Tag: Medicaid Reform

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Oregon withdraws a waiver request to run a closed Medicaid formulary

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[MM Curator Summary]: While the OR waiver request contains many new features, a closed drug formulary will not be one of them.

 
 

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.

 
 

 
 

In response to a raft of concerns, Oregon has withdrawn a request made to federal officials to restrict medicines covered by the state Medicaid program, which is currently required to provide coverage for all treatments. However, state officials are still seeking to exclude certain drugs from Medicaid when effectiveness evidence is lacking.

By seeking a so-called closed formulary, the same approach to coverage taken by private health insurers, Oregon officials had hoped to lower expenses by only covering one drug for each therapeutic class. So far, though, only Tennessee has been granted a waiver to use a closed Medicaid formulary and the Biden administration is reviewing that decision, which was issued by the Trump administration.

 
 

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Clipped from: https://www.statnews.com/pharmalot/2022/02/28/oregon-medicaid-cms-alzheimer-biogen/

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Improper Medicaid payments expand after ObamaCare and pandemic, studies find

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[MM Curator Summary]: Payments determined by CMS to be improper range from 22%-37% across states reviewed.

 
 

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.

 
 

As Medicaid rolls have ballooned – becoming the most expensive item in most state budgets – so have improper payments largely driven by ineligible patients that states have been reluctant to remove, according to data released by the Foundation for Government Accountability, a watchdog group.  

As of December 2021, Medicaid had 91 million enrollees – a boost of 18 million people in two years, meaning that a quarter of Americans are on Medicaid, according to the FGA. Of those, 17 million people were ineligible.  

 
 

The number of people on Medicaid, a joint federal and state health insurance program for the poor, has increased almost two and a half times what it was in 2000, putting an accumulated $700 billion strain on state budgets. Much of the increase came after the Medicaid expansion from the Affordable Care Act – better known as ObamaCare – that grew the program by 80% since 2013, according to the FGA findings.  

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“What’s interesting is that most of the improper payment rates are pre-COVID, so we may not know how high the number really is yet,” Hayden Dublois, deputy research director for the Foundation for Government Accountability, told FOX Business. “It’s not a clear red state, blue state divide, but the two highest states for improper payments are states that expanded Medicaid under ObamaCare.” 

The FGA released two recent reports about why this has become such a problem with suggestions about what states can do.  

More than one in five, or 22%, of Medicaid dollars are improperly spent, and that is overwhelmingly due to ineligible people on Medicaid, according to one of the FGA reports.  

 
 

A sampling of states shows some higher than the national average. Ohio’s Medicaid improper payment rate is double the national average at 44%, and 98% of that is caused by ineligible patients.   

Illinois isn’t far behind, with 37%, of which 95% is caused by ineligible patients. In Missouri, a third of the payments are improper, with 70% driven by eligibility errors. For Kansas, it’s 28% improper payments – not that far out of sync with the national average – but the cause is 99% ineligibility errors.   

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Congress passed and former President Trump signed the Families First Coronavirus Response Act, which gave a 6.2% increase in traditional Medicaid funding to states during the COVID-19 pandemic. The extra money was conditioned that states could not change eligibility, adjust the enrollment process, or remove enrollees from the program whether eligible or not until the pandemic is over.  

“According to data from 17 states, roughly 90 percent of all new enrollees during the COVID-19 pandemic are no longer eligible for Medicaid,” one of the FGA reports says. “This means that up to 17 million enrollees nationwide were ineligible by the end of 2021.” 

The FGA has called for states to remove ineligible enrollees – noting that it posed a minimal risk and that the Centers for Medicare and Medicaid Services would not “claw back,” or require states to pay back money from previous cycles. 

 
 

The Medicaid website states that if a state opts out of the extra COVID-19 money requirements it will only lose the extra federal funding for the quarter in which it opts out and remaining quarters until the pandemic end. But it will not have to return the money. FGA urges states, since they face little risk, to work at removing ineligible enrollees from the program.  

“CMS has also never stated that locking ineligible enrollees onto the program is an ongoing condition that could be used to punish a state retroactively,” one of the FGA reports continues.  

