Tag: Medicaid Reform

MM Curator summary

[MM Curator Summary]: The money is there, the referral system is in place- there’s just not enough actual houses.

 
 

 
 

 
 

By Clarissa Donnelly-DeRoven

North Carolina’s state Medicaid office is sending millions of dollars to organizations that help people with housing, domestic violence, and other chronically stressful situations. 

By paying these agencies to help people on Medicaid with extreme life stressors, the state hopes it can help those same people avoid illness and in the process save money that would otherwise be spent on health care.

The project, called the Healthy Opportunities Pilot, or HOP, began its three-phase roll out in March after years of planning. It started with services to reduce hunger, which many say are going pretty well. In May, the pilot began funding housing and transportation services. In June, the state planned to begin reimbursing organizations that deal with domestic violence. 

 
 

Some portions of the project have been stalled, though.

Researchers have long documented the ways that extremely stressful situations, such as homelessness and domestic violence, impact mental and physical health. The last two decades have also brought research showing how these events can wreak havoc on the mind and body. 

Experiencing and coping with stress is a critical part of human development. Stress – in moderate amounts – is designed to keep us safe. The so-called “fight or flight” response causes the heart to start beating faster, blood vessels to restrict to more quickly push blood, oxygen, and other nutrients throughout the body. We make hormones – like adrenaline – that can give the energy needed to fight, flight, or flee. Our immune system turns up its inflammatory response.

As the body tunnels all its energy into overcoming a stressful situation, it diverts resources from other energy-intensive bodily processes, such as reproduction and the part of the brain that deals with decision-making and controlling emotions.

Over short periods of time, the response works. But if it never turns off — which is what happens when you’re constantly worried about where you’ll sleep, or if your partner will put you in the hospital again — that’s where problems start. 

A heart pumping too hard for too long can cause vascular disease, high blood pressure, and increase the likelihood of a heart attack. Too many stress hormones can exacerbate conditions like diabetes, while reproductive hormones needed to sustain a healthy pregnancy can struggle to turn back on after being suppressed for too long. 

An overactive inflammatory response can lead to the suppression of the immune system — so rather than stress causing sickness, it stops a body from being able to fight off diseases as effectively. Brains can even begin to “rewire,” building up the parts that deal with the threat response, while ignoring the parts that deal with complex problem solving.

Paying someone’s rent is no good if there’s no houses

No other state has ever attempted a project like Healthy Opportunities before, and so there’s been a fair amount of growing pains, from issues with the referral process, to a lack of information about the pilot for Medicaid recipients.

Some of the issues the pilot is facing are more issue specific — the state-wide housing shortage, for one.

Amy Upham is the executive director of the Buncombe County’s Eleanor Health Foundation, an organization helping people with substance use disorder and other mental illnesses connect with transportation, housing, affordable medications, employment, and more.

“We’re ready. We’ve got staff. We’ve got reserves where we can front the cost until we get reimbursed by Medicaid,” Upham said. “We’ve got all the resource lists for housing. We are able to house someone.”

But, she added, “Is there a place to put them? No.”

“We’re finding that there’s not a lot of housing available in Murphy,” said Charam Miller, the director of Macon Program for Promise. “I feel like it’s just a struggle for all of Western North Carolina right now to find safe, affordable housing.”

Those experiences are echoed by research done by the National Association of Realtors, which found that post-pandemic, housing prices across the U.S. rose by about 30 percent, even as the inventory of homes for sale dropped to record lows in 2021. 

At a roundtable discussion hosted by the Duke Margolis Center in July, officials from different agencies involved in the project acknowledged the scope of this issue. 

“When we think about housing, we have a strain in our housing system,” said LaQuana Palmer, who works with the platform NCCARE 360 through which all the program referrals happen.

Even with their expertise and funding, some HOP providers have been struggling to find places for Medicaid recipients in need to live. Other organizations have successfully helped only a handful of Medicaid patients, either through getting them on a housing waitlist or helping them with their utility bills. 

Then there’s the paperwork: housing sustainability plans, inspections and other federal requirements. 

