Tag: Medicaid Reform

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GA is staying strong with its plans to use work requirements to expand Medicaid, with go live in a few weeks.

 
 

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

 
 

Georgia officials say they’re still working toward a July 1 launch of the waiver plan to add more people to the state’s Medicaid program, despite a harsh initial assessment by the Biden administration.

This story also appeared in Georgia Health News

The conflict with the feds involves the eligibility requirements that Georgia proposed and that the Trump administration approved. President Joe Biden, who took office in January, and his fellow Democrats have sharply different views on Medicaid than do former President Donald Trump and many Republicans.

Georgia’s waiver says that to get Medicaid coverage, a low-income adult is required to put 80 hours a month into a job, an education program, a volunteer organization or another qualifying activity. It is strongly backed by Gov. Brian Kemp, who has called it “a ‘hand up’ for hard-working Georgians in our state who are more than deserving.”

A February letter from the federal Centers for Medicare and Medicaid Services (CMS) criticized Georgia’s policies “that condition health care coverage on meeting work or other community engagement requirements.”

The Kemp administration fired back at the CMS letter, appealing the new federal position. The Georgia letter said the waiver’s possible revocation by the Biden administration would be “an arbitrary and unlawful bait-and-switch,” and would prompt a state challenge in court.

Other states with approved work requirements got similar federal letters. Later, CMS sent letters notifying Arkansas, Michigan, New Hampshire, and Wisconsin of its final decision to withdraw work requirement waiver authorities in those states, according to the Kaiser Family Foundation.

“None of these work requirements have passed muster in the courts,” said Bill Custer, a health insurance expert at Georgia State University. “The courts have said these violate the original purpose of Medicaid.”

A CMS spokesperson told GHN on Thursday that the agency is still reviewing the Georgia plan.

The Georgia Department of Community Health, which runs Medicaid here, said Wednesday that it is “still progressing toward implementing Georgia Pathways to Coverage,” the Medicaid waiver plan that is expected eventually to cover 50,000 people.

The launch is less than a month away. Kemp health care adviser Ryan Loke told the AJC that the governor’s administration has discussed the waiver issues with federal health officials.

And CMS sent Georgia officials another letter Thursday raising doubts about a key part of a second Georgia waiver: eliminating the health insurance portal healthcare.gov in favor of a privately run set-up.

Using waiver applications, states seek federal permission to make changes in certain health care programs. But as the Georgia situation indicates, getting and keeping federal approval can depend on which presidential administration is in power.

The waiver drama comes as the federal government dangles new incentives for states to pursue a much larger enrollment increase in Medicaid through a standard expansion of the program as called for under the Affordable Care Act, something most states have done already. Georgia is one of 12 states that have decided against that expansion, with Republican political leaders citing the cost involved.

Medicaid expansion is an idea clearly endorsed by the Biden administration. Under a COVID-19 relief law, the federal government has increased incentives for the 12 holdout states to pursue a regular Medicaid expansion.

A standard expansion would give Medicaid eligibility to 480,000 to 600,000 people in the state, according to the consumer group Georgians for a Healthy Future. It’s paid for with 90 percent federal funds, higher than the rest of the Medicaid program, which in Georgia is 67 percent federally funded.

States that expand the program at this point, though, would receive an additional 5 percentage-point increase in their regular federal Medicaid matching rate for two years.

So over that time, even factoring in the costs of implementing expansion, Georgia would net $700 million under the new incentives, according to the Kaiser Family Foundation.

Medicaid currently provides health coverage to low-income and disabled residents, including about 2 million in Georgia.

Will the state fight?

If the feds reject the waiver requirements, the Kemp administration’s choices include dropping the whole plan, or battling the feds over the proposal in the courts, experts say.

Another choice would entail jettisoning the work and other requirements altogether, a move that likely would gain CMS approval. That would mean the waiver would cover many more adults – perhaps as many as 300,000 people, much higher than the 50,000 envisioned under the original waiver plan. That would have a big impact on the state budget, increasing Georgia’s costs.