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A Centers for Medicare & Medicaid Services spokesperson told FOX Business the agency is committed to transparency and “protecting our program sustainability for future generations.” 

“Improper payment rates are often tied to routine or minor documentation errors and do not necessarily indicate fraud. While any improper payment is unacceptable, the vast majority of improper payments are made with respect to people who may be eligible for care but for whom the state or a provider furnished insufficient documentation to discern if the payment was proper,” the spokesperson said in an emailed statement. “For example, improper payments include both overpayments made by Medicaid, as well as underpayments. Both can result from a variety of circumstances that do not involve fraud – including services with incomplete documentation or insufficient documentation to affirmatively validate that the required verification of eligibility data, such as income, was completed.” 

The CMS spokesperson added that Medicaid is working on regular reporting similar to what helped to reduce improper payments in Medicare, the federal health insurance program for the elderly.  

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“CMS will continue to work with state Medicaid agencies to apply lessons learned from their successful reduction of Medicare Fee-for-Service (FFS) improper payments,” the spokesperson said. 

 
 

Clipped from: https://www.foxbusiness.com/politics/improper-medicaid-payments-expand-obamacare-pandemic-studies 

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MO- Republicans seek new route to impose work requirements on Missouri Medicaid recipients

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[MM Curator Summary]: Legislators want voters to weigh in on whether able-bodied bennies should have to meet school, volunteer or employment requirements to get benefits.

 
 

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.

 
 

Jenna Roberson from Wentzville holds a sign wile listening to speakers at the Rally to Save Missouri Health Care outside the Missouri State Capitol Building in support of Medicaid expansion on Tuesday, April 27, 2021, in Jefferson City.

Photo by Daniel Shular

Daniel Shular

JEFFERSON CITY — Republicans in the Missouri House are charting another path aimed at requiring low-income people to get a job if they want to receive Medicaid health insurance benefits.

A proposed constitutional amendment under consideration in the House would ask voters to remove a prohibition on imposing restrictions on eligibility or enrollment in the state’s MO HealthNet program.

Though the language makes no specific reference to work requirements, it could open the door to them down the road.

“It would just lay the groundwork for allowing work requirements in the future,” said Rep. J. Eggleston, a Maysville Republican who is sponsoring the latest proposal.

 
 

Rep. J. Eggleston, De Kalb, is sworn into the Missouri House during the opening ceremonies of the 99th General Assembly in Jefferson City on Wednesday, Jan. 4, 2017. Photo by David Carson, dcarson@post-dispatch.com

David Carson

Republicans for years have resisted attempts to expand Medicaid under the terms of the 2010 federal health care law signed by former President Barack Obama.

In 2020, advocates bypassed the Legislature and went directly to voters who approved a constitutional amendment expanding access to the program with 53% of the vote.

Previously, Missouri’s health care program did not cover most adults without children, and its income eligibility threshold for parents was one of the lowest in the nation.

Even after voters approved Medicaid expansion, GOP lawmakers have continued to fight it.

Legislators last year refused to front the money needed to pay for health care for the newly eligible population in hopes of blocking the program’s expansion. A judge ruled in August that Republican Gov. Mike Parson’s administration must implement the program anyway, and lawmakers have since budgeted for the program’s expansion.

Under a separate proposal also moving through the House this year, Medicaid recipients older than 19 and younger than 65 would need to spend at least 20 hours a week working, volunteering, going to school or getting substance abuse treatment, among other work-related options. That change would require approval from the federal government in order to be implemented.

Eggleston said he believes work requirements lead to more “self-sufficiency.” He wants voters to weigh in on the idea.

“We’re just offering the suggestion to see what they want,” Eggleston said.

The concept drew support from GOP members of the House Budget Committee.

“My people want this, and I work for them,” said Rep. Hannah Kelly, R-Mountain Grove.

Democrats said the proposal is another effort by Republicans to undermine the will of the voters, who supported Medicaid expansion in an August 2020 statewide referendum.

“I’m very concerned about this,” said Rep. Sarah Unsicker, D-Shrewsbury.

Rep. Doug Richey, R-Excelsior Springs, said the legislation is merely a modification of the Medicaid expansion vote, not an attempt to gut the program.