“We can’t even find them a place to live, let alone that they’re gonna want to jump through all these hoops or that the landlord’s gonna want to jump through all these hoops to house this person,” Upham said.

 
 

“Housing services, in particular, have been one of the more challenging types of services for us to implement,” said Amanda Van Vleet, the associate director of innovation at NC Medicaid who oversees the pilot. “The really challenging part there, the core of it, really gets to integrating non-medical services into the Medicaid program.” 

Getting paid by reimbursements, rather than grants, is new for many of the participating organizations. And the process is more cumbersome because the federal Centers for Medicare and Medicaid Services has strict documentation rules for providers that haven’t participated in Medicaid before — which, for the Healthy Opportunities Pilot, is all of the organizations. 

“We are proposing modifications to that right now to try to eliminate what we can while still having enough program integrity in place, but making it a little bit more doable and manageable for the [organizations],” Van Vleet said.

Privacy concerns complicate help for domestic violence survivors

Despite the challenges, housing services are actually starting to get up and running. 

Domestic violence services are a different story. This part of the pilot was supposed to begin its roll out in June, but it didn’t, and the state doesn’t have a timeline for when it will begin. 

The first challenge comes from strict federal privacy laws around handling information and data about domestic violence survivors. These laws are often major funding sources for domestic violence agencies, and they impose limitations on how client information can be shared, and with whom. 

For the purposes of the HOP project, the state is treating domestic violence survivors as Medicaid patients, but that’s tricky.

“A health plan, for example, will need to know who received the service and if they’re a covered member of theirs so that they can pay for their services,” Van Vleet said. “They also need to know exactly what service that person received in order to reimburse for it.”

The state and domestic violence agencies realized that these needs conflict with each other, but it seems they underestimated how complicated they would be to disentangle. 

“That’s the fundamental tension that we’ve been dealing with, is kind of how we’re able to make both of those things work,” Van Vleet said. 

There are technical changes that need to be made to the NC CARE 360 referral platform in order to comply with federal privacy regulations. Those have to be made by the company Unite Us, which contracts with the state to run the platform. 

In a statement, Unite Us said they’re working with state officials and advocates to protect survivors while allowing service providers to get paid.

Contracts between the state and every organization participating in the pilot also need to be updated to include stipulations about data gathering and sharing. And anyone in the program who deals with participants’ data will need to undergo training about domestic violence, privacy, and data security. 

“Because receiving domestic violence services is such a delicate topic, survivors need to be aware of who will know that they have qualified for these services,” said Kathleen Lockwood, the policy director at the North Carolina Coalition Against Domestic Violence, an organization that’s pushed the state around best practices for years.

Each agency in an individual case needs to be mindful of survivor safety. The clearest way this comes up, Lockwood explained, is in contact preferences. For example, if somebody says not to call them or leave a message, that request must be respected — for many, it could be a matter of life or death. 

“We anticipate a survivor accessing services through the Healthy Opportunities Program versus through interacting with their domestic service provider in the community to be receiving a very similar if not the same experience,” Lockwood said.

A stop-gap solution

Organizations have been creating privacy workarounds, explained Jennifer Turner-Lynn, the assistant director at REACH of Macon County, an organization that supports survivors of domestic violence and plans to participate in the pilot.

“When a client comes to us, and we believe they qualify for services, we discuss those service options with them,” she said. “If they are interested… we have them sign a release of information. We assist them in contacting Medicaid.” 

Once they reach their Medicaid case manager, they’ll be referred to another organization in the pilot. Then the client tells that organization they want to receive services through REACH. 

“Our staff completes the service, provides the assistance, and places notes in the system, but never at any point stipulates this person is a ‘victim’; because it’s in [the other organization’s] system,” Turner-Lynn said. “It will look just like any client they serve as it’s under their umbrella, not ours.”

The other human service organization bills Medicaid and then pays REACH after receiving payment. 

“There is only one person, outside of REACH, who ever knows that this person qualifies as a victim, and that’s the key point person at the contracted [human service organization] with whom they talk with immediately,” she said.

It’s definitely roundabout, she said, but so far it’s worked. Those in the field hope the problems will be resolved soon, so they can start providing services and have the effectiveness of their services be evaluated.

