Tag: Medicaid Reform

MM Curator summary

 
 

One of the last remaining approved work requirements waivers got nullified by CMS memo this week.

 
 

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.

 
 

COLUMBUS (WCMH) — The Biden administration today overturned the Trump-era approval of Ohio’s Medicaid Work Requirement Waiver.

In a letter from The Department of Health and Human Services to the Medicaid director in Ohio, the administration wrote:

“… In light of the ongoing disruptions caused by the COVID-19 pandemic, Ohio’s community engagement requirement risks significant coverage losses and harm to beneficiaries.”

Winter virus sickening kids in summer isn’t COVID-19, children’s hospital says

The letter goes on to explain that people who need help might be harmed. The COVID-19 pandemic means that people who might be looking for job skills training and work in the future might not be able to find it, and may also have problems with access to transportation and child care.

That means they might lose their healthcare coverage to circumstances beyond their control.

The agency believed it was risky to tie work requirements to Medicaid eligibility since no one knows what long-term effects the COVID-19 pandemic will have on the economy. 

Coronavirus in Ohio Wednesday update: a new recent high of 3,393 new cases

Also, the letter indicates, people who are dealing with COVID-19 infections and long-term illness as a result of the coronavirus might really be harmed by losing Medicaid benefits.

U.S. Sen. Sherrod Brown (D-OH) agreed with the end of the policy. Brown said it had the potential to force thousands of people off of their health insurance coverage.

“We should be making it easier for Ohioans to access care, not harder – especially at a time when Ohioans are fighting against the COVID-19 global pandemic,” stated Brown in a media release. “Medicaid is a program that helps working families and burdensome work requirements create a barrier to health care for those who need it most, especially those who suffer with addiction.”

Ohio man accused of setting seven wildfires in California

Brown says Medicaid is an essential safety net program, and the implementation of work requirements would have made it harder for Ohioans to access it in a time when overdose deaths are rising.

But, being in a recovery program is one of the requirements, as Gov. Mike DeWine (R) pointed out in a statement:

“By requiring an individual to work, learn new job skills, or be involved in a recovery program, Ohioans would be providing critical assistance to individuals when they needed it while laying the groundwork for their success in the future.”

U.S. Sen. Rob Portman (R-OH) also thought the work requirement was a good thing that should remain in place. He pointed out the waiver was approved by the Trump administration in March 2019.

“Work requirements provide much-needed flexibility in the Medicaid system to provide greater well-being and self-sufficiency to individuals who are able to work while slowing the growth rate of Medicaid and thus the burden on taxpayers,” Portman said in a media statement.

Sen. Rand Paul calls suspension from YouTube a ‘badge of honor’

 
 

Clipped from: https://www.nbc4i.com/news/state-news/ohios-medicaid-work-requirement-approved-by-trump-now-overturned-by-biden/

MM Curator summary

 
 

The new CMS administration has begun a federal comment period after the state already had theirs on the approved waiver.

 
 

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.

 
 

NASHVILLE, Tenn. (AP) — President Joe Biden’s administration says it will keep a drastic overhaul of Tennessee’s Medicaid program in place while it seeks more public comment and considers what to do with the plan approved under former President Donald Trump.

In a federal court filing this week, Acting Assistant Attorney General Brian Boynton asked a judge to put a lawsuit challenging the TennCare block grant program on hold while the government reopens a 30-day public comment period. The judge signed off on the litigation pause.

The filing says the previous approval of the program under Trump remains in effect during the process. It says the federal government doesn’t know yet whether it will reverse or modify the previous decision.

Tennessee is the first state approved to receive lump sum block grant funding for its Medicaid program. But the overhaul’s fate remains unclear under Biden. The Democrat who has opposed Medicaid block-grant efforts can rescind the change, but has not taken any action on it to date. Democrats in the state, including U.S. Rep. Jim Cooper of Nashville, have urged Biden to scrap the block grant change.

“While the agency does not yet know whether the new decision will modify that prior approval decision, or the extent of any such modification, the agency believes that this procedure may narrow the issues in the case,” the Biden administration’s filing states.