And yet another alternative – and also costly – would be to fund this coverage without federal funding at all, running it as entirely a state program.

“If the governor is feeling an urgency to act and get Georgians covered, the quickest and easiest way to do that would be through Medicaid expansion,” said Laura Colbert of Georgians for a Healthy Future.

“Any attempt to implement the Pathways waiver without an official thumbs-up from CMS could put Georgia on the hook for 100 percent of the costs. That would add up quickly, likely outstripping the costs of Medicaid expansion while covering many, many fewer Georgians.”

Reinsurance plan will be spared

The Thursday letter from the feds indicated that Georgia’s proposed insurance waiver has one provision that will almost certainly get continued approval

That’s a “reinsurance” program that state officials estimate will cut insurance premiums for individual coverage by an average of 10 percent. Reinsurance aims to stabilize health insurance premiums by capping the cost that insurers incur in covering people with high medical costs.

The reinsurance provision has been embraced by both supporters and opponents of the Affordable Care Act.

But the new CMS letter showed concern over the state plan to replace the healthcare.gov enrollment system with a new online platform that people will use to sign up for insurance coverage. Under the plan, individuals would enroll directly through insurers, local brokers or agents, or through private-sector broker sites.

The Kemp administration says the 1332 Access waiver will help promote competition among insurance companies, reduce premiums and streamline enrollment for coverage.

But the letter from Chiquita Brooks-LaSure, the CMS administrator, said the state platform would be funded “by uncertain and unquantified private sector efforts, not by the state.”

She added that the regular insurance exchange, with enhanced subsidies and an extended enrollment window, is working well nationally and in Georgia. In Georgia, healthcare.gov brought in more than 67,000 new enrollees in the first 10 weeks of the special enrollment period, more than three times the number from the year before.

Laura Harker, senior health policy analyst with the Georgia Budget and Policy Institute, said Friday that “the state’s proposal to take away the most popular option for selecting a health plan—healthcare.gov—could exacerbate our state’s already high rates of uninsured Georgians and inadequate health care infrastructure. This letter from CMS is a step in the right direction to ensure no one loses access to care. The state plan is not clear on how much the private sector would invest in targeted outreach to get more people enrolled or how to ensure enrollees are not steered toward short-term or non-ACA-compliant plans that cover fewer services.”

The feds are asking Georgia for updated actuarial analysis by July 3 for the Georgia enrollment model, which is scheduled to debut in 2023.

Cody Hall, a spokesman for Kemp, said Friday that the state is reviewing the new CMS letter.

This story available through a news partnership with Georgia Health News.

Clipped from: https://thecurrentga.org/2021/06/04/kemps-medicaid-waiver-plan-marches-on-despite-sharp-criticism-from-federal-review/

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A lawsuit has been filed to force the state to move forward with expansion without funding for it.

 
 

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.

 
 

JEFFERSON CITY, Mo. — Three single moms are suing the state of Missouri after the governor decided not to expand Medicaid. But the lawsuit could impact thousands of Missourians. 

After the General Assembly voted not to fund Medicaid expansion earlier this month, Gov. Mike Parson said there was no way the state could expand. In less than three weeks, the lawsuit will be in front of the judge who will rule if Missouri has to cover those making less than $18,000 a year. 

Lowell Pearson is a public policy attorney in Jefferson City who has focused on Medicaid expansion the past three years. He filed the lawsuit against the state, representing the three mothers. 

Special session could be on horizon for Missouri lawmakers to fund Medicaid program

“The trigger to this was the state withdrawing its state plan amendments,” Pearson said. “They [the three moms] fall into a gap in the system, really. They don’t make enough money to qualify for the old Medicaid program, but they are working people.”

One of the mothers is Stephanie Doyle who has three children and makes $12 an hour working a full-time job. According to the lawsuit, Doyle suffers from severe eczema and needs two medications but cannot afford them without health coverage. 

The lawsuit decision affects not only the three women, but thousands of Missourians. 

