Tag: Medicaid Reform

 
 

MM Curator summary

 
 

WA state senators are targeting multiple fixes to the state Medicaid program, with a focus on maternity care, Alzheimers patients, nursing homes and increasing the physician participation rate.

 
 

 
 

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 economic devastation accompanying the coronavirus pandemic drove Washingtonians onto Medicaid in record numbers, even as the state held back money meant to protect the lives of mothers and elderly people reliant on the publicly funded insurance.

Now, though, state legislators are looking to bolster key aspects of the state Medicaid system that has seen enrollment jump 11% during the pandemic and now insures 2 million Washingtonians. That’s more than one in five Washington residents, including nearly half the state’s children.

And then there’s COVID-19.

“COVID has really shown a light on the disparities in our health outcomes,” Sen. Emily Randall, a Bremerton Democrat serving as majority whip, told InvestigateWest. “Folks are not getting the same access to care.”

Lawmakers are proposing funding increases to:

• Close a hole in coverage that limits thousands of new mothers to only three months of postpartum care, a shortcoming that can prove fatal, according to a recent report on maternal deaths. One in 9,000 births in Washington ends with the death of the mother.
• Provide better care for older people suffering from Alzheimer’s disease and similar illnesses by raising pay rates to, it’s hoped, open up more space in assisted living apartments for people dementia insured through Medicaid.
• Slow the loss of nursing homes after dozens of homes that served people on Medicaid closed because of low state reimbursement rates.
• Entice doctors and nurses to keep seeing Medicaid patients, so the state’s poorest residents can receive basic medical care without waiting for months or driving for hours.

The pandemic’s disparate impact on people of color and those living near the poverty line exposed longstanding inequities in America’s public health systems, said Sen. Emily Randall, a Bremerton Democrat who has introduced several pieces of legislation that would expand or enhance Washington’s Medicaid system.

Legislators’ current moves to shore up the public health system come after Gov. Jay Inslee, as he faced an imploding state budget in the pandemic’s early days, vetoed millions of dollars in spending passed by the Legislature last spring. By June, Medicaid-paid dental insurance, hospice care and abortion services were all on the chopping block, as was medical care for noncitizen children.

A mild rebound in the state economy and a resulting improvement in tax revenues appears to have secured those programs for the moment. In part because of Democratic gains in Congress that state lawmakers hope will translate to increased federal funding for public insurance programs, they are looking at targeted improvements to Medicaid with state funds.

Marketed as Apple Health in Washington state, Medicaid is a publicly funded insurance program that uses federal and state money to provide free health coverage to the elderly, people with disabilities and lower-income residents, nearly 80% of whom are employed, as well as children. The $9.7 billion program currently draws $2.7 billion a year from state coffers, with the federal government picking up the rest.

Since reconvening Jan. 11, the Legislature has held hearings on bills that would increase Medicaid payment rates to primary care doctors — an effort to reduce the number of doctors dropping out of the Medicaid system — and extend postpartum coverage from 60 days to one year. Other legislation would increase payment rates to Washington’s nursing homes, which had been struggling financially even before COVID-19 ravaged the industry.

‘A healthcare cliff’

Washington has seen 25 nursing homes close since 2017, a loss of more than 1,000 beds, according to industry statistics provided by Alyssa Odegaard of LeadingAge, an advocacy organization representing not-for-profit nursing homes and assisted living facilities. That’s a significant decline for an industry serving about 18,600 people.

About 63% of nursing home residents are insured through Medicaid, and the program’s low reimbursement rates are driving nursing home operators out of business, said Odegaard, LeadingAge’s vice president for public policy.

Medicaid reimbursement rates — about $274 a day — don’t come close to covering the costs of care in Washington. That gap between revenues and expenses has created an industry-wide annual shortfall of $117 million in the state. While residents paying out of pocket or with other insurance balance the books at some homes, many operators are on the verge of shutting down.

Washington’s reimbursement rates are lower than those in Oregon and Idaho, states with less expensive operating costs. Though emergency federal funding helped keep nursing homes open during the pandemic, that shortfall is expected to deepen unless the Legislature acts, Odegaard said.

