Tag: Medicaid Reform

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As relief stalls, restoring Medicaid for Dubuque’s Marshallese is hanging in the balance

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Funding for Medicaid services in the Marshall Islands may resume at higher levels under the latest coronavirus relief bill.

 
 

 
 

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.

 
 

Clipped from: https://kwwl.com/2020/12/23/as-relief-stalls-restoring-medicare-for-dubuques-marshallese-is-hanging-in-the-balance/

DUBUQUE, Iowa. (KWWL) —– It’s Wednesday night, December 23rd, 2020. Two days ago, leadership in the U.S. House and Senate passed a coronavirus relief bill. Americans are waiting for details of long-awaited relief to be cemented.

For the Marshallese community, the wait for relief has lasted over 20 years.

Maitha Jolet is a Marshallese man living in Dubuque. He’s been watching national cable news, wishing for the moment the bill passes.

“[The pandemic] is really hard for the Marshallese community,” said Jolet.

Within the federal COVID-19 relief bill text, a proposal: restoring Medicaid eligibility for the roughly 30,000 migrants from the Marshall Islands who now live in the States.

U.S. troops took control of the Islands from the Axis powers near the end of World War II. U.S. nuclear testing started after the war, forcing migrants out.

Doctors think the testing resulted in staggeringly high rates of pre-existing conditions, including diabetes and heart disease.

This puts Islanders at extremely high risk for COVID-19 complications. Marshallese people make up less than 1% of the county’s population. By summertime, more than 20% of the county’s COVID-19 deaths were among Marshallese.

The community reacted, working fast with outreach groups, physicians and translators to get Marshallese connected to the care they needed, according to Kelly Larson, director for Dubuque’s Human Rights department.

“Pre-existing conditions — things that people from the Marshall Islands experience —- come from us having bombed their islands,” Larson said.

A pact between these Pacific islands and the U.S. (called COFA) gave the Marshallese the freedom to live and work in the U.S. In return, the States could sustain military presence there.

In 1986, the U.S. promised migrants eligbility for Medicaid coverage. Then, when Medicaid was reformed in 1996, the promise was broken.

 
 

Maitha Jolet

Jolet hopes the decades-long struggle will end soon.

“The government still owes people for what has been done,” Jolet said. “One of my friends’ wife, she died from the COVID. And he showed me the bill. The bill is around $114,000.”

“Something is not right. We are in poverty. We don’t have money.”

Two days before Christmas, Jolet waits with all of us for relief to be certain.

 
 

 
 

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State still waiting to hear word about Medicaid waiver

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Tennessee has not given up his efforts to get its first-of-a-kind Medicaid block grants approved by CMS.

 
 

 
 

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.

 
 

 
 

 
 

Clipped from: https://www.johnsoncitypress.com/news/state/state-still-waiting-to-hear-word-about-medicaid-waiver/article_d9f456e2-448a-11eb-b3a2-5bd255df0d79.html

 
 

State Sen. Jon Lundberg, R-Bristol.

Tennessee officials are hoping to get a response soon from the federal government regarding the state’s year-old request for a block grant waiver from the Centers for Medicare and Medicaid Services.

The proposal would amend the way the state distributes its Medicaid dollars through the TennCare program.

In November 2019, Tennessee became the first state to submit a block grant waiver to the federal authority under a new law approved by the state General Assembly.

State Sen. Rusty Crowe, R-Johnson City, said under this amendment, Tennessee is asking to convert the federal share of its Medicaid funding, which totals more than $7.9 billion annually, into a block grant to “provide core medical” services under TennCare.

“The goal is to provide the state an opportunity to address the specific health care needs of all Tennesseans, while lowering costs and increasing access to patient-centered care,” said Crowe, who presides as chairman of the state Senate Health and Welfare Committee.

If an agreement is reached between the state and federal governments on the waiver, Crowe said the plan will come back to Tennessee lawmakers for a final vote during the 2021 legislative session. The 112th session of the state General Assembly is scheduled to convene on Jan. 12.

Repub-licans, who hold a supermajority in the General Assembly, say the waiver gives Tennessee more flexibility to supervise its Medicaid programs while also providing the state with an opportunity to rein in spending.

“Tennessee has completely different health care needs across its nearly 500-mile span,” state Sen. Jon Lundberg, R-Bristol, said Tuesday. “This will give us a better opportunity to disperse those Medicaid dollars to meet those needs.”

Lundberg said the state officials are hoping to hear word of the waiver before President Donald Trump leaves office.

“We really don’t know how the new administration will react,” Lundberg said.