“What we’re seeking here is an order from the court that says the state has to enroll everybody who’s eligible. So this isn’t just about the three named plaintiffs; it’s about 275,000 other people as well,” Pearson said. 

Last August, 53% of Missouri voters approved to expand Medicaid. In the budget request to lawmakers in January, Parson asked the General Assembly to fund the expansion. It was expected to cost $1.9 billion, with less than $130 million coming from the state. 

“Every other constitutional right, the government has an obligation to carry out its job to be sure that, that right is enforced,” Pearson said. 

He said the lawsuit does not order the General Assembly to come back and fund expansion, just move to allow those eligible under the new requirements into the program. 

“Whether the money runs out during the course of the fiscal year is something to be addressed down the road. But right now, what we want the court to do is to enroll these people and give them the benefits that they constitution says they’re entitled too,” Pearson said. 

Some lawmakers previously said the ballot question was invalid since it didn’t have a funding mechanism. 

“I don’t think that argument holds water,” Pearson said. “There’s absolutely no requirement in the law that a funding mechanism be included.”

The trial is set for June 18 at the Cole County Courthouse in Jefferson City. 

“There will be a trial, although I don’t expect it to look like a conventional trial on TV,” Pearson said. “I don’t think there will be any witnesses called. Really it will be the lawyers telling the judge why they should win based on those facts.”

Pearson expects a ruling before July 1 but believes the state will file an appeal.

Pearson is joined by Jefferson City attorney Chuck Hatfield in lawsuit against the state. Circuit Judge Jon Beetem is presiding over the case.

The governor’s office said Parson does not comment on pending litigation. 

Clipped from: https://fox4kc.com/news/missouri-news/ttrial-date-set-after-3-moms-sue-missouri-over-medicaid-expansion/

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The TX request for 10 year approval in its resubmission request is likely to be rejected.

 
 

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 Texas Health and Human Services Commission’s (HHSC) inclusion of another 10-year extension in its Medicaid 1115 waiver extension request is unlikely to receive approval from the Centers for Medicare and Medicaid Services (CMS), according to some experts following the waiver. If CMS approves the extension, they are likely to only grant it for 5 years.

HHSC only asked for a five-year extension in its initial waiver extension application in January 2020, but the Trump administration increased the period to ten years in its approval.

 
 

Anne Dunkelberg, associate director of Every Texan, explained how atypical the Trump administration’s 2020 extension increase was:

“That’s one of only three examples ever in the history of Medicaid waivers of a state getting a ten year extension, and all three of them were done in the last several months of the Trump administration.”

Stephen Love, president and CEO of the Dallas-Fort Worth Hospital Council, agreed. He said although 10 years would be “fantastic,” a five-year extension is more likely.

Subsections (e) and (f) of Section 1115 of the Social Security Act state that both initial 1115 waiver approvals and subsequent extensions should last three years — five at the maximum. Despite this federal statute, the Trump administration’s CMS released guidance in 2017 stating it could grant extensions of up to 10 years to “routine, successful, non-complex” extension requests.

Dunkelberg said such a lengthy extension is particularly uncommon because 1115 waivers are designed to be temporary demonstration projects. In fact, the Obama Administration’s original approval of Texas’s 1115 waiver application in 2011 was intended to be a bridge for the state to eventually expand Medicaid.

“I am not expecting that the new administration will be taking the 10-year leap, but that’s just a guess. 1115 waivers are supposed to be demonstration projects.”

“…the 10-year extension request is inconsistent with federal statute, and the Texas extension request regarding expenditure authorities is far from ‘non-complex.'”

While the state’s current waiver doesn’t expire until September 2022, federal funding for its Delivery System Reform Incentive Program (DSRIP) will run out at the end of September of this year — placing considerable urgency on a replacement plan for, or renewal of, the waiver.

DSRIP provides critical funding for the state’s uncompensated care pool, hospital reimbursements and services for its Medicaid population. Dunkelberg said uncompensated care funding is the only “immediately pressing issue” concerning the waiver.