“From our perspective any data — however long the span or however short the span — that can show the linkages between health and safety in the domestic violence realm will be valuable data,” Lockwood said. 

“The correlation or causation between receiving services and later health outcomes are really going to make the case for communities to continue to invest in domestic violence services.”

 
 

Clipped from: https://www.northcarolinahealthnews.org/2022/09/08/new-housing-program-faces-hurdles/

[MM Curator Summary]: The author suggests that the success of welfare reform- which got single mothers into the workforce- should be considered before we burn the Republican witches at the stake.

 
 

“Work requirements” are back in the news, after a federal judge ruled in favor of Georgia’s Medicaid “waiver.” It’s worth exploring what this means — and what it doesn’t.

You may recall this discussion from years past. Rather than expanding Medicaid as envisioned by Obamacare, Gov. Brian Kemp sought and received federal permission for a more limited expansion, including a work requirement. But within days of Joe Biden entering the White House, the federal government signaled it would rescind that approval, which it did late last year.

First things first: “work requirements” is a misnomer. In fact, the Georgia Pathways program offers several ways to meet the 80-hours-per-month qualification. Those include a job, job training, community service and some types of education.

 
 

But to the extent “work requirements” are fulfilled by actual work, they’re a proven way to help Americans better themselves financially. We can see this from the successful welfare reforms of the 1990s.

A 2016 study of the effects of the reforms by the Manhattan Institute found child poverty, for example, fell from 29% in 1993 — exactly where it stood back in 1967 — to 18% in 2000 and 17% in 2009. Even after the Great Recession, it was significantly lower than pre-reform, at 19% in 2012.

What changed? Single mothers joined the workforce. Before, they faced a choice between working and receiving benefits — a choice that skewed toward welfare because of the relatively high wages one would have to earn to replace those benefits. With greater latitude to work, single mothers began working at much higher rates: a 15-percentage-point increase between 1996 and 1999, compared with a 10-point increase between 1980 and 1996. The share of single mothers on welfare fell from 50% in 1996 to 17% in 2008.

How does that apply to Medicaid? It largely hasn’t. Courts ruled that adding work requirements for existing recipients in Arkansas and Kentucky was unlawful because it would cost some people their coverage. Opponents of Georgia’s waiver pointed to those rulings as a reason Kemp was wasting his time.

But Kemp’s program, called Georgia Pathways, essentially reverse-engineered the Arkansas and Kentucky rulings. Rather than adding work requirements for current beneficiaries, Georgia uses “qualifying activities” to determine eligibility for the new program. People can’t lose coverage they never had.

 
 

Thus, Georgia Pathways can only increase coverage. That was central to the Aug. 19 decision by U.S. District Judge Lisa Godbey Wood, which set aside the Biden administration’s rescission of Georgia’s waiver.

Pending an appeal by CMS, we may finally get to see how work requirements fit with Medicaid. We can expect good things.

First and foremost, we can expect better health outcomes for recipients — even if federal judges have said health outcomes aren’t a priority for Medicaid waivers, because coverage is the program’s central objective. Why better outcomes? Research indicates employed people tend to remain healthier. Even if that isn’t a primary objective of Medicaid, it would be a worthy result.

Georgia Pathways also prioritizes private coverage for workers whose employers offer health insurance. That’s beneficial for them in two key ways. First, private insurance is much more widely accepted by providers than traditional Medicaid, so these workers are far more likely to gain access to care.

Then there’s continuity of coverage. The income limit for Georgia Pathways is 100% of the federal poverty line, or $13,590 for a single adult this year. A part-time worker earning $13.50 per hour would barely qualify. But if he got an hourly raise of even 10 cents, he might lose it.

With traditional Medicaid, that would mean losing his specific plan, with its specific network of doctors. But with Georgia Pathways, he would already be on his employer’s plan. Although he would have to pay more in premiums, he could stay on the same plan and keep the same doctors.

All of this is more complicated than our bumper-sticker politics prefers. But it’s clear that with this ruling, Georgians may finally get a plan that works.