The shortfall results in a lower quality of care. Nurse salaries are the dominant cost at nursing homes, and low pay makes recruitment and retention challenging — especially at a time when a pandemic is attacking those who need care and those who care for them.

“You’re not able to attract enough staff and you’re not attracting the best staff, because you’re competing with hospitals and clinics that are paying more and offering better benefits,” said Robin Dale, president and CEO of the Washington Health Care Association, which represents for-profit nursing homes and assisted living facilities in the state.

“The state, to some degree, gets the nursing home system that it pays for,” Dale continued. “If they’re not paying an adequate rate, you’re not going to have the best nursing home that you can have.”

The money shortage means fewer nurses and nursing aides. That means nursing home residents wait longer for help. Not only that, they more often wind up hospitalized, Dale said. High turnover creates space for mistakes while leaving little room for bonds to build between nursing home staff and patients.

Bills currently before the Legislature would narrow the gap by changing the way inflation adjustments are figured and increasing reimbursement rates. Together, they would inject about $11 million of state and federal money into the system annually, compared to a 2019 total Medicaid expenditure on nursing homes of $703 million.

For older Washingtonians, the shortfall means disconnection. Residents in need of nursing care sometimes have to move into homes far from their spouses, families and friends. Hundreds of residents are also displaced each year as facilities close; about 1,300 residents have had to move due to closures since 2017.

Some nursing homes are turning away Medicaid clients to make ends meet. Particularly in rural Washington, Medicaid-insured residents increasingly have to leave their communities to find a home.

“I would like people to have the option of staying in their community, where they know people,” said Rep. Joe Schmick, a Republican from Colfax in southeastern Washington who is sponsoring legislation to change how inflation-related adjustments are calculated. “I think they do better.”

That shortfall is driving operators to stop accepting residents on Medicaid or requiring them to pay in cash for years before allowing them to use the insurance, which reimburses providers for 58% of their costs.

Inslee also vetoed a $1.4 million rate increase for facilities serving residents with dementia passed during the 2020 legislative session. Advocates hope the increase, which amounts to $10 a day per resident, will survive this session.

Extending postpartum coverage

Half of all babies born in Washington enter the world covered by Medicaid. But that medical coverage is often short-lived for the mother.

Medicaid covers any pregnant person with an income under about $34,000 a year. That’s the limit for a single pregnant person, which increases with family size. Any children born into those families would be covered, but the income limits are far lower for parents — about $23,700 a year for a single parent.

New parents currently have two to three months of postpartum coverage. That essentially ensures they are insured long enough for one post-pregnancy checkup. But more than a quarter of all pregnancy-related deaths occur more than 45 days after birth, and many birth-related ailments, particularly some postpartum mood disorders, don’t manifest themselves immediately.

Mothers and birthing fathers usually have their postpartum checkup about six weeks after giving birth, Randall said, leaving them days or a few weeks to get care before their insurance lapses.

“That’s a healthcare cliff that no one deserves,” said Randall, who is the lead sponsor on a bill that would extend coverage to a year.

Rokea Jones, a doula and outreach worker with Open Arms Perinatal Services, spends most of her time working with those patients insured through Medicaid. As a doula, she helps pregnant people prepare for childbirth, assists them during delivery, and checks up on them afterward.

Depression, anxiety, psychosis and PTSD can all occur after a birth, often to the surprise of the parent and those close to them. Jones said a longer postpartum care window would give families time to respond.

“If we can help a family identify or get the support for a postpartum mood disorder, that can really change someone’s life,” Jones said.

 
 

Rokea Jones, a doula and outreach worker with Open Arms Perinatal Services, is pictured in Renton, Wash. on Sunday, Feb. 7, 2021. As a doula, she helps pregnant women prepare for childbirth, assists them during delivery, and checks up on them afterward. (Jason Redmond/Cascade Public Media Archive)

Unlike Oregon, Washington doesn’t include doula services in its Medicaid program. The Washington Legislature nearly created a program last session — a Governor’s Office funding proposal was pulled during pandemic cost cutting — and Jones said she hopes legislation will be introduced again this session.

A booster for her profession of more than a decade, Jones said doulas can guide parents through childbirth while advocating for them when they run into the kinds of cultural and language barriers identified that are key drivers of maternal death, rates of which have more than doubled since the late 1980s.