In the federal lawsuit, the Tennessee Justice Center and several Medicaid recipients claim the federal government under Trump exceeded its authority in approving the proposal. The complaint also argues Trump’s administration failed to provide enough time for the public to provide feedback on the plan.

“Federal officials are now willing to reconsider, and they are inviting the public to comment,” said Michele Johnson, executive director of the Tennessee Justice Center. “It is rare that citizens have such an opportunity to affect government policy. That makes it really important that everyone who cares about health care in Tennessee take a few minutes to share their concerns about access to affordable care, medical debt, rural health, care for children with chronic illness or Tennesseans’ other health care needs.”

A TennCare official on Friday noted that the organization held its own public comment period, but also said its leaders “welcome additional input.”

“We are encouraged that CMS’ (the Centers for Medicare and Medicaid Services) action in no way delays or prevents implementation of TennCare III, and we remain full steam ahead,” said TennCare spokesperson Connor Tapp.

Supporters had pushed for the block grant, claiming it would produce flexibility and savings inside TennCare that would then fuel additional health coverage offerings. Lee, and other supporters, said the new plan would do all of this without cutting benefits or eligibility.

Currently, the federal government pays a percentage of each state’s Medicaid costs, regardless of cost increases in any given year. In Tennessee, the government pays 66%, which currently is $7.5 billion of its $12.1 billion Medicaid program.

Republicans argue the current system gives states little incentive to control expenses because no state pays more than half the total cost.

However, Democrats and health advocates have expressed concern that spending caps might cause states to purge their rolls or reduce services. They instead want to expand Medicaid eligibility, which Tennessee’s Republican leaders have declined to do under former President Barack Obama’s health care law.

Tennessee’s General Assembly passed a resolution in 2019 calling for the submission of a block grant plan for federal consideration.

Lee declared in January that Tennessee had become the first state in the nation approved for the plan. Trump’s administration signed off on the idea shortly before the president left office.

 
 

Clipped from: https://apnews.com/article/joe-biden-health-67887ccddd276783fc03c01592fce0fc

MM Curator summary

 
 

The local lawsuit opposing the approved shared-savings waiver is on hold while CMS holds another comment period in addition to the comment period the state already conducted.

 
 

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.

 
 

 
 

Tennessee Attorney General Herbert Slatery

Manuel Balce Ceneta / AP

(The Center Square) – A lawsuit challenging Tennessee’s TennCare III Medicaid block grant has been put on hold by a federal judge while a public comment period on the funding occurs.

The state became the first to have a Medicaid block grant approved when the Trump Administration endorsed the grant in its final weeks. It was then authorized quickly by the Tennessee Legislature and signed into law in January by Gov. Bill Lee.

Under the block grant, Tennessee would receive federal money for the state’s Medicaid program in one lump sum instead of periodically. State officials said doing so would allow the state more autonomy in running the program and save the state money.

The lawsuit, filed by The National Health Law Program, the Tennessee Justice Center, and King & Spalding LLP on behalf of 13 Tennessee Medicaid recipients, claimed, in part, the rushed federal approval did not allow for a required public comment period.

The U.S. Department of Health and Human Services recently reopened that federal comment period until Sept. 9. HHS granted an experimental waiver when the program was approved and did not use the full public comment period.

“By rushing the approval of the TennCare III, the Trump administration neglected to open the required public comment period, depriving Tennesseans and other interested parties the opportunity to oppose the project,” said Michele Johnson, Executive Director of the Tennessee Justice Center. “The State’s decision to radically restructure our Medicaid program would harm many low-income individuals and families, including our plaintiffs.”

Tennessee Attorney General Herbert Slatery filed a motion in May to intervene in the case to protect the interests of the state, which was granted. The matter was filed in U.S. District Court in Washington, D.C., naming the U.S. Department of Health and Human Services, the Centers for Medicaid and Medicare Services and several individuals as defendants.

“The corporate plaintiffs behind this lawsuit, who consistently sue the State, are trying to stop a significant and beneficial policy reform for our state with a federal lawsuit filed in D.C.,” Slatery said in a statement when the state intervened. “Our office is intervening to make sure Tennessee’s unique healthcare infrastructure is appropriately defended.”