“I realize this is an emotional issue for people on both sides,” Richey said.

Rep. Ashley Bland Manlove, D-Kansas City, said Republicans should wait and see how the expansion works.

“The whole point of the program is to give people health care so they can go to work,” Bland Manlove said.

Sharon Geuea Jones, a lobbyist for the pro-expansion Missouri Health Care for All group, said the Republican-led Legislature should leave the program alone while it is still in its early stages.

“We haven’t fully implemented it. Why are we going back into it?” Geuea said.

She also said Republicans continually try to alter voter-approved initiatives that they disagree with.

“This body does not trust them and does not care what they think,” Geuea Jones said.

“I think we need to continue to uphold the will of the people,” said Rep. Rasheen Aldridge, D-St. Louis.

The legislation is House Joint Resolution 92.

The Associated Press contributed to this report.

Originally posted at 9:40 a.m. Tuesday, March 1. 

 
 

Clipped from: https://www.stltoday.com/news/local/govt-and-politics/republicans-seek-new-route-to-impose-work-requirements-on-missouri-medicaid-recipients/article_40a50821-dd57-5ed5-9445-22669cd1041b.html

 
 

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DHS proposed rule would exclude Medicaid, other benefits from public charge determinations

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[MM Curator Summary]: Estimated costs for immigrant candidates use of safety net services will not be used in determining admission under a new Biden rule.

 
 

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.

 
 

Feb 18, 2022 – 11:10 AM

 
 

The Department of Homeland Security today released a proposed rule that would exclude noncash benefits, such as the Children’s Health Insurance Program and most Medicaid benefits, when making a public charge inadmissibility determination for noncitizens requesting admission to the United States or permanent residency. The rule also would exclude disaster assistance received under the Stafford Act; pandemic assistance; benefits received via a tax credit or deduction; and Social Security, government pensions or other earned benefits, DHS said. The proposed rule will be published in the Feb. 24 Federal Register with comments accepted for 60 days.

The Biden Administration last year removed from the Code of Federal Regulations a public charge rule that made immigrants who used certain public benefit programs, including Medicaid, ineligible for visas or permanent U.S. residency. The AHA and other hospital groups supported several legal challenges to that rule, which they said would deter immigrants from seeking health care to which they are entitled and would harm the health of patients and the hospitals that serve them.
 

 
 

Clipped from: https://www.aha.org/news/headline/2022-02-18-dhs-proposed-rule-would-exclude-medicaid-other-benefits-public-charge

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Smokers in Medicaid Rarely Accessed Cessation Medication, Counseling

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[MM Curator Summary]: Very few Medicaid smokers who tried to quit used cessation benefits.

 
 

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.

 
 

Less than 10 percent of smokers in Medicaid-fee-for-service who recently tried to quit reported a claim for cessation medication or counseling services.

 
 

Source: Getty Images

 
 

By Victoria Bailey

February 21, 2022 – Medicaid fee-for-service beneficiaries who tried to quit smoking cigarettes rarely accessed cessation medication or counseling despite the wide range of cessation treatments that Medicaid covers, a study published in Nicotine & Tobacco Research found.

Individuals enrolled in Medicaid are more likely to smoke cigarettes than individuals with private health insurance. Smoking cessation treatments, such as counseling and seven FDA-approved medications, can help individuals quit smoking and reduce smoking-related morbidity and mortality.

To understand how often Medicaid fee-for-service beneficiaries utilized cessation treatment and the spending associated with it, researchers gathered Medicaid claims data from the Medicaid Analytic eXtract (MAX) files from 2010 to 2014.

They used the most recent data for each state and the District of Columbia, including data from 2014 for 17 states, 2013 for 11 states, 2012 for 20 states, 2011 for two states, and data from 2010 for one state. They estimated the number of beneficiaries who tried to quit smoking using the Behavioral Risk Factor Surveillance System data.

Thirty-seven states reported cessation medication claims for Medicare fee-for-service beneficiaries. Among these states, 24 offered Medicaid coverage for all seven medications.