“What we’re seeing is that there are a lot of preventable deaths, and it’s boiling down to a lack of communication,” she said. “There are some human-to-human things that are breaking down in our medical system.”

‘They just can’t take any more Medicaid patients’

Primary care — routine medical checkups and check-ins for adults and children — is another failing piece of Washington’s publicly funded health system.

Under-reimbursement by the state Medicaid program has prompted many primary care providers to stop accepting patients with public insurance. The problem is particularly acute in rural areas, where residents increasingly must wait or travel for basic medical services.

“If you have to drive an hour to find a provider who can see you, that means you’re going to be less healthy,” said Sen. Randall, who introduced legislation that would raise reimbursement rates for primary care doctors and, in a separate bill, highly trained nurses. Rep. Schmick, the ranking Republican on the House Health Care & Wellness Committee, said his own doctor recently stopped taking Medicaid patients. The practice, Schmick said, had hit its financial limit.

“They just can’t take any more Medicaid patients,” Schmick said. “And I think that’s the reality, sadly, across rural areas.”

Broadly speaking, Medicaid pay rates are too low for many providers, particularly those providing primary care, family medicine and pediatric care, said MaryAnne Lindeblad, the state Medicaid director with the Health Care Authority, which administers federally funded insurance programs in Washington.

Low reimbursement rates are also driving therapists, substance use counselors and other behavioral health workers away from the public insurance system. Schmick noted that that exodus is occurring even as there are strong
indications that the pandemic has left more Washingtonians in need of substance abuse treatment and mental health help.

Lindeblad stopped short of suggesting that more money is the solution. Rates, she said, could be adjusted to better fund areas of health care that deliver long-term benefits to patients, like primary care.

“There’s a lot of money that comes into the system,” Lindeblad said. “I’m not ready to say there’s not enough money, but perhaps we can look at how we can use those dollars more effectively.”

The 2020 legislative session’s aftermath saw a 15% increase in primary care reimbursement rates fall to a cost-cutting veto by Inslee. Randall has put forward the same bill this session, which comes at a cost of $9.9 million in state dollars annually.

Despite the difficulties the past year presented, Randall strikes a hopeful note in part because of her family’s experience with Medicaid.

Randall was 7 when her sister Olivia was born with medical issues that meant she required a wheelchair, feeding pumps and a great deal of care to live her best life. Olivia did so for 20 years.

“I can’t imagine how that would’ve been possible if she didn’t have Medicaid coverage,” the senator said.

“Our values are there,” Randall reflected. “We know that we need to get better care to people who are struggling under so many burdens, and we’re making progress.”

 
 

Clipped from: https://www.invw.org/2021/02/12/2-million-washingtonians-rely-on-a-medicaid-system-thats-driving-away-doctors-and-dropping-new-mothers/

 
 

 
 

 
 

MM Curator summary

 
 

SD’s work requirement request will not have to be un-approved, because CMS never responded to 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.

 
 

PIERRE, S.D. (KELO) — A 2018 plan by then-Governor Dennis Daugaard’s administration to have many adults in Minnehaha and Pennington counties work in return for Medicaid benefits never went forward, because the federal agency didn’t respond to South Dakota’s application.

That’s according to state Department of Social Services Secretary Laurie Gill. President Biden’s administration sent letters to states Friday halting waivers issued by the federal Centers for Medicaid and Medicare under President Trump and rescinding the offer. More than half the states applied.

There is currently no mandatory work requirement tied to the Medicaid program in South Dakota, Gill said Friday in a written statement to KELOLAND News.

“Currently, the only way a state Medicaid program can implement mandatory work requirements is to obtain a waiver from the Centers for Medicare and Medicaid (CMS). The Dept. of Social Services submitted a waiver request in July, 2018.  As of today, DSS has not yet received a response from CMS,” Gill said.

South Dakota’s Career Connector was to focus on Sioux Falls and Rapid City, the two largest cities in the state. The 32-page waiver application proposed cutting off benefits after three months of non-compliance. More than 200 pages of public comments were included in the August 10, 2018, packet.