The complaint is based on the block grant allowing the state to restrict prescription drug coverage, eliminate the three months’ retroactive coverage and require beneficiaries to enroll in managed-care plans, which the state has used since 1994 and more than two-thirds of Medicaid recipients nationally use.

Around 1.2 million low-income and disabled Tennesseans receive TennCare.

“As approved by the Trump administration, the TennCare III waiver contains a number of features that are at odds with how Congress has designed Medicaid coverage, affecting everything from financing and retroactive coverage to prescription drug services and managed care arrangements,” said Jane Perkins, Legal Director at the National Health Law Program. “We think the approval is rife with legal errors – including that the Trump administration approved this waiver without allowing the public to comment as required under the law. Transparency in government is critical, and we welcome this step by HHS to allow the public to be heard.”

The block grant allows Tennessee to keep half of the savings it would get from spending less than the federal allotment, money that could be used on future health care savings initiatives. Over the past five years, Tennessee saved $6 billion compared to the federal cap and will be allowed to use that funding as well.

Those savings previously could be used only against future overages of the federal Medicaid funding cap. The TennCare III funding cap will then reset in 2026 based upon how much the state has spent, per capita, between 2021-24.

“Our State has a lengthy history of mismanaging Medicaid, and the hastily approved changes to TennCare III would make it worse,” Johnson said. “That is why we are heartened by the opening of the federal comment period and the opportunity for our clients and other key stakeholders to make their voices heard regarding the harmful changes to our Medicaid program.”

Clipped from: https://www.murfreesboropost.com/news/state/court-places-tennessees-medicaid-block-grant-lawsuit-on-hold/article_8d1c74e9-7bdb-539c-bc2f-c56cf8eb3642.html

MM Curator summary

PA joins the list of states that will take additional federal money to extend post-partum care to a full year.

 
 

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.

 
 

Harrisburg, PA – The Wolf Administration today joined leadership from the legislative Women’s Health Caucus, the Maternity Care Coalition, and the Pennsylvania Health Access Network to announce Pennsylvania’s intent to extend the postpartum coverage period for mothers eligible for Medicaid because of their pregnancy.

This historic investment in the health and well-being of new mothers and their babies will allow thousands of birthing parents to continue to access physical and behavioral health care necessary to keep themselves healthy and their families on a path to good health and well-being.

“Access to health care is essential to well-being. Ending pregnancy-related coverage for mothers covered through Medicaid just 60 days after birth risks mothers going without necessary and potentially life-saving care,” said Department of Human Services Acting Secretary Meg Snead. “The first year post-birth is a critical time for the entire family’s health and well-being and this expansion will help mothers maintain relationships with care providers undisrupted. As our nation seeks to reverse rising trends in maternal mortality, this coverage can help us save lives and is a necessary investment in maternal-child health across Pennsylvania.”

Federal law requires Medicaid – or Medical Assistance in Pennsylvania – to extend eligibility for pregnant women with incomes up to 138 percent of the federal poverty level for 60 days following the birth of a baby. Under the American Rescue Plan Act, states are able to implement a new state plan option beginning April 1, 2022, to expand the Medicaid postpartum coverage period for mothers to one year following the birth of a baby.

“The expansion of postpartum Medical Assistance coverage will help improve long-term health outcomes for entire families and will help decrease the number of pregnancy-related deaths in Pennsylvania,” Acting Physician General Dr. Denise Johnson said. “Maternal mortality is devastating for families and communities worldwide, which is why maternal and child health is a priority for the state. This expansion is not only essential, but is critical to helping ensure mothers have access to important health care and is another step toward creating a healthy Pennsylvania for all.”

According to an analysisOpens In A New Window of 2018 data, the United States’ has the highest rate of maternal mortality among 10 similar nations. Maternal mortality data for 2019Opens In A New Window released earlier this year shows that the trend is growing – up to 20.1 deaths per 100,000 live births from 17.4 per 100,000 in 2018, and maternal mortality is significantly more common among Black women as compared to White and Latinx women.