Only 9.4 percent of Medicaid beneficiaries who attempted to quit smoking accessed cessation medication. Certain states saw higher rates than others. For example, only 0.2 percent of individuals in Arkansas had a cessation medication claim, while 32.9 percent accessed medication in Minnesota. Just 13 states saw rates of 10 percent or higher.

There was an average of 21.5 prescriptions per 100 Medicaid fee-for-service beneficiaries who tried to quit smoking, the study found. The number of prescriptions ranged from 0.5 per 100 beneficiaries in Arkansas to 89.2 per 100 beneficiaries in Minnesota. The average number of cessation medication claims per user was 2.5.

Even fewer Medicaid fee-for-service beneficiaries who had a past-year attempt to quit smoking received cessation counseling services. Only 2.6 percent of beneficiaries on average had a claim for cessation counseling, ranging from 0.1 percent in Florida to 5.6 percent in Missouri, the study revealed.

There was an average rate of 4.3 counseling services per 100 beneficiaries who tried to quit smoking.

The researchers found that if all Medicare fee-for-service beneficiaries who had a past-year quit attempt sought and received cessation treatment, the total Medicaid spending would only be a sliver of what Medicaid spends annually on treating smoking-related diseases.

Total spending for cessation medication among Medicaid beneficiaries was around $12.9 million, according to the study. Total Medicaid spending for cessation counseling was $342,008.

If all Medicaid fee-for-service smokers who tried to quit accessed cessation medication, the projected total spending would be $127.1 million. After including Medicaid managed care beneficiaries, the project spending would be $841.1 million—1.7 percent of the $45.9 billion Medicaid spends per year to treat smoking-related diseases.

The total projected spending for cessation medication was less than 0.2 percent of Medicaid’s total expenditure per year.

The prevalence of cessation treatment claims varied across states. This could be due to differences in state Medicaid coverage, promotion efforts, and variations in the extent that healthcare providers prescribed medications or suggested counseling services to Medicaid beneficiaries.

In 2014, the Affordable Care Act introduced a policy that requires all state Medicaid programs to offer coverage for FDA-approved cessation medications.

The study results suggested that Medicaid programs and healthcare professionals should increase the promotion of cessation services, as counseling and medication can lead individuals to quit smoking and see better health outcomes.

“Covering these treatments with minimal barriers and promoting this coverage so that Medicaid smokers and their providers are aware of and use the covered treatments are essential,” the study concluded.

“Continued monitoring of Medicaid enrollees’ use of cessation treatments is vital to track progress in quitting smoking in this vulnerable population.”

 
 

Clipped from: https://healthpayerintelligence.com/news/smokers-in-medicaid-rarely-accessed-cessation-medication-counseling
 

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Planned Medicaid Work Rules’ Impact at Heart of Georgia Lawsuit

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[MM Curator Summary]: The GA case is different because it only would have added members, not taken away coverage for existing members.

 
 

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 Centers for Medicare and Medicaid Services office stands in Woodlawn, Maryland.

Photographer: Jay Mallin/Bloomberg via Getty Images

Georgia’s lawsuit in defense of its Medicaid work requirements could turn on whether a court concludes the state’s proposal will increase or reduce the number of people in the program.

At issue is the Medicaid agency’s rescission under President Joe Biden of the Trump-era waiver that allowed Georgia to partially expand eligibility to include working age adults earning up to 100% of the federal poverty level, set at $27,750 for a family of four in 2022. Beneficiaries would have to complete 80 hours per month of work, education, volunteer work, or other qualifying activities. Adults earning above 50% of the poverty level would have to pay premiums.

Georgia says its plan would add about 60,000 people to the state’s Medicaid rolls. That prediction “might sound OK,” said Sara Rosenbaum, professor of health law and policy at the George Washington School of Law. “But that’s only when you ignore the fact that hundreds of thousands more would get coverage if the state were to fully expand Medicaid.”

The lawsuit filed in U.S. District Court for the Southern District of Georgia will concern fairly typical administrative law issues: whether the Centers for Medicare & Medicaid Services had the authority to withdraw approval for Georgia’s plan, and whether the agency had good reasons for its decision—or whether its action was “arbitrary and capricious.”

But inside the administrative-law wrapping is a policy question that hasn’t been tested: whether work requirements in Medicaid are acceptable as part of a proposal to bring new people into the program, even if more people would gain coverage if the work requirements were removed.