 
 

Clipped from: https://thebrunswicknews.com/opinion/editorial_columns/medicaid-work-requirements-arent-inherently-a-bad-thing/article_809114f7-f637-51ec-96da-48b291302c98.html

 
 

[MM Curator Summary]: Ruh-roh.

 
 

Photo: VisionsofAmerica/Joe Sohm/Getty Images

A federal judge has reinstated a Medicaid work requirement program in Georgia, saying that the Centers for Medicare and Medicaid Services, under the Biden administration, unfairly struck down the program that was first approved by the Trump administration.

CMS said last year it was revoking the work requirement, as well as a proposal to charge some Medicaid recipients monthly premiums. That prompted Georgia officials to sue, saying the agency lacked the authority to rescind the provision.

U.S. District Judge Lisa Godbey Wood issued the ruling on Friday, saying CMS’ decision was “arbitrary and capricious.” She said the agency measured pathways against a baseline of full Medicaid expansion rather than taking the demonstration on its own terms.

Wood also said CMS violated federal law by not engaging in reasoned decision-making, and failed to adequately explain why it changed course from the previous administration’s approval. She added that rescinding the approval may mean less Medicaid coverage in the state.

CMS does not comment on litigation as a matter of policy, but said last year that similar work requirements in other states had created confusion and hardship for Medicaid beneficiaries, with more than 18,000 losing coverage in Arkansas upon implementation of that state’s work program.

Georgia’s plan was to add an estimated 50,000 low-income and uninsured residents to the Medicaid rolls within two years, with the requirement that new Medicaid recipients would need a minimum number of qualifying hours through work, job training, education or volunteering.

Georgia Democrats have said full Medicaid expansion would cover hundreds of thousands of people at a much lower cost to the state, owing to expansion options under the Affordable Care Act, with the federal government picking up 90% of the cost of expanding the program to adults who make up to 138% of the federal poverty level.

In a recent Tweet, Georgia Governor Brian Kemp said the state’s plan “would better serve Georgians than a one-size-fits all Medicaid expansion.”

WHAT’S THE IMPACT

CMS began implementing work requirements for Medicaid coverage four years ago, a move opposed by those who said it would kick many receiving coverage off of Medicaid’s rolls.

In order to qualify for the program, individuals must comply with specific requirements, including participating in 80 hours of work monthly, or other qualifying activities. Most people with income between 50% and 100% of the FPL would be required to make initial and ongoing monthly premium payments.

Applicants and beneficiaries with disabilities who require reasonable accommodation will have options available to complete and report their qualifying activities and hours. The state is providing support to those not already working in order to encourage and enable those beneficiaries to obtain employment and take part in other education and job-supporting activities.

THE LARGER TREND

The Biden administration first began taking steps to roll back Medicaid work requirements in 2021, citing the economic and health impacts of the COVID-19 pandemic, which it said could make it more difficult for Medicaid recipients to fulfill the requirements.

“Uncertainty regarding the current crisis and the pandemic’s aftermath, and the potential impact on economic opportunities (including job skills training and other activities used to satisfy community engagement requirements, i.e., work and other similar activities), access to transportation and to affordable child care have greatly increased the risk that implementation of the community engagement requirement approved in this demonstration will result in unintended coverage loss,” CMS said in letters to states at the time.

Hospitals in states that implement Medicaid work requirements could see their Medicaid revenues decrease by as much as 21%, their uncompensated care costs increase as much as 133% and their operating margins fall by upward of 2%, according to estimates by The Commonwealth Fund.

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

 
 

Clipped from: https://www.healthcarefinancenews.com/news/federal-judge-reinstates-georgia-medicaid-work-requirements

In issuing the ruling, U.S. District Judge Lisa Godbey Wood said CMS’ decision was “arbitrary and capricious.”

 

MM Curator summary

[MM Curator Summary]: Texas is upping the visibility around CMS singling out its request to expand postpartum coverage for mothers.

 
 

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.

 
 

 
 

Nearly 130 Texas lawmakers sent a letter Thursday to the Centers for Medicare and Medicaid Services administrator, asking for reconsideration of Texas’ application to extend postpartum health care coverage for new mothers across the state.