Pennsylvania’s Department of Health released a report last year analyzing 457 deaths determined to be pregnancy-associated, which is defined as deaths that occurred while pregnant or within one year of the end of a pregnancy, that occurred in Pennsylvania from 2013-2018. According to the report, pregnancy-associated deaths in Pennsylvania grew by more than 20 percent from 2013 to 2018. Pennsylvania also followed national trends of higher maternal mortality among Black women and women whose births were covered through Medicaid. Medicaid covers 4 in 10 births nationally and about 3 in 10 in Pennsylvania. Medicaid was the primary payer in Pennsylvania in about 53 percent of pregnancy-associated deaths and nearly 60 percent of all pregnancy-associated deaths came between six weeks and one year after giving birth, largely outside of the 60-day limitation on coverage.

Expanding postpartum coverage for mothers covered through Medical Assistance will provide continuity in health care through a critical period in the mother’s life and a foundational time for the health and well-being of their children and furthers the Wolf Administration’s work to promote good health and strong starts for mothers and children across Pennsylvania. Since taking office, Governor Wolf has expanded access to home visiting services that support parents and young children through significant investments in home visiting program and an inclusion of home visiting services in Pennsylvania’s Medical Assistance program. This expansion will also support the work of Pennsylvania’s Perinatal Quality CollaborativeOpens In A New Window, a cross-system public-private partnership that seeks to advance maternal-child health, increasing screenings for and follow-up services for postpartum depression, and leverage perinatal health providers to improve health and wellbeing of pregnant and postpartum mothers and their children.

“Maternity Care Coalition is thrilled Pennsylvania is pursuing the American Rescue Plan’s option to extend postpartum coverage,” said Marianne Fray, CEO of the Maternity Care Coalition. “This is a significant step forward for perinatal health equity in our Commonwealth and brings us one step closer to making Pennsylvania a place where parents can birth with dignity, parent with autonomy and raise babies who are healthy, growing and thriving.”

The postpartum expansion will be available to states to take effect in April 2022. A formal declaration of intent to expand the postpartum coverage period will be submitted to the federal government once guidance is issued to states from the Centers for Medicare and Medicaid Services.

 
 

Clipped from: https://www.media.pa.gov/pages/dhs_details.aspx?newsid=735

MM Curator summary

 
 

Montana may not continue its expansion program if Biden rejects their request to include 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.

 
 

Federal health officials will likely reject Montana’s request to include work requirements for beneficiaries of its Medicaid expansion program, which insures 100,000 low-income Montana adults, state officials said.

 
 

Three years after the Trump administration encouraged states to require proof that adult enrollees are working a certain number of hours or looking for work as a condition of receiving Medicaid expansion benefits, the Centers for Medicare & Medicaid Services has reversed course under Democratic President Joe Biden.

“CMS has communicated to [the Montana Department of Public Health and Human Services] that a five-year extension of the Medicaid expansion waiver will not include work/community engagement requirements,” health officials wrote in a Medicaid waiver amendment application out for public review.

It’s unclear what that means for the future of the Montana program. In 2019, Montana lawmakers approved extending the 2015 program — the Supreme Court made the Medicaid expansion provision in the Affordable Care Act optional for states — as long as it included work requirements. Those requirements were a key condition for the moderate Republicans who joined Democratic lawmakers to muster enough votes to pass the 2019 bill over the objections of conservative GOP legislators.

The state’s position officially remains that it wants “to condition Medicaid coverage on compliance with work/community engagement requirements,” according to the amendment application. If state negotiators are proposing an alternative, they have not disclosed it.

If CMS does not approve the waiver with the work or community engagement requirements, the state health department will operate Medicaid expansion according to what is approved and await legislative review of the program, said department spokesperson Jon Ebelt.

The Montana Medicaid expansion program is scheduled to end in 2025 if the legislature doesn’t renew it. State lawmakers meet every other year, giving them the 2023 and 2025 sessions to consider changes to the popular program, which enrolls 10% of the state’s population.