The plan called for the state Department of Labor and Regulation to be responsible for “conducting the employment assessment, identifying the integrated resource team, developing the employment and training plan, identifying monthly milestones, tracking achievement of monthly milestones, and tracking/verifying hours worked” and to notify Social Services when a Medicaid recipient in the program didn’t fulfill the requirements.

“Closure of the participant’s Medicaid eligibility will not affect the eligibility of a child, spouse, or other household member that is not required to participate,” the application said.

An estimated 15% of the approximately 1,300 participants in the two counties would have become ineligible annually because of increased income or choosing to not participate, according to the plan, which calculated the 1,300 received approximately $9,672,000 from Medicaid in federal fiscal 2017.

Daugaard spoke about the plan in his State of the State speech opening the 2018 legislative session and distributed a governor’s column on it. After winning election in November 2018, Governor Kristi Noem chose Greg DeSautel to replace Lynne Valenti as secretary, then tapped Gill in mid-2019 following DeSautel’s resignation.

Clipped from: https://www.keloland.com/news/capitol-news-bureau/feds-never-replied-to-south-dakotas-request-to-join-medicaid-work-program-dss-secretary-says/

 
 

 
 

 
 

MM Curator summary

 
 

SC is another state that will be denied the opportunity to test their CMS-approved 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.

 
 

File/Lauren Petracca/Staff

A program approved by the Trump administration requiring South Carolina adults with Medicaid to prove that they work or participate in various community engagement activities will likely be eliminated under the new Biden administration before it even gets off the ground. 

“Healthy Connections Works” was approved by the federal Centers for Medicare & Medicaid Services in 2019, but has not been implemented to date, according to the federal government. It would have eventually required adults with Medicaid coverage in South Carolina to prove that they spend at least 80 hours a month working or engaging in other productive pursuits outside the home, such as education, job skills training or community service. 

In a letter to the South Carolina Medicaid agency dated Feb. 12, the Centers for Medicare & Medicaid Services laid out several reasons why the program was “infeasible.” 

“CMS has serious concerns about testing policies that create a risk of substantial loss of health care coverage in the near term. The COVID-19 pandemic has had a significant impact on the health of Medicaid beneficiaries,” wrote CMS Acting Administrator Elizabeth Richter. “Taking into account the totality of circumstances, CMS has preliminarily determined that allowing work and other community engagement requirements to take effect in South Carolina would not promote the objectives of the Medicaid program.” 

The state will have 30 days to submit information in favor of sustaining the work requirements. 

In the lead-up to its approval three years ago, Gov. Henry McMaster championed the plan, citing that jobs yield healthier lifestyles, financial independence and opportunity. 

“Whenever possible, we should always endeavor to help South Carolinians in need find their path to gainful employment and away from the temporary assistance of government,” McMaster said in 2018. 

 
 

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McMaster’s office did not immediately respond to questions about the federal decision on Saturday.

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Ten states, including South Carolina, approved Medicaid work requirements under the Trump administration, but Arkansas was the only state to fully implement the rules, according to Politico. 

Critics meanwhile argued the plan didn’t take into account a lack of available jobs, child care or transportation. 

Sue Berkowitz, executive director of the Appleseed Legal Justice Center in Columbia, has protested the Medicaid work requirements since they were first proposed. If the rules had been implemented, she said her group would have challenged them in court. 

“The premise that work makes people healthy was just ludicrous. No. When people are healthy, they are able to work,” Berkowitz said. “Needless to say McMaster’s office and our office have differing opinions on this. He was clearly following the lead of Trump … without doing the work of determining if this was really in the best interest of South Carolina.” 

At one point, the state Medicaid agency anticipated 180,000 adult Medicaid beneficiaries in South Carolina would be subject to the work rules, but that most of them already satisfied the requirements or would qualify for an exemption. Former S.C. Medicaid Director Joshua Baker estimated fewer than 10,000 adults with Medicaid coverage would need to look for work or risk losing their health insurance. 

Those estimates are likely low now considering the growth in Medicaid enrollment during the pandemic. Medicaid eligibility rules vary widely from state to state, and in South Carolina, existing rules make it difficult for adults without children to qualify for coverage, no matter their poverty level. Still, adult enrollment in the program has grown substantially during the COVID-19 pandemic. 