A total of 128 lawmakers signed on to the bipartisan letter, which came after federal regulators – who must approve the proposal and help pay for services – told state health leaders last week that they would likely reject Texas’ plan to extend Medicaid for new mothers because the benefits are too restrictive.

Specifically, the federal agency took issue with eligibility restrictions Texas imposed in legislation passed in 2021 that would extend the safety net for new mothers from two to six months, but only be available to new moms who deliver the child or have an involuntary miscarriage. If the pregnancy is terminated, even in a medical emergency, the patient is ineligible for coverage.

Lawmakers said the failure to approve the state’s application would be a “major setback,” though no formal decision by the federal agency to reject the application has been made.

“A large bipartisan coalition of lawmakers at our state Capitol have sought to better support hundreds of thousands of new mothers, children and families — and such a decision will put the care and needs of those Texans at risk,” the letter read.

Initially, Texas representatives passed a bill that would extend coverage to 12 months after birth, but state senators chopped that down to six months. House members said they are determined to introduce legislation this coming session that would again attempt to stretch the coverage period to 12 months, as well as push for other proposals that “make meaningful improvements in support of Texas moms, children and families,” they said.

While there will be no immediate impact to Texas moms as the pandemic-era rules remain in place that disallow mothers to be kicked off the program, it would be a setback for the state that is already reluctant to expand Medicaid coverage.

Texas is one of 12 states that opted out of expanding Medicaid under the Affordable Care Act, leaving approximately $15.3 billion of federal funding on the table and nearly 1.75 million eligible Texans without coverage. A reintroduction of the bill may have a different outcome as new lawmakers make their way to the Capitol after the November election.

“One of our top objectives in the Texas House has been to make maternal health care efforts and resources a priority of both the most recent and upcoming regular legislative sessions,” the letter read. “We remain hopeful that (CMM) will reconsider (its) decision and work with our state to achieve approval so that women enrolled in Texas Medicaid will continue to receive critical postpartum care.”

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Clipped from: https://www.itemonline.com/news/texas-lawmakers-ask-feds-to-reconsider-medicaid-expansion-proposal/article_7e0fe4e2-1a8d-11ed-b0f5-1b034c877185.html

MM Curator summary

[MM Curator Summary]: Allowing schools to use Medicaid enrollment as eligibility for free meals will get free meals to an additional 90,000 kids in Minnesota under a new pilot being run in 8 states nationwide.

 
 

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.

 
 

An estimated 90,000 additional Minnesota students will get free meals at school this year under a pilot program that will automatically qualify kids who are enrolled in Medicaid, Gov. Tim Walz announced Monday.

Students generally qualify for free school meals in one of two ways: Their parents fill out a form stating they have a low enough family income, or their school “directly certifies” the student based on their enrollment in other government assistance programs, such as SNAP (formerly known as food stamps) or Women, Infants and Children (WIC).

This year, Minnesota is one of eight states chosen for a U.S. Department of Agriculture pilot program that will directly certify Medicaid recipients for free school meals, Walz’s office said.

“This project means fewer children will go hungry at school next year, and we know that’s the number one way we can help students succeed,” Walz said in a news release.

Walz said the Medicaid option adds about 202,041 students to the number of kids directly certified for free meals. Of those, an estimated 90,000 have not already signed up for free meals.

The impact, both on school district budgets and the number of kids getting free meals, figures to be greater than those 90,000, however.

If a school or group of schools has 40 percent of their students directly certified, they can qualify for free meals for all students under the Community Eligibility Provision; schools that reach 62.5 percent can do so at no additional cost to the school district because federal reimbursements will fully cover the meal costs.

St. Paul Public Schools previously announced it plans to spend $1.7 million next school year in order to provide free meals for all students at 18 schools that still qualify for the provision but no longer qualify at the full reimbursement rate.

Congress provided free meals to all students regardless of family income each of the past two school years because of the coronavirus pandemic, but that benefit is going away.

 
 

Clipped from: https://www.twincities.com/2022/08/15/90000-more-mn-students-to-get-free-school-meals-based-on-medicaid-enrollment/