“The thing about Georgia is that it’s not like other states that tried to impose work requirements after having expanded Medicaid to adults,” said Sidney Watson, director of the Center for Health Law Studies at the Saint Louis University School of Law and a critic of work requirements. “In those states, the work requirements ended up taking coverage away from people who already had it. But Georgia is saying, that’s not what’s happening here, no one will lose coverage from this plan.”
 

A CMS letter formally withdrawing approval for the Georgia plan came Dec. 23. The state filed its lawsuit over that decision Jan. 21. A response to the lawsuit from the Department of Justice is expected shortly.

Limited Expansion

States are allowed under the Affordable Care Act to expand Medicaid eligibility to include adults earning up to 138% of the federal poverty level. Georgia is one of 12 states that hasn’t expanded.

Around 500,000 working-age Georgia residents would be eligible for Medicaid if the state fully expanded the program, according to the Georgetown University Health Policy Institute.

“This Georgia proposal, if it weren’t so tragic, it would be laughable,” Rosenbaum said. “Here we are, in the middle of a global pandemic in which having as many people covered as possible is a public health imperative, here we have a state that wants to impose work requirements on the people who have been hardest hit by the pandemic, and have been the most dislocated.”

Bait and Switch

The CMS’s goal in withdrawing approval for work requirements and premiums, but not for the entire Georgia proposal, was to leave the option of a broader Medicaid expansion on the table, Watson said.

The work requirement and premium provisions “would not promote the objectives of the Medicaid program,” especially in light of the impact of the Covid-19 pandemic, the agency said.

“It’s interesting that the CMS didn’t withdraw the entire demonstration project,” Watson said. “The withdrawal is limited to the work requirement provisions, which allows the rest of the project to go forward.”

That, in turn, would provide coverage for far more people.

But letting the CMS’s partial withdrawal stand would let the agency get away with an “egregious regulatory bait and switch on the core terms of a massive federal-state program,” Georgia said in the lawsuit. Medicaid is a joint federal-state health insurance program for low-income people.

The plan was “carefully negotiated” with federal regulators, and the work requirement provisions can’t be separated from the expansion provisions, the lawsuit said.

“Georgia agreed to expand Medicaid eligibility only if expansion was conditioned on the community engagement and premium requirements,” the lawsuit said. “By selectively withdrawing those parts of the demonstration, CMS is effectively seeking to convert this [plan] into a full expansion of Medicaid coverage in Georgia—which in no way resembles the program that the State agreed to in its exhaustive negotiations with CMS.”

Georgia argues that its plan will lead to an increase in coverage notwithstanding the impact of work requirements, and therefore does promote the objectives of the Medicaid program, said Thomas Barker, co-chair of the health practice at Foley Hoag LLP in Washington, and a former Department of Health and Human Services general counsel.

“Georgia is saying, ‘Here we are making coverage available to low-income people, they just have to jump through an extra hoop,'” Barker said. “Coverage isn’t currently available to these people, and the combined waiver will make it available to them when they wouldn’t have it otherwise. That’s going to be Georgia’s argument.”

Work Requirements

Work requirements for adults in Medicaid were a policy priority under the Trump administration, which approved them for 12 states, including Georgia. Seven other states submitted requests for work requirements, according to the Commonwealth Fund.

Supporters say the must-work requirements encourage self-sufficiency and provide a path to independence for working-age Medicaid recipients. Critics say they reduce health-care coverage for the working poor, impose unmanageable paperwork burdens on beneficiaries, and are ill-suited for the Covid-19 pandemic.

The CMS began rolling back work requirements in the states that had received approval for them shortly after Biden took office, and Georgia paused its plans to implement its proposal in June.

The case is Georgia v. Brooks-LaSure, S.D. Ga., No. 2:21-tc-05000, filed 1/21/22.

 
 

Clipped from: https://news.bloomberglaw.com/health-law-and-business/planned-medicaid-work-rules-impact-at-heart-of-georgia-lawsuit

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IA- House scales back proposed changes to Medicaid, food stamp eligibility

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[MM Curator Summary]: There are actually several new eligibility-confirming steps required in the new version of the bill this year, including enforcement of routine eligibility checks and cooperation with child support.