Officials say approval of the Medicaid waiver has been delayed as federal authorities have asked the state for more details to clarify the proposal.

In the meantime, recommendations from a legislative panel appointed to study possible changes to the state’s Temporary Assistance to Needy Families Program is expected to be considered by the General Assembly in 2021. Tennessee has $741 million in unspent funds from the federal block grant program that supports Tennessee’s Families First program.

Families First provides support to Tennessee families in need of child care assistance, temporary cash assistance, transportation and job training.

“Discussions on how to best allocate the unspent funds were interrupted by COVID-19 last session,” Crowe said.

The Johnson City senator said he will sponsor legislation to require the state’s Department of Human Services submit an annual report to the General Assembly that includes information pertaining to TANF program. Crowe said that report would give details of organizations receiving TANF funds, and how recipients are spending those dollars.

 
 

 
 

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Work Requirements Can Preserve Medicaid For Those Who Need It Most

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The author of this Forbes op-ed argues that ACA underprojections and the rich FMAP for expansion enrollees has created a moral hazard for state programs that results in disadvantaging disabled Medicaid enrollees.

 
 

 
 

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.

 
 

 
 

 
 

Clipped from: https://www.forbes.com/sites/sallypipes/2020/12/21/work-requirements-can-preserve-medicaid-for-those-who-need-it-most/?sh=127720f841ca

 
 

A view of the front portico of the United States Supreme Court building in Washington, DC.

 
 

This month, the U.S. Supreme Court agreed to hear a case early next year that will decide whether states have the power to impose work requirements as a condition of receiving Medicaid benefits.

The question before the high court is a legal one. But as a matter of policy, work requirements are a great way to rein in Medicaid’s out-of-control spending and preserve the program’s scarce resources for the truly needy.

Several states—including Kentucky, Arkansas, and New Hampshire—have pondered work requirements in hopes of limiting Medicaid enrollment, which has exploded in recent years. The program was created more than a half-century ago to provide health insurance to the poor, disabled, and pregnant women. But as of July, it covered nearly 69 million people. That’s roughly one in five Americans.

About 12.4 million of those enrollees signed up through Obamacare’s expansion of the program to everyone with income below 138% of the federal poverty line, or roughly $17,600. That includes the able-bodied. To date, 38 states and District of Columbia have signed onto the expansion.

Many states thought expanding Medicaid would be a great deal. After all, Obamacare bound the federal government to pay 90% of the cost of covering the expansion population.

Even with that hefty assist, several states are struggling with their Medicaid tab.

For starters, many more people have signed up than the states projected. In 2017, the Foundation for Government Accountability investigated enrollment of the expansion population in 24 states as of 2015 and 2016—and found that it was more than double what the states expected.

Medicaid has long been the 800-pound gorilla in state budgets. States cover a little over one-third of the more than $600 billion the country spends on the program each year. Together, Medicaid and the related Children’s Health Insurance Program account for nearly 30% of state spending. They’re the second-largest line item in state budgets.

Every dollar that goes toward a new, able-bodied Medicaid beneficiary is a dollar that can’t go toward other state responsibilities like public safety or infrastructure.

And thanks to the pandemic-induced economic downturn, those tax dollars are harder to come by. According to a Kaiser Family Foundation survey, 17 of 19 states with budget projections for 2021 reported a Medicaid budget shortfall was “nearly certain” or “likely.”

Work requirements can help states preserve their Medicaid resources for the program’s original beneficiaries—the impoverished and disabled—by nudging the able-bodied on the path to self-sufficiency. Research from the Buckeye Institute has found that work requirements can increase lifetime earnings close to $1 million for individuals who eventually transition off Medicaid.

It’s far better for taxpayers—and would-be Medicaid beneficiaries themselves—to get insurance through their jobs or to accumulate enough income to pay for coverage on their own.

Further, by tightening eligibility for the program, work requirements can make it easy for the program’s legacy beneficiaries to secure care.

Medicaid pays doctors and hospitals less than Medicare or private insurance. So healthcare providers often limit the number of Medicaid patients they’ll see. About 70% of providers accept Medicaid, according to a national survey from 2015. Eighty-five percent accept Medicare, and 90% private insurance.

Expanding Medicaid has created additional competition for scarce appointments. That can mean legacy beneficiaries have to wait longer than they would have pre-Obamacare.

States’ limited resources—and the higher payments they receive from the federal government for expansion enrollees—can cause them to de-emphasize the needs of disabled enrollees, for whom they bear more of the cost. A study from the Foundation for Government Accountability found that nearly 250,000 disabled individuals were on waiting lists for Medicaid care as of 2016 in states that had expanded the program to able-bodied people.

