https://www.stwnewspress.com/news/hospitals-question-fee-increase-to-help-pay-for-medicaid-expansion/article_689342fc-b900-11eb-b270-37fd5e8a42d4.html

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The Biden Administration Greenlights $12 Billion In Federal Medicaid Home Care Money. How Will States Spend It?

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CMS has released guidance on the initial $12B of HCBS additional funds states can receive.

 
 

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 Biden Administration has given the green light for states to begin to tap into about $12 billion in additional funding for Medicaid home-based long-term supports and services. In guidance issued to state Medicaid directors late last week, the federal Centers for Medicare and Medicaid Services (CMS) granted the states broad flexibility in how they use the money. The funds, included in the American Rescue Plan Congress passed in March, reflect a one-year 10 percentage point increase in the federal contribution to Medicaid home and community-based services (HCBS).

The big immediate question is how will states use the money, and how many will take it at all.

Just as important, the guidance also may signal how the Biden Administration would use a much larger, $400 billion increase in federal Medicaid HCBS spending that it included in the American Jobs Plan that currently is being considered on Capitol Hill.

Medicaid is funded jointly by the federal government and the states, but operated individually by each state. States are required to provide long-term care in nursing homes but home-based care is optional and can only be provided with CMS permission. Every state has requested such a federal waiver for home-based care, but states vary widely in the kinds and amount of home care they provide.  The payment bump will come on top of the federal contribution that ranges from 50 percent in Colorado and other states to 78 percent in Mississippi.

PROMOTED

“Expand, enhance, and strengthen”

In 26 pages of guidance, CMS opened the door to a long list of benefits and services that states could buy with the extra dollars. They range from short-term initiatives such as higher wages or COVID-19 testing for home care aides to longer-term structural reforms.  

However, the guidance explicitly requires states “expand, enhance, and strengthen” Medicaid HCBS and to “supplement, not supplant” existing programs. In other words, Medicaid won’t allow a state to simply offer the same services but with federal dollars replacing state funds.  

To provide a check on state activity, CMS will require states to develop a funding proposal within 30 days and report quarterly on how the funds are used. However, states will be allowed to revise their proposals as needs change. In addition, while the law allows CMS to boost funding for HCBS programs only through March of 2022, states will have until March, 2024 to spend the money. This could give them time to develop new programs.  

A home run

The states also will be allowed to use the extra funds to increase payments to Medicaid managed long-term care programs, but only if the plans increase approved services.

One close observer called the guidance, “a home run.” But it remains uncertain how many states will take the extra funding and what they will do with it.

CMS urged states to build long run reforms to their systems, such as expanding available services, increasing eligibility, and building partnerships with state housing and other programs to develop more coordinated services.

However, because the extra federal contribution is for only one year, many states may think more short term. State officials tell me they are more likely to use the funds to provide one-time enhancements to existing services rather than trying to stand up new long-range initiatives with federal money that could dry up after a couple of years.

How will states respond?

Given wide state variation that already exists in Medicaid HCBS , states are likely to respond very differently to the feds’ offer. Some, such as Oregon and Minnesota, may continue to be extremely creative. Others such as Alabama and Louisiana, which tilt heavily toward nursing home care, may not—and some may not take the money at all.   

CMS is anxious to get the extra dollars out the door. It gave states just 30 days to develop an initial plan and the agency promises to respond within an additional 30 days. Thus, funds could be out the door by mid-July.

States, providers, and advocates anxiously awaited the guidance for two reasons. They want to use the new funding as quickly as possible, of course. But they also see it as a clue about how the Biden Administration would use its proposed $400 billion increase in the federal contribution to Medicaid HCBS.

Any increase in the federal payment for Medicaid HCBS has to walk a narrow line. Too much flexibility and states will find ways to divert the funds to non-Medicaid programs, something they regularly do now. Too little flexibility and one benefit of Medicaid—the ability of states to innovate—would be lost. And, worse, states would be unlikely to even take the money if it comes with too many strings.

CMS has done a good job finding that balance. The question now: How will the states use the money? Will they increase pay for direct care workers? Increase home-based benefits for current enrollees? Or expand eligibility? Even with $12 billion, they won’t be able to do it all.

 
 

Clipped from: https://www.forbes.com/sites/howardgleckman/2021/05/19/the-biden-administration-greenlights-12-billion-in-federal-medicaid-home-care-money-how-will-states-spend-it/?sh=479bab8e50e3

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Texas sues Biden admin over decision to pull Medicaid waiver

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The lawsuit accuses CMS of breach of contract and abuse of federal power to compel the state to adopt Medicaid expansion.

 
 

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.

 
 

Texas has sued the Biden administration over its decision to revoke a waiver that extends the state’s Medicaid program.

The federal lawsuit, filed Friday, calls for the waiver surrounding the state’s Medicaid program to be reinstated. It said the original decision by the Biden administration last month was without warning or proper authority.

“The Biden administration cannot simply breach a contract and topple Texas’ Medicaid system without warning,” said Texas Attorney General Ken Paxton in a statement Friday. “Not only does this violate agency regulations and threaten to rip a $30 billion hole in Texas’ budget.”

The Centers for Medicare & Medicaid Services said in a letter to the state last month that the process to approve the waiver was flawed and that it did not include time for public comment. The agency was also concerned with the length of the extension, which runs through 2030 and is typically longer than waivers for other state Medicaid programs.

Texas’ Healthcare Transformation and Quality Improvement Program expires Sept. 30, 2022, and administers benefits for Medicaid enrollees via the state’s managed care program.

The Trump administration fast-tracked the original waiver and approved it on Jan. 15.

 
 

The lawsuit charges that the Biden administration’s decision is part of an effort to compel the state to expand Medicaid under the Affordable Care Act and called the threat unconstitutional.

It calls for the Biden administration’s decision to be set aside as it imposes “unconstitutional conditions on federal funding for Texas’ Medicaid program.”

Rep. Michael Burgess, R-Texas, grilled Department of Health and Human Services Secretary Xavier Becerra about the waiver withdrawal during a recent hearing before the House Energy and Commerce Committee.

Becerra told lawmakers that the current Medicaid program runs through September 2022, and there is plenty of time to renegotiate a new extension.

He said if there were an extension of an existing waiver, it must comply “with all aspects of the law and the notice and public comment was deficient.”

Clipped from: https://www.fiercehealthcare.com/payer/texas-sues-biden-admin-over-decision-to-pull-medicaid-waiver