“The only thing that was in the Trump Administration’s approval that is now lost until there’s a new agreement is the HHSC request for a brand new, $1.5 billion a year for a brand new uncompensated care pool for local health departments and local mental health authorities.”

The public comment period for HHSC’s new extension request opened on May 28 and will last until June 31. Individuals can submit their feedback on the application draft either via email or U.S. mail, or by attending one of three public meetings organized by HHSC. The lack of a public comment period was CMS’s reasoning for rescinding Texas’s previous waiver extension in April.

Dunkelberg believes some of the feedback during the public comment period will concern the abnormally long length of the extension request. Given the public’s overwhelming support for Medicaid expansion, she also thinks HHSC will receive a large number of calls to expand Medicaid instead of extending the waiver.

“It is significant and meaningful for people in Texas to be able to express that both to HHSC and to the feds, and say, ‘Uncompensated care pools are great when you have the worst uninsured rate in the country, and we don’t have any problem paying better Medicaid rates either.'”

Following HHSC’s public comment period and its submission of the extension request to the federal government, CMS will hold a second, federal public comment period prior to its decision. 

“Under the federal law, there’s a thirty day minimum period that states can take public comment. So that’s comment from people — mostly in Texas, presumably — to the agency, which is supposed to be taken into account by the agency before they submit their request for extension to federal Medicaid. And then there will be another federal public comment period before the feds make their decision about whether or not to approve it.”

The timeline for CMS’s decision on the waiver isn’t set in stone, Dunkelberg explained.

“Typically, on everything that’s related to waivers, there’s usually a whole lot of informal back-and-forth, and question asking, and stuff like that. So how long it takes, in part, depends on how complicated or controversial things are.”

 
 

Clipped from: https://stateofreform.com/featured/2021/06/another-10-years-for-texass-1115-waiver-experts-say-its-unlikely/

 
 

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Nevada is close to passing a law that would begin a multi-year process to establish a system for managed care-run public option plans.

 
 

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 state will bid out the business to private insurance carriers instead of doing the work in-house. Medicaid managed care organizations will be required to submit a bid.

 
 

 
 

Nevada’s plan to launch a public option health plan hinges on participation from the state’s Medicaid managed care organizations.

After passing both houses of the legislature, Democratic Gov. Steve Sisolak told reporters Tuesday he will sign the bill that will likely crown Nevada as the second state to pass a public option — a government-run plan that promises to lower premiums and increase access to care by creating an additional insurance option for residents.

To achieve its aims, Nevada’s public option plan requires premiums to be 5% lower than the benchmark silver Affordable Care Act plan in each ZIP code and, ultimately, premiums must be reduced by 15% over a four-year period. At the same time, reimbursement to providers must not go below Medicare rates.

Coverage under the public option would begin in 2026. The bill is just the beginning of a process in which Nevada will seek a waiver from the federal government to enact the public option plan. In short, the state is asking to capture the savings it may generate for the federal government.

Similar to other public health programs, the state of Nevada will bid out the public option business to insurance carriers instead of doing the work in-house. The state will rely heavily on Medicaid managed care organizations, at least at first, as it tries to spur participation.

“As a condition of continued participation in any Medicaid managed care program,” Medicaid MCOs will be forced to offer a public option plan if they want a Medicaid contract with the state, according to the bill sponsored by a Democratic state senator and Nevada’s majority leader, Nicole Cannizzaro, which passed the body earlier this week.

The bill says Medicaid MCOs must submit a “good faith proposal,” in response to an eventual RFP.

Sabrina Corlette, a research professor at Georgetown’s Center on Health Insurance Reforms, said she “assumed they wanted a guaranteed pool of potential bidders for the public option. Maybe they were afraid that if they didn’t require some bidders, they might not get any.”

Currently, there are three Medicaid MCOs in the state of Nevada: Centene, UnitedHealthcare and Anthem Blue Cross Blue Shield.

None of the companies responded to a request for comment.

The Nevada bill comes at a time when there is a renewed interest at the federal level for a public option plan, and a push from a handful of other states interested in creating an affordable health plan option for residents who have found themselves ineligible for Medicaid but unable to afford a marketplace plan.