 
 

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 steps of the Iowa Capitol. (Photo by Katie Akin/Iowa Capital Dispatch)

Iowans would face new requirements when applying for programs like Medicaid or food stamps under a bill advancing in the Iowa House.

The proposal was born of a 2021 Senate bill that would have required additional identity verification and asset testing for public assistance applicants. House lawmakers did not take up the bill last session.

Upon returning to the Capitol in 2022, the House split the Senate bill into several parts, holding separate subcommittees on each component. Lawmakers combined some of the proposals into House Study Bill 698, a single bill to address the integrity of Iowa’s public assistance programs.

“We have done a lot of work on this bill to make sure that we are providing a safety net that Iowans need, but we also want to protect the taxpayer dollars,” said Rep. Ann Meyer, chair of the House Human Services Committee and a leader on the package.

The new proposal, which advanced Tuesday through the House Human Resources Committee, would make several changes to Iowa’s public assistance program:

  • Applicants would be required to complete a computerized, knowledge-based questionnaire to confirm their identity before receiving public assistance from the state.
  • The Department of Human Services (DHS) must routinely check whether recipients of public assistance are still eligible for the Supplemental Nutrition Assistance Program (SNAP) or Medicaid. 
  • Applicants for SNAP would be required to cooperate with child support in order to qualify for the program.

The Iowa Department of Human Services is tasked with implementing the changes – as permitted by federal law – by 2024, under an amended version of the proposal. 

Some of the more controversial provisions from the original Senate proposal, such as asset testing for food stamps, are not part of the current House bill. But Democrats still raised concerns that the changes could create new burdens on families.

“I’m just concerned that, at a time when grocery costs are skyrocketing and we know that SNAP recipients are already having their benefits reduced, I just want to move forward with ultimate caution,” said Rep. Kristin Sunde, D-West Des Moines. “… I don’t want kids to be impacted adversely.”

The Human Services Committee voted 13-8 to approve the bill, marking it eligible for floor debate and clearing a Friday legislative deadline.

 
 

Clipped from: https://iowacapitaldispatch.com/2022/02/15/house-scales-back-proposed-changes-to-medicaid-food-stamp-eligibility/

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OIG permits retailer to use Medicaid enrollment as qualification for discount program

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[MM Curator Summary]: HHS says its ok to use your Medicaid ID to get discounts on groceries and other items.

 
 

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.

 
 

In the first advisory opinion of 2022, the Department of Health and Human Services’ Office of Inspector General (OIG) allowed Medicaid beneficiaries to qualify for a benefit available to low-income individuals, even though the arrangement would not qualify as a “retailer reward.”

The OIG stated it would not seek enforcement of the federal Anti-Kickback Statute or the Beneficiary Inducements Civil Monetary Penalty Statute (CMP Law) for an arrangement proposed by a web-based retailer that that sells a wide variety of consumer goods and services, and that offers fee-based membership programs with a number of benefits, including pharmacy-related benefits.

The retailer requested an advisory opinion from OIG to allow individuals to use Medicaid enrollment to qualify as eligible for participation in the discount programs that provided certain expedited free shipping, and discounts on food and grocery items. In issuing a favorable advisory opinion, OIG determined that allowing individuals to use their Medicaid enrollment status as a qualification presented a minimal risk of fraud and abuse to federal health programs.

The arrangement would not qualify for any available fraud-and-abuse exception, including the CMP Law’s “retailer rewards” exception because the discount programs would not be offered on equal terms available to the general public, regardless of health insurance status.

Nevertheless, the OIG issued a favorable opinion, including because participation in the discount programs was substantially attenuated from any potential pharmacy purchases. In fact, the grocery discount program did not even apply to pharmacy purchases at all. Moreover, the OIG found that the membership discount, while it might encourage individuals to order from the retailer to take advantage of free expedited shipping, it wouldn’t encourage those individuals to purchase drugs that they wouldn’t otherwise order.