Other government programs for the poor, like the Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families, have employed work requirements with great success. When the Clinton administration required single parents to work or seek work to receive TANF, childhood poverty plummeted, and employment soared in the years that followed.

Medicaid was created to help the needy, not those who should be able to take care of themselves. Requiring able-bodied adults to seek employment in exchange for taxpayer-funded health insurance shouldn’t be controversial. It should be common sense.

 
 

 
 

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DHHS childhood reading program gains $3 million in federal Medicaid funding

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The NC Reach and Read program just got more funding to partner with pediatricians to encourage early childhood reading.

 
 

 
 

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.

 
 

 
 

Clipped from: https://journalnow.com/news/local/dhhs-childhood-reading-program-gains-3-million-in-federal-medicaid-funding/article_dfc922b2-4527-11eb-86d9-13970d4be00e.html

 

 
 

Richard Craver

A federal Medicaid program is providing just more than $3 million in funding for the state’s early childhood program known as Reach Out and Read.

The program will be conducted by the N.C. Department of Health and Human Services with matching funds.

DHHS said the reading initiative is one of the first in the country among state Medicaid programs.

The goal is improving literacy and language comprehension through participation from low-income children who would be eligible for Medicaid or the federal Children’s Health Insurance Program 

Meanwhile, the federal Centers for Medicare and Medicaid Services said the program has proven in other states to have improved patient-clinician relationships and well-child visit attendance.

“Expanding Reach Out and Read recognizes that children’s healthy development and early literacy are intertwined,” Dr. Mandy Cohen, the state’s health secretary, said in a statement.

“This program meets families where they are and through people they trust.”

Reach Out and Read partners with pediatric primary care locations to deliver training for medical providers, literacy tools for families, and to encourage healthy routines and relationships through shared stories.

 
 

 
 

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CMS finalizes rule for greater pricing flexibility for Medicaid drug purchases

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CMS has begun the process to define value based purchasing arrangements for drugs in the Medicaid program, with a focus on the value delivered by a drug to the individual patient. One key change to regs is to allow manufacturers the ability to report multiple best prices.

 
 

 
 

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.

 
 

 
 

Clipped from: https://www.benefitspro.com/2020/12/23/cms-finalizes-rule-for-greater-pricing-flexibility-for-medicaid-drug-purchases/

New value-based pricing approaches could save up to $228 million in federal and state dollars through 2025.

 
 

 
 

The final rule codifies a broad definition of VBP, which can better align pricing and payment to observed or expected evidence and/or outcomes-based measures in a targeted population. (Image: Shutterstock)

States, private payers and manufacturers now have more flexibility to enter into value-based purchasing (VBP) arrangements for prescription drugs under Medicaid. The Centers for Medicare & Medicaid Services on Monday finalized regulatory changes to modernize Medicaid prescription drug purchasing and drive payment innovation.

“Rules on prescription drug rebates and related reporting requirements have not been updated in thirty years and are thwarting innovative payment models in the private sector,” CMS Administrator Seema Verma said. “Medicaid’s outdated rules have consistently stymied the ability of payers and manufacturers to negotiate drug reimbursement methods based on the actual outcome of the treatment. A new generation of approaches to payment methods is needed to allow the market the room to adapt to these types of curative treatments while ensuring that public programs like Medicaid remain sustainable and continue to receive their statutorily required discounts.”

Related: Drug pricing legislation and the impact on self-insurers’ pharmacy spend

Under current regulations, prescription drug manufacturers face challenges accounting for VBP arrangements in their Medicaid best price reporting to CMS. This has the unintended consequence of hindering providers, insurers and prescription drug manufacturers in their efforts to develop innovative payment models for new drug therapies and other innovative treatments. Current regulations also discourage payers and manufacturers from designing new payment arrangements based on the value their product may provide.

With the new flexibilities under this final rule, manufacturers are expected to be more willing to negotiate with payers, including Medicaid, with
drug pricing being driven by the value of their drug to the individual patient.
New genetic-based treatments initially may be expensive but in the long run offer significant value to the patient and payer.

Payers will be able to negotiate prices with manufacturers for these genetic-based treatments based upon outcomes and evidence-based measures such as reduced hospitalizations, lab visits and physician office visits, ensuring that if such measures fail to support the value of a drug, the payer is not held accountable for the full price.