Washington was the first state to implement a public option plan, which went live this year. 

President Joe Biden is a proponent of a public option plan — instead of “Medicare for All” — as it would build on the ACA, a law he helped usher in under former President Barack Obama, instead of dismantle it.

The insurance lobby is strongly opposed to a public option and previously expressed concern over Nevada’s plan via an opposition letter dated May 3 and addressed to Cannizzaro and the state’s Health and Human Services Committee.

AHIP, America’s Health Insurance Plans, took aim at the way in which the bill requires premiums for the public option plan to be lower than certain competitive plans on the exchange. AHIP characterized it as arbitrary “government rate setting.”

The tactic of prodding insurers into offering a separate business line in a specific state is not new.

The exchanges, launched under the ACA, relied on insurers to voluntarily sell plans to a relatively new market. At times, some counties were at risk of having no exchange plan at all. Some states tried to alleviate this problem by creating incentives for Medicaid MCOs if they also offered an exchange plan.

In a more extreme example, New York banned insurers from providing plans to any other program, including Medicaid, if they exited the exchange, according to a 2017 executive order from Gov. Andrew Cuomo.

Over time, the exchanges have become a core business for Medicaid MCOs.

Selling exchange plans is a complementary business for Medicaid MCOs that traditionally contract with states to care for Medicaid-eligible members. By selling exchange plans, Medicaid MCOs attempt to attract the Medicaid members they were serving as they churn off the program as their income fluctuates. It’s a key strategy for players like Centene.

However, if they’re forced to participate in the public option plan they will have to undercut their own premium prices on the exchange.

In Nevada, UnitedHealthcare and Centene command the largest market share on the exchange, according to the Kaiser Family Foundation.

Clipped from: https://www.healthcaredive.com/news/medicaid-insurers-at-heart-of-nevada-public-option-plan/601084/

 
 

 
 

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Medicaid beneficiaries in the new Nebraska expansion group will get dental, vision and OTC drug coverage without having to meet any volunteer or wellness 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.

 
 

 
 

LINCOLN, Neb. — State officials are dropping plans for a two-tier system to cover voter-approved Medicaid expansion in Nebraska.

The Nebraska Department of Health and Human Services (DHHS) announced Tuesday that all Nebraskans covered by the expansion will get a full range of benefits starting Oct. 1, the Omaha World-Herald reported. The announcement is a change from the earlier plans of Gov. Pete Ricketts’ administration to offer a two-tier system that would include a “basic” plan covering physical and behavioral health care services and a “prime” plan that would also cover dental, vision and over-the-counter drugs.

The two-tiered system would not have applied to those who receive benefits through the traditional Medicaid program, only those who qualify for the expanded coverage.

To qualify for prime coverage, recipients would have been required to meet work or volunteer benchmarks or participate in educational or job-training programs. They also would have had to meet with a health care provider for a wellness assessment.

Tuesday’s announcement means the state will provide the full range of benefits without the additional requirements.

The Trump administration approved Ricketts’ two-tier plan last year, prompting a lawsuit by advocacy group Nebraska Appleseed. But President Joe Biden’s administration made clear early this year that it would not approve the system.

It’s unclear how Tuesday’s announcement will affect Nebraska Appleseed’s lawsuit, but a hearing in the lawsuit was set for Monday.

Voters expanded Medicaid through a 2018 ballot measure, but the state Health and Human Services Department stalled implementation of it for nearly two years — the longest delay in the nation among states that have expanded the program. Activists placed the measure on the ballot after years of failed attempts to expand Medicaid in the Republican-dominated Legislature and strong opposition from the state’s GOP governors.

The expansion extends coverage to able-bodied, working-age adults who earn too much to qualify for regular Medicaid but too little to be eligible for tax credits to help them buy health insurance under the Affordable Care Act.

 
 

Clipped from: https://nebraska.tv/news/local/state-officials-drop-plans-for-2-tier-medicaid-system