In December, more than 1.3 million South Carolinians were enrolled in Medicaid, representing a jump of about 90,000 beneficiaries since last March. About half of all Medicaid enrollees in this state are children, but largest gains in enrollment growth were observed among adults this past year.

Clipped from: https://www.postandcourier.com/health/biden-administration-likely-to-cancel-controversial-sc-medicaid-work-requirements/article_8206b49e-6dfb-11eb-9915-df24179bda51.html

 
 

MM Curator summary

 
 

Biden’s CMS has let 10 states that requested and received approval for their work requirements features that they are being un-approved.

 
 

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.

 
 

WASHINGTON — The Biden administration was planning Friday to wipe out one of the core health policies of the Donald Trump era, taking actions that will immediately rescind permission for states to compel poor residents to work in exchange for receiving Medicaid benefits.

Federal health officials will withdraw their predecessors’ invitation to states to apply for approval to impose such work requirements and will notify 10 states granted permission that it is about to be retracted, according to a draft plan obtained by The Washington Post and confirmed by two individuals familiar with the decision.

The actions anticipated Friday, outlined in bullet points in the draft, will come two weeks after President Joe Biden signed an executive order instructing officials to remove barriers to Medicaid coverage. Work requirements enabled under President Donald Trump were the one policy mentioned in Biden’s directive.

In practice, the moves have little immediate effect because work requirements adopted in three states — Arkansas, Kentucky and New Hampshire — have been ruled illegal by two levels of federal courts, and other states have held back during the legal challenges to the policy. A case on the constitutionality of such requirements is now before the Supreme Court.

Still, the swift rescinding of the Trump administration’s effort to remake the safety-net program represents a particularly sharp pendulum swing on the ideological divide over the proper roles of government and individuals living under economic strain.

Spokesmen for the Department of Health and Human Services did not respond Thursday night to a request for comment on the plan, first reported by Politico.

Medicaid, a collaboration between the federal government and states, was a pillar of the War on Poverty of the mid-1960s and is the nation’s largest source of public health insurance. For years, conservative state leaders had sporadically asked federal officials to allow them to compel some people on Medicaid to work for their benefits, but such requests always had been rebuffed.

However, in early 2018, Seema Verma, then-administrator of the Centers for Medicare and Medicaid Services, issued a letter to state Medicaid directors inviting them to apply for permission to create what she called “community engagement requirements,” in which certain people on Medicaid would need to work or participate in activities to prepare for employment. That letter is expected to be withdrawn Friday, according to the draft and the individuals who spoke on the condition of anonymity before the actions are made public.

Verma and other proponents have contended that such requirements promote economic self-reliance, eventually weaning poor people off government assistance. Undeterred by court rulings against the requirements, she advocated for them until the Trump administration ended last month. “I support innovative efforts by governors that are trying to help people, trying to lift them out of poverty and find a path forward” she told the Aspen Institute in October.

Opponents of the policy, including most Democrats, counter that insurance that helps poor people to be healthy is a prerequisite to being able to work. Unlike the federal welfare system, which has required work since the mid-1990s, they argue, health coverage should be considered a right, not a privilege that is contingent on following other rules.

In its planned announcement, the Biden administration said the requirements were especially unwise during the coronavirus pandemic, which has sickened millions of Americans and forced many out of work. The agency overseeing Medicaid “has serious concerns that now is not the appropriate time to test policies that risk a substantial loss of health care coverage or benefits,” according to the draft plan.

According to the 15-page document, the Trump administration approved work programs in 13 states, and 10 others were still seeking approval. A few withdrew when GOP governors were replaced by Democrats. Arkansas was the only state that actually implemented its requirements, and 18,000 poor residents there were removed from Medicaid rolls over several months before the program was blocked by a judge on the U.S. District Court for the District of Columbia.

Accompanying the steps to reverse the Trump policy, HHS also plans to release an analysis Friday assessing how the Trump policy limited low-income Americans’ access to health coverage, according to the two individuals familiar with the plans.

The analysis was overseen by Ben Sommers, a longtime Harvard researcher who joined HHS last month as a deputy assistant secretary for strategy and planning and had previously written about the drawbacks of Medicaid work requirements, the officials said. “[W]e found no evidence that the policy succeeded in its stated goal of promoting work and instead found substantial evidence of harm to health care coverage and access,” Sommers and colleagues wrote in a September 2020 analysis in the journal Health Affairs.