As a result of this advisory opinion, retailers may consider seeking approval of arrangements that provide benefits to Medicaid beneficiaries, particularly when the goal of those programs is to bring benefits to low-income individuals and the use of Medicaid enrollment status is only a proxy for low-income status.

 
 

 
 

 
 

Clipped from: https://www.lexology.com/library/detail.aspx?g=0123f02e-122b-46c7-a270-00f4a7ab1c23

 
 

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GA- Georgia Senate approves Medicaid expansion for new mothers

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[MM Curator Summary]: GA joins the list of states seeking maternity funding from ARPA.

 
 

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.

 
 

ATLANTA – New mothers in Georgia could receive health coverage through Medicaid for up to a year after giving birth, up from the current six months, under legislation that cleared the state Senate unanimously.

Gov. Brian Kemp backs the measure and included $28.2 million in his fiscal 2023 budget proposal to pay for it.

Expanding Medicaid coverage for new mothers was the top recommendation of a task force formed to examine the issue, Sen. Dean Burke, R-Bainbridge, the bill’s chief sponsor, told senators before Monday’s vote.

As the opioid crisis continues to ravage the U.S. in greater numbers, drug treatment facilities are having to keep up with the demand. Based on data from the Click for more.

State Sen. Nan Orrock noted that Georgia consistently has been among the states with the highest rate of maternal mortality. Low-income mothers used to receive Medicaid coverage for only two months postpartum in Georgia, which was increased to six months two years ago.

“This is a great leap forward,” Orrock said.

Senate Minority Leader Gloria Butler urged her colleagues to move beyond expanding coverage for new mothers to a full-blown expansion of Medicaid.

“We need to stop nibbling around the corners of this problem,” said Butler, D-Stone Mountain. “Senate Bill 338 will save lives. We can do more and save thousands more lives.”

Kemp and legislative Republican leaders oppose a full expansion of Medicaid as too expensive.

The bill now heads to the Georgia House of Representatives.

This story is available through a news partnership with Capitol Beat News Service, a project of the Georgia Press Educational Foundation.

 
 

 
 

Clipped from: https://www.news-daily.com/local/health/georgia-senate-approves-medicaid-expansion-for-new-mothers/article_e7dc65eb-7532-5884-a1f4-59c39e94923f.html

 
 

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Missouri GOP again pushes for Medicaid work rules despite setbacks elsewhere

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[MM Curator Summary]: Lawmakers are working to get key changes to their expansion program, including ways to track costs of Medicaid expansion more precisely and work requirements.

 
 

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.

 
 

 
 

Rep. Hannah Kelly, R-Mountain Grove, left, Rep. Cody Smith, R-Carthage, Center, and House Republican Aid Ryan Nonnemaker talk during a debate over a Medicaid tax bill in the House chambers at the Missouri State Capitol Building in Jefferson City on Wednesday, June 30, 2021. The special session was called to pass the Medicaid tax bill, which has passed the Senate. Photo by Colter Peterson, cpeterson@post-dispatch.com

Colter Peterson

By Grace Zokovitch St. Louis Post-Dispatch

At a budget committee hearing, Missouri House members asked questions to the bill’s sponsor, Republican Rep. Cody Smith. Democrats’ questions focused on the work requirement language, and wording that would allow the legislature to fund only portions of people in the Medicaid program.

JEFFERSON CITY — Missouri lawmakers are kicking around work requirements for Medicaid enrollment for the fifth year running.

This year’s push packages the work rules within a proposed constitutional amendment giving the Legislature legal authority to defund voter-approved Medicaid expansion, for which an estimated 275,000 residents are now eligible. That number includes nearly 127,000 low-income adults whose families include at least one full- or part-time worker.

The legislation, sponsored by House Budget Chairman Cody Smith, R-Carthage, would institute a requirement for Medicaid recipients to work or do qualified community engagement for 80 hours a month. If passed by lawmakers, the amendment would go on the November ballot for voters to decide.

These requirements could take the form of traditional employment or fall under the “community engagement” as outlined in the resolution — education, substance abuse treatment, community service, volunteer child care, and job search or readiness training.

“Having those requirements alongside a benefit package like Medicaid is helpful — it helps people enter the workforce, or provide community service, or further their education,” Smith said. “Those are all positive outcomes.”