The final rule codifies a broad definition of VBP, which can better align pricing and payment to observed or expected evidence and/or outcomes-based measures in a targeted population. The final rule also allows manufacturers to report multiple best prices instead of a single best price when offering their VBP arrangements to all states. By making these changes, effective in January 2022, CMS hopes to encourage VBP arrangements and negotiations to help make new, innovative therapies more available to all patients. As a result, it is estimated that these new

VBP approaches could save up to $228 million in federal and state dollars through 2025. Basing payment on the effectiveness of a given therapy can foster innovation in the treatments that are most beneficial to patients, while reducing overall health-care spending and hospital visits. When payers are positioned to be stronger negotiators with drug manufacturers, Medicaid beneficiaries will benefit from better access to prescription medications.

 
 

 
 

 
 

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U.S. Supreme Court takes Medicaid work-requirement appeal with N.C. implications | Local News | journalnow.com

 
 

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North Carolina Medicaid expansion is tied to whether the state can have a work requirement, so the upcoming SCOTUS decision has a large impact on the TarHeel state.

 
 

 
 

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.

 
 

 
 

 
 

 
 

Clipped from: https://journalnow.com/news/local/u-s-supreme-court-takes-medicaid-work-requirement-appeal-with-n-c-implications/article_d3905850-4228-11eb-9bfb-abb4c897576c.html

 
 

One potential North Carolina path to Medicaid expansion — a controversial work requirement — has reached the U.S. Supreme Court.

Medicaid covers 2.2 million North Carolinians, with projections of expansion adding between 450,000 and 650,000 residents.

The justices are expected to review during their spring session the 3-0 D.C. Circuit Court ruling from February against work-requirement laws passed by Arkansas and New Hampshire.

The separate state cases have been consolidated by the Court.

Arkansas’ law placed a work, education and/or public service requirement on certain Medicaid recipients to qualify for benefits.

The N.C. General Assembly has not advanced a similar Medicaid-expansion work-requirement bill sponsored by Rep. Donny Lambeth, R-Forsyth, despite begrudging Democratic support.

Why? Because of intense Senate Republican opposition led by Senate leader Phil Berger, R-Rockingham.

Berger and other GOP legislative leaders claim the federal government could end its 90% match on additional administrative costs for expansion.

They also oppose an annual $758 million assessment that the state’s hospitals and health-care systems have agreed to provide to help cover the state’s 10% expense share.

However, several public-health advocates, as well as Lambeth, have said the GOP warning is unfounded.

Berger’s opposition carries more weight than similar Medicaid expansion scenarios in Idaho, Missouri, Nebraska and Utah because North Carolinians do not have the ability to initiate statewide ballot referendums.

As a result, there’s not much optimism that a favorable decision by the conservative-leaning U.S. Supreme Court on the work requirement would persuade senior GOP leadership to support Lambeth’s bill.

“The only potential option for any productive discussion on allowing access to Medicaid for North Carolina is some form of a work requirement,” Lambeth said.

Yet, Lambeth acknowledged that “even with that being allowed, it will be a very difficult decision for North Carolina going forward.”

Lawsuit background

The Trump administration’s Department of Health and Human Services approved changes in March 2018 to Arkansas’ Medicaid policies that allowed the state to add a work requirement for “able-bodied” individuals between ages 19 and 64.

The Affordable Care Act makes Medicaid available to households with incomes below 138% of the poverty line, or nearly $36,000 for a family of four. Arkansas’ waiver lowered the income level to qualify, thus reducing the number of eligible beneficiaries.

Residents in Arkansas and Kentucky sued U.S. DHHS in August 2018, claiming the agency acted “in an arbitrary and capricious manner” when approving the work requirements.

The three-judge appellate panel affirmed the D.C. District Court’s ruling that the agency “failed to analyze whether the (Medicaid work) demonstrations would promote the primary objective of Medicaid — to furnish medical assistance.”

Kentucky ended its Medicaid work requirement in December 2019, shortly after the election of Democratic Gov. Andy Beshear.

Lambeth had expressed confidence for several years that his Medicaid legislation — the latest version being House Bill 655 — has bipartisan support even with the work requirement.

HB655 stalled in the House Rules and Operations committee in September 2019 after Lambeth agreed to make a few changes and consider others requested by Democrats.

There are 36 states, though only Virginia in the Southeast, that have expanded their Medicaid program.

The Missouri and Oklahoma legislatures have adopted expansion, but it hasn’t been implemented.

Another path?

The 2019-20 N.C. budget stalemate hinged on Gov. Roy Cooper’s veto of the legislation, chiefly because the GOP budget does not include a form of Medicaid expansion and also contains a lower pay-rate increase for public school teachers than Cooper proposed.

Centers for Medicare and Medicaid Services has said it will not consider any Medicaid expansion waiver unless it has been passed by a state legislature.