Sommers did not respond Thursday night to a request for comment.

Clipped from: https://www.unionleader.com/news/health/bidens-hhs-to-rescind-medicaid-work-requirements-nh-attempt-thwarted-by-courts/article_28c3add2-122c-5f41-abd8-0a572b72a6e3.html

 
 

 
 

MM Curator summary

 
 

Biden administration nullified the work requirements requested by GA (and approved by CMS), citing COVID as too much a barrier to compliance.

 
 

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.

 
 

 
 

October 15, 2020 Atlanta – Governor Brian Kemp and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma celebrate with fist bump after they signed on healthcare reform at the Georgia State Capitol on Thursday, October 15, 2020. The federal government approved Gov. Brian Kemp’s plan to reshape Medicaid and individual insurance in Georgia under the Affordable Care Act, the governor and a top Trump administration health official announced on Thursday. (Hyosub Shin / Hyosub.Shin@ajc.com)

The Biden administration pulled back approval of Gov. Brian Kemp’s plan to provide Medicaid coverage to thousands of low-income and uninsured adults in Georgia who meet a work or activity requirement because the still-raging coronavirus pandemic makes meeting some of the key guidelines “unfeasible.”

Federal health officials said Friday the state’s Medicaid overhaul proposal was switched from “approved” to “pending” over concerns that it’s “unreasonably difficult or impossible for many individuals to meet the community engagement requirement” in the plan in the midst of a global coronavirus outbreak.

“Taking into account the totality of circumstances, CMS has preliminarily determined that allowing work and other community engagement requirements to take effect in Georgia would not promote the objectives of the Medicaid program,” according to a letter sent to state officials by Elizabeth Richter, the acting administrator for the Centers for Medicare and Medicaid Services.

The decision could undermine the centerpiece of Kemp’s plan to reshape Medicaid in the state, which was greenlit by President Donald Trump’s top health official in October. At the celebratory press conference, Kemp declared the “status quo is simply unacceptable” as he cited the state’s lofty premium costs and high level of uninsured people — second-worst in the nation.

Kemp’s office said Saturday it was reviewing the decision by President Joe Biden’s administration, which throws into doubt the fate of his plan to allow perhaps as many as 50,000 poor and uninsured adults be added to the Medicaid rolls within two years. Kemp’s health deputies have 30 days to respond.

Advocacy groups and Democrats applauded the move and amplified calls for a full Medicaid expansion to all the state’s very poor, as envisioned by the Affordable Care Act and already carried out by 39 states. State Republican leaders say a full expansion is too costly in the long run, although some GOP elected officials have embraced the idea.

State Sen. Michelle Au, a physician and newly elected Johns Creek Democrat, said she was happy to see the “misguided work requirements” were under new federal scrutiny. And state Sen. Jen Jordan said she hoped the decision scuttled Kemp’s “half-measure” and put full expansion of the program within reach.

“This is really positive news,” said Jordan, D-Sandy Springs. “Because if we can be fiscally responsible, cover more people and make sure everyone has access to expanded health care, it would be a big step forward.”

Georgia Medicaid now mostly covers children, and some adults, such as those who’ve been declared disabled by the government. Under Kemp’s plan, other working-aged Georgians could apply but would have to meet requirements the state would impose. That might include working at a registered employer for 80 hours a month or attending college full time.

A separate Kemp waiver program also approved last year by Trump’s administration appears to remain intact. That plan amounts to a “reinsurance” plan to lower premium prices for those who buy individual insurance. If that proposal moves forward, Kemp plans to pour public money into the private insurance market with a goal to reduce premium prices for some Georgians.

Staff writer Ariel Hart contributed to this report.

WHAT IT MEANS

The decision throws into doubt the fate of the governor’s plan to allow perhaps as many as 50,000 poor and uninsured adults be added to the Medicaid rolls within two years.

 
 

Clipped from: https://www.ajc.com/politics/feds-temporarily-halt-approval-of-kemps-medicaid-overhaul/FVWZNMVD7BCYVFJIZZXIUQIJP4/