Meanwhile, Republican-led lawmakers and Republican Gov. Greg Gianforte’s administration have proposed other measures designed to trim the Medicaid expansion rolls and defray costs, including raising the premiums some enrollees pay and ending a provision that allows 12 months of continuous eligibility regardless of changes in income. Those proposals are also pending federal approval, and it was in the state’s application for the 12-month continuous eligibility waiver that the status of the work requirement negotiations was disclosed.

In June, the number of Montanans enrolled in the expansion program passed 100,000 for the first time in its 5½-year history. The program provides health insurance coverage to adults who earn up to 138% of the federal poverty level, which is $26,500 for a family of four.

The negotiations between state and federal health officials involve what’s called a Section 1115 waiver amendment application to CMS, which is made when a state Medicaid program seeks to deviate from federal requirements. CMS’ deadline for acting on the application, originally submitted in 2019, was extended to Dec. 31, 2021, because of the covid-19 pandemic.

The Trump administration approved work requirement waivers in 12 other states, though no states are implementing those requirements, either because of the pandemic or lawsuits, according to research by KFF. (KHN is an editorially independent program of KFF.)

Since Biden took office, CMS has withdrawn the Trump administration’s approval of work requirement waivers in Arizona, Arkansas, Indiana, Michigan, New Hampshire and Wisconsin.

Asked to comment about the Montana negotiations, CMS officials said Medicaid is a lifeline for millions of Americans who would be put at risk by work requirements.

“The pandemic and uncertainty surrounding its long-term social, health, and economic effects exacerbate the risks associated with tying Medicaid eligibility to requirements that have been demonstrated to result in significant coverage losses and substantial harm to beneficiaries,” an unattributed CMS statement said.

Montana health department officials said in their waiver application that they expect negotiations with CMS to be finalized in the fall and the Medicaid waiver to be extended for five years starting in January. That Jan. 1, 2027, end date of the waiver, presumably without work requirements, would be subject to the state’s own 2025 sunset.

The 2019 state law granting a six-year extension to the Medicaid expansion included the condition that work and community engagement be part of it. The law states beneficiaries must work at least 80 hours each month or be engaged in a job search or volunteer work, unless they are exempt for specific reasons, such as pregnancy, disability or mental illness.

State Rep. Ed Buttrey (R-Great Falls), who sponsored both the 2019 bill and the 2015 bill that created the original Montana Medicaid expansion program, said lawmakers added the 2025 sunset so that they could assess and revise the program, if needed.

“So in a couple sessions we’ll have to take another look at the program and the federal rules and find out how things are performing and how we want to move forward.” Buttrey said.

He defended work requirements, saying the goal of Medicaid expansion has always been to create a healthy workforce to improve Montana’s economy.

State Rep. Mary Caferro (D-Helena) said work requirements can cause unnecessary hurdles for people who qualify for the Medicaid expansion program. She said that 7 in 10 Montanans who gained Medicaid coverage under the expansion are already working and that the rest can’t for various reasons, such as they are caregivers, have an illness or are going to school.

“Work requirements don’t make sense for our particular population,” Caferro said.

The disclosure of the ongoing work requirement negotiations was made in an application that seeks to eliminate 12-month continuous eligibility for Medicaid expansion beneficiaries plus a separate group of Medicaid beneficiaries with severe disabling mental illnesses.

Currently, those people are enrolled in the Medicaid expansion program for a full year regardless of changes in income or assets. The proposed change, included in the state budget passed by lawmakers earlier this year, would kick enrollees out of the program if their income rises — even if only temporarily because of a one-time payment or seasonal work.

The state also proposes increasing premium payments for certain expansion beneficiaries to up to 4% of their household income in the same waiver application that proposes work requirements.

Buttrey said the goal was to offset the costs of Medicaid so that the people benefiting from it bore some of the costs, and hopes CMS will approve the proposal.

The public comment period for the state’s waiver applications is open until Aug. 31. A legislative committee is scheduled to meet Tuesday to review the proposals.

 
 

Clipped from: https://montanafreepress.org/2021/08/05/feds-to-nix-work-requirements-in-montana-medicaid-expansion-program/