With Cooper’s re-election and the Republicans maintaining their advantages in both chambers — Senate 28-22 and House 69-61 — there’s a significant likelihood that there could be gridlock on Medicaid expansion during the 2021-22 session.

That reality is a major reason behind a bipartisan push behind the N.C. Council on Health Care Coverage, which held its second of four scheduled meetings Friday.

Cooper and state Health Secretary Dr. Mandy Cohen are among the 44 participants that include five representatives with Triad ties: Lambeth; Sen. Joyce Krawiec, R-Forsyth; Winston-Salem businessman Don Flow, owner and chief executive of Flow Automotive Cos.; Sen. Gladys Robinson, D-Guilford; and Gene Woods, president and chief executive of Atrium Health, the not-for-profit parent of Wake Forest Baptist Medical Center.

The council features other members from the state’s health care, business and nonprofits sectors, as well as members of the Cooper administration and legislators from both sides of the political aisle.

The council focused on Medicaid expansion during the first virtual meeting on Dec. 4.

During Friday’s second meeting, some strategies discussed have conservative-backing, such as Association Health Plans for small businesses and reinsurance program.

Some are overall neutral, such as pursuing more innovation waivers through CMS.

Some are liberal leaning, such as increasing coverage for pregnant and postpartum women, and for parents with foster children. 

Also a priority: increasing access to, and coverage of, behavioral health services, in particular for individuals with intellectual and development disabilities.

“I think that there are core principles that we can agree to, like the fact that more people in North Carolina deserve health insurance,” Cooper told The Associated Press.

“This is not just purely a Medicaid expansion issue.”

Forecasts

Mark Hall, a public-health and law professor at Wake Forest University, said the Court could clarify what authority the federal government has to authorize individual-responsibility requirements for Medicaid enrollees.

 
 

 
 

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HHS Proposes New Prior Authorization Rules for Medicaid, CHIP and Certain Marketplace Plans – Manatt, Phelps & Phillips, LLP

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A new federal DHS rule will require payers to implement technology that reduces complexity and delays associated with prior authorizations in Medicaid, CHIP and exchange coverage. This rule also would add new requirements and clarifications related to the Interoperability Rule finalized in May 2020.

 
 

 
 

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.

 
 

 
 

 
 

Clipped from: https://www.manatt.com/insights/newsletters/manatt-on-health/hhs-proposes-new-prior-authorization-rules-for-med

 
 

On December 10, the U.S. Department of Health & Human Services (HHS) released a Proposed Rule with the goal of “making the prior authorization process less burdensome for payers and providers, and in turn, avoiding care delays for patients.” In addition, HHS proposes to build on the Interoperability Rule released in May 2020 by significantly expanding the circumstances under which healthcare payers must make data available in a standardized fashion via Application Programming Interfaces (APIs). (See here for Manatt’s June 2020 white paper on consumer digital health privacy, which addresses these API requirements and other issues.)

The Proposed Rule would apply to the following “impacted payers”:

  • Medicaid and CHIP programs, including both fee-for-service programs and managed care plans.
  • Qualified health plans offered on the Federally Facilitated Exchanges (FFE QHPs). Unlike the Interoperability Rule, the Proposed Rule would not affect Medicare Advantage plans or commercial plans offered on State-Based Exchanges.

If finalized, the Proposed Rule would take effect in 2023, and could require impacted payers to make significant updates to their existing technology and prior authorization procedures.

HHS has solicited public comments on all aspects of the Proposed Rule, and also on a variety of other issues related to prior authorization procedures. Comments are due by January 4, 2021. This timeline is significantly shorter than is typical for proposed rules, and suggests that the Trump Administration may be hoping to finalize the rule before President Trump leaves office.

What Are the Proposed Rules Regarding Prior Authorization?

If finalized as proposed, the following requirements would apply starting in 2023 with respect to prior authorization procedures for all services except prescription drugs. HHS has proposed to allow exemptions or extensions, however, for impacted payers that meet certain requirements.

  • Electronic requests and responses. Medicaid, CHIP and FFE QHPs would be required to implement APIs that: (1) allow providers to identify in advance each payer’s prior authorization requirements, including the list of services that require prior authorization and the documentation needed to request it; and (2) offer a HIPAA-compliant mechanism for providers to electronically send prior authorization requests and receive responses through the provider’s electronic health record (EHR) platform.
  • Tighter time frames. Medicaid and CHIP (but not FFE QHPs) would be subject to stricter time frames for responding to prior authorization requests. Specifically, Medicaid and CHIP payers would be required to provide notice of prior authorization decisions:
     

 
 

  • For expedited decisions, no later than 72 hours after receiving a request (consistent with existing standards for Medicaid managed care and CHIP);
  • For standard decisions, no later than seven days after receiving a request (down from the current limit of 14 days in Medicaid managed care and CHIP).
  • Reasons for denials. When denying prior authorization, Medicaid, CHIP and FFE QHPs would be required to provide a specific reason for the denial (e.g., a determination that necessary documents were missing, the service was not medically necessary or the patient has exceeded applicable service limits).
  • Increased transparency.
     