The proposed work requirements would apply to applicants between ages 19 and 65 and allow for some exemptions.

Exemptions include people with disabilities or serious illnesses, certain caregivers, those with limited access to public transportation or education, and those suffering from traumatic or exceptional circumstances. The proposal allows the Department of Social Services to use discretion in determining a candidate’s eligibility for an exemption.

The House Budget Committee conducted a public hearing on the resolution Wednesday, which is further than past proposals have progressed in recent years.

While Missouri’s debate may be gathering momentum, similar work requirement programs around the country have been collectively hitting a wall.

Other states

In 2018, Centers for Medicare and Medicaid Services leadership under President Donald Trump’s administration sent a letter to states greenlighting potential work requirement programs, a reversal of former CMS policy. States could institute work requirements by passing the policy and applying for a federal CMS waiver.

The letter led to a wave of attempts to pass work requirements, but court rulings and then the COVID-19 pandemic stalled the states’ programs or applications. At the time President Joe Biden took office last year, none of the 17 states that had attempted work requirements had succeeded.

Biden’s administration halted further attempts at implementation, and CMS has indicated it will not approve new applications.

“I have noted that CMS has not looked favorably upon the requirements in recent past,” said Smith, adding that he felt charged to put forth “good public policy” for the state regardless.

“It would be unfortunate if CMS denied our ability to govern as we see fit in Missouri,” Smith said. “I’m hopeful that they would take the will of the people and a constitutional change as a signal that this is how we want our Medicaid program to work and that they would try to help accommodate that rather than oppose it.”

Effect on enrollment

Testimony at Wednesday’s budget committee hearing was split on the likely end result of the policy — an increase in employment or a decrease in health care.

Proponents argued the requirements built in a “path to independence.” Others countered that barriers to health care were more likely to drive people further from economic stability.

Most testimony opposed the legislation, with many fearing that new bureaucratic and administrative barriers would result in significant disenrollment, even with the exemptions.

Emily Kalmer, representing the American Cancer Society Cancer Action Network, cited the experience of Arkansas, the only state to fully implement a work policy. The program lasted nearly a year, she said, before a federal judge halted it in 2019. Kalmer said the requirements resulted in the about 18,000 people disenrolling from Medicaid in the first six months.

“In Arkansas, many individuals who met an exemption category were unaware that they were exempt, while others were unable to successfully navigate work requirement reporting and lost their Medicaid coverage,” said Kalmer.

Letters that CMS sent last year to inform states of the work rule reversal cited similar concerns.

A letter to South Carolina, for example, referenced a Kaiser Family Foundation study that found 77% to 83% of disenrollments would likely be caused by simple nonreporting, based on a nationwide model.

The CMS letter said that work requirements had “only modest and temporary effects on employment, failing to increase long-term employment or reduce poverty.”

Similarly, a 2020 Harvard study reviewing the effect of Arkansas’ Medicaid work requirements on employment found the policy had failed to boost employment.

Opponents noted the requirements leave large gaps in types of employment. People with temporary or seasonal work, gig jobs or those with unpredictable or irregular hours, and other nontraditional work have reportedly been unable to consistently meet requirements, as noted in the CMS letters.

Policy costs

Debate has also centered on the cost of the policy. Though lower Medicaid enrollment decreases the cost, running the work requirement program takes significant funding, critics say.

The administrative costs in five states with approved work requirement proposals, according to a 2019 Government Accountability Office report, ranged from $6 million to $270 million. These costs would be shared between states and the federal government. At the high end, Kentucky’s estimate included significant technology updates.

But Smith said he believes those costs in Missouri “would be minimal.”

“We do already, obviously do eligibility checks, and enrollment, verification, those types of things,” he said. “I’m hopeful that we could fold additional reporting requirements into the process already.”

The legislation is House Joint Resolution 117.

 
 

 
 

Clipped from: https://www.stltoday.com/news/local/govt-and-politics/missouri-gop-again-pushes-for-medicaid-work-rules-despite-setbacks-elsewhere/article_6852134b-3fbe-51fd-a4c1-7270f5c715bc.html

 
 

Grace Zokovitch

gzokovitch@post-dispatch.com