 
 

  • Information on pending and approved prior authorization requests would need to be made available to patients and providers through the Patient and Provider Access APIs (described below).
  • Impacted payers would be required to publish certain prior authorization data, including the list of services that are subject to prior authorization, the payer’s average and median response times for prior authorization requests, and the percentage of requests that were denied or approved, as well as information on appeals and extensions of time.

How Does the Proposed Rule Interact With the May 2020 Interoperability Rule?

  • Enhanced Requirements for the Patient Access API. The Interoperability Rule requires payers to make various types of clinical, claims and encounter data available to patients through a “Patient Access API.” The Proposed Rule would add new requirements for these Patient Access APIs, which are generally consistent with HHS’s existing guidance regarding API development and procedures for vetting the security of third-party apps that patients might use to access their data. In addition, the rule would require impacted payers to report quarterly on certain metrics regarding API data requests.
  • Two New APIs for Data Exchange. Over and above the Patient Access API, HHS proposes to require that Medicaid, CHIP and FFE QHPs implement a Payer-to-Payer API to facilitate data transfers when a patient switches payers, and a Provider Access API that allows providers to access data on their patients in real time.

Conclusion

HHS is proposing to enhance the ability for patients and providers to access payer-held data and to communicate with payers about prior authorization. These proposals would, however, require new compliance activities for Medicaid and CHIP programs as well as commercial plans offered on the Federally Facilitated Exchanges. Stakeholders interested in expressing their views on these proposals should be sure to submit their comments before the January 4, 2021 deadline.

 
 

 
 

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Opinion: Medicaid expansion states less prepared for COVID-19

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.

 
 

 
 

Curator summary

Medicaid expansion contributed to increased shortfalls in hospital revenues (because of lower reimbursement)- and led to a bed-shortage in expansion dates during the COVID pandemic.

 
 

 
 

Clipped from: https://www.detroitnews.com/story/opinion/2020/12/08/opinion-medicaid-expansion-states-less-prepared-covid-19/6494763002/

As I scrolled through Twitter Monday morning, a news headline caught my attention: “Southern Colorado Hospitals Reach ICU Bed Capacity As COVID Hospitalizations Continue To Rise.”

Indeed, from New York to New Mexico, the ability of hospitals to house additional COVID-19 patients across the country is a major concern.

Unfortunately, this is less a feature of the COVID-19 pandemic, and more a symptom of how hospital bed capacity has diminished quietly over the past two decades.

 
 

According to data from the American Hospital Association, the number of hospital beds per thousand persons fell by more than 16% between 2000 and 2017. Some states have seen double-digit declines in bed space over the past five years alone. This problem was brewing long before the virus hit U.S. soil.

However, some states have weathered the crisis better than others. States entering into this pandemic with greater hospital bed capacity have had an advantage.

Contrary to popular myth, states that expanded Medicaid under Obamacare have been faced with greater constraints on hospital and ICU beds, while non-expansion states have been better equipped to confront the pandemic with more capacity and better resources.

How did we get to this point? Medicaid expansion provided welfare to able-bodied adults in states that chose to adopt it, but because Medicaid reimburses medical providers at far lower rates compared to private insurers — and in many cases below the actual cost of care — hospitals in these states have seen their resources dwindle as they take on more patients at lower rates.

It’s no surprise that since Medicaid expansion was adopted, hospitals’ collective Medicaid shortfalls have skyrocketed by $5 billion, or more than 50%. 

These unfortunate financial realities have forced many expansion states’ hospitals to close their doors completely. Others were unable to invest in additional capacity, contributing to the decline in bed space.

The proof is in the data. According to a study I co-authored, since 2013, the number of hospital beds per capita has declined by more than 6% in Medicaid Expansion states — while the number of beds has increased in non-expansion states. 

Today, non-expansion states have 510 more beds per capita than their expansion counterparts. And it’s not just beds — states that have resisted Obamacare’s Medicaid Expansion have 35% more hospitals per capita compared to expansion states.

We’re seeing this unfortunate reality play out in real time. According to data from the Department of Health and Human Services (HHS), the only states with more than 90% of their staffed adult ICU beds occupied — New Mexico, Rhode Island and North Dakota — have one thing in common: They all expanded Medicaid under Obamacare.

These otherwise unrelated states — with unique regions, demographics, economies, populations and health characteristics — are bonded together by the same decision to expand Medicaid, which has manifested itself in reduced bed capacity for COVID-19 patients.

The Medicaid expansion state of Colorado — the focus of the news headline — went into this national health crisis with less than half of the bed capacity of bordering Wyoming, a non-expansion state. According to the HHS data, Colorado presently has nearly 70% of its staffed ICU beds occupied, while Wyoming has roughly half of its beds occupied — the second lowest level in the nation. Had Colorado chosen to follow Wyoming’s lead and resist the adoption of Medicaid expansion under Obamacare, the situation would have been far different. 

As policymakers gear up for the start of legislative sessions, there’s an important lesson in this analysis: Don’t fall for the myth that Medicaid expansion is a cure-all, especially for hospitals.

Rejecting Obamacare’s expansion is a commonsense step states can take to avoid the harsh reality they could otherwise be forced to reckon with.

Hayden Dublois is a research analyst at the Foundation for Government Accountability. He wrote this for InsideSources.com.

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Supreme Court to consider Medicaid work requirements | Healthcare Finance News

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.

 
 

 
 

Curator summary

 

SCOTUS will hear a case to determine whether work requirements can be used in the Medicaid program.

 
 

 
 

Clipped from: https://www.healthcarefinancenews.com/news/supreme-court-consider-medicaid-work-requirements

 

 
 

Late last week, the Supreme Court agreed to decide whether outgoing President Donald Trump and his administration can allow states to tack work requirements onto their Medicaid programs, a proposal that has been shot down in the lower courts.

At issue is the administration’s approval of Medicaid work requirements in Arkansas and New Hampshire. In a brief order, the Justices granted review in Azar v. Gresham and Arkansas v. Gresham, and consolidated the cases for an hour of oral argument. The Justices are being asked to decide whether the U.S. Court of Appeals for the District of Columbia erred in concluding that the secretary of Health and Human Services may not authorize demonstration projects to test the work requirements to facilitate the transition of Medicaid beneficiaries to commercial coverage.

WHAT’S THE IMPACT?

Work requirements have been controversial in some states. In February, for example, a federal appeals court ruled that the Trump Administration unlawfully allowed Arkansas to implement a work requirement on those covered under that state’s Medicaid expansion program, echoing a lower court ruling from 2019.

Arkansas was the first state to create such a work requirement, tasking enrollees aged 19-49 with clocking 80 hours per month on work, volunteering or job hunting, which then had to be reported via Internet or phone. According to Arkansas Online, 18,164 people lost coverage during the nine months the requirement was in effect, and were barred from re-enrolling for the remainder of the year.

The unanimous decision in the Arkansas case, written by Reagan appointee Judge David Sentelle, upheld a district court ruling that found the administration had not analyzed whether work requirements would promote the primary objective of Medicaid, which is to “furnish medical assistance.”

In issuing approvals of state work-requirement waivers, the administration had argued that the move would help some beneficiaries transition to private policies and could lead to better health outcomes, and help states conserve financial resources, CNN reported. The administration began granting state work requirement requests in 2018.

According to a blog on the Supreme Court’s website, the cases will likely not be argued until late winter or early spring. On Friday, law professor Stephen Vladeck said on Twitter that President-elect Joe Biden could rescind the government’s approval of work requirements when he takes office, although this would likely take time, opening up the possibility that the state would pursue an administrative hearing to challenge any rescission. 

In Arkansas, more than 18,000 people lost coverage in 2018 before the courts stepped in.

THE LARGER TREND

In October, the Centers for Medicare and Medicaid Services’ announcement of work requirements in Nebraska drew push-back from Nebraska Appleseed, a nonprofit focused on, in part, promoting access to affordable healthcare. It called the Heritage Health Adult waiver “unnecessary” and “a step in the wrong direction.”

“By the Department of Health and Human Services’ own estimates, the waiver will result in tens of thousands of people being locked out of dental, vision, and over the counter drug benefits,” the group wrote on its website. “The waiver does not ‘enhance’ benefits; it is indeed designed to deprive enrollees of those benefits.

“Nebraska does not need a complicated waiver system that makes it harder for people to access the care that they need.”

Similar requirements were recently introduced in Georgia. Specifically, CMS announced the approval of Georgia’s new Medicaid section 1115 demonstration called “Pathways to Coverage.” It requires working-age Georgia adults who are ineligible for Medicaid to opt into Medicaid coverage by participating in qualifying activities such as work and education, as well as meeting premium and income requirements.

This applies to those between the ages of 19 and 64, with income up to and including 100% of the federal poverty level, and is effective through September 30, 2025, with implementation beginning July 1, 2021.
 

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

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Missouri House budget leader hopes for cost-saving Medicaid reforms, expects tough budget 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.

 
 

 
 

Curator summary

 

MO lawmakers are signaling that next year’s budget will be where the full impact of the COVID pandemic is seen in terms of decreased revenues and impact on the economy; Medicaid costs savings measures will be required.

 
 

 
 

Clipped from: https://www.newstribune.com/news/local/story/2020/dec/10/missouri-house-budget-leader-hopes-for-cost-saving-medicaid-reforms-expects-tough-budget-year/852078/

 
 

Rep. Cody Smith, committee chair, addresses the state’s joint budget committee Tuesday, May 7, 2019. Photo by Tim Bommel/Mo. House of Reps.

The Missouri House Budget Committee chairman hinted Wednesday during a meeting of the Coordinating Board for Higher Education there may be a lengthy debate in the coming legislative session over cost-saving reforms to the state’s Medicaid program, which would happen as legislators figure out how to expand the program, per voters’ desire.

House Budget Committee Chairman Rep. Cody Smith, R-Carthage, also said next year will be a challenging one from a budget perspective because that’s when the economic effects of the COVID-19 pandemic will appear in tax receipts.

Smith and his Senate counterpart, Sen. Dan Hegeman, R-Cosby, who is chairman of the Appropriations Committee, were included in the higher education board’s virtual meeting Wednesday because the topic of next year’s budget was on the agenda for discussion. It’s the Department of Higher Education and Workforce Development’s priority to restore institutions’ core funding and support financial aid programs.

Gov. Mike Parson in the spring and early summer withheld a combined total of more than $95 million from four-year colleges and universities’ budgets, and more than $18 million from community colleges, because of the pandemic and its effects on the state’s budget. That was for the 2020 fiscal year.

When the new and current 2021 fiscal year started in July, Parson withheld nearly $28 million for Missouri’s colleges and universities, and more than $18 million less for community colleges — though about half of what was withheld from community colleges and four-year institutions was restored in October.

Revenue collections for the state are doing well — more than $100 million, or 14.5 percent, more last month than November 2019, the Office of Administration reported Wednesday.

Smith said, however, that the 2021 fiscal year is complicated by 2019 calendar year tax revenue that normally would have come in during the spring and the previous fiscal year instead coming in during July, on account of the tax filing deadline being pushed back because of the pandemic.

He said the budget for the 2022 fiscal year, which lawmakers will have to craft in the spring, will be the first in which tax receipts were affected by the pandemic, tax receipts from the 2020 calendar year — reflecting businesses closing, unemployment and decreased tax liabilities.

“We are looking to the next year to be one that will be challenging” from a state budget perspective, Smith said.

Complicating that is that voters in August approved expanding the state’s Medicaid program, MO HealthNet, and the program is estimated to grow by about 230,000 people.

Perspectives on the pros and cons of Medicaid expansion vary, but Smith, Hegeman and other Republican lawmakers and leaders stated ahead of the August election they were decidedly against expansion, arguing it would come at the cost of public education, among other claims.

Medicaid expansion is an option given to states under the federal Affordable Care Act, and the federal government pays 90 percent of the costs for people who qualify.

A fiscal note received by the state House Budget Committee over the summer said there is a possible range in cost to expand from an annual expenditure of $200 million to a savings of $1 billion.

“There’s no easy way” to expand Medicaid, Smith said Wednesday, adding, “It will have a cost and an impact on the larger budget.”

To that end, he said, “We will need to have some reforms to our Medicaid program that will generate cost savings,” and that would probably be a work in progress until the last days of the session.

Hegeman said a consensus revenue estimate for the 2022 fiscal year would be released soon, and Smith said it would be what he considers a conservative estimate.

“The saving grace has been federal dollars,” including the use of federal money to supplant general revenue in the state’s budget and offer more flexibility, Hegeman said.

Smith said it’s possible the state will be given an extension on the use of its federal aid money — which currently has an end-of-the-year deadline for spending — and a new federal stimulus package would come through.

In the meantime, as for what higher education institutions could do to advocate lawmakers for more funding, Smith advised: “That is drawing as straight a line as possible from higher education to the workforce needs of our state,” and showing why funding higher education is important to those efforts.