Tag: Reform

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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.

 
 

[MM Curator Summary]: Parents of children with I/DD and other special needs are concerned the plan to create a new program will disrupt the existing group homes systems.

 
 

 
 

 
 

Clipped from: https://www.newscentermaine.com/article/news/health/parents-and-providers-weigh-in-on-building-a-new-system-for-people-with-disabilities/97-28791323-ef17-42d7-81e5-e252ddc76e1a

AUGUSTA, Maine — It’s a huge undertaking—Maine is currently building a new system for children and adults with developmental and intellectual disabilities. 

The “Lifespan Waiver” would provide more comprehensive services at age 14 to help them transition into adulthood.

The program is expected to clear years-long waitlists and provide more opportunities to live independently. However, some families fear a new system will eventually cause much-needed services, like group homes, to disappear.

“Her housemates are her friends; they have been her friends since high school,” Debbie Dionne explained about her daughter Kate. 

Kate lives in a group home in Brunswick. She has cerebral palsy and an intellectual disability following a traumatic birth 43 years ago. Staff help her live independently, which would be difficult for Debbie and her husband to do for their daughter. Another worry, 75 group homes have closed their doors in Maine amid low Medicaid reimbursement rates. 

“If she were to lose this housing, I am 71 and we are aging; my home is not accessible. I do worry,” Debbie said with fear in her voice.

Parents have been raising many concerns since the Maine Department of Health and Human Services announced a new plan last spring, revamping the state’s services system for children and adults with intellectual and developmental disabilities. Families of special needs children must apply for different waivers for home and community services based on their needs, primarily paid for by federal Medicaid dollars. The Lifespan Waiver would enroll children as young as 14, eliminating waivers and wait-for lists across their lifespan.

“Our goal around Lifespan is that a person can stay in one wavier and not have to switch and get the services they need as they age,” Betsy Hopkins, the associate director of the DHHS Office of Aging and Disability Services, said.  

Hopkins said under Lifespan, people can continue to live in group homes and receive services under Section 21 and Section 29.

DHHS officials, who have been gathering comments from the public over the summer, are currently holding listening sessions with parents and providers. Lucinda Turcotte is an adult case manager with Brighter Heights Maine, which provides several services, including case management for special children and adults. Severe shortages of skilled staff to work with this vulnerable population are still a big concern, as is funding.

“We are being told we are developing another waiver that will not have a waitlist. I am not confident that is a guarantee. We all know the funding has to go through the Legislature,”  Turcotte said.

A current rate study could improve pay for direct support workers and agencies. Lifespan still needs approval from the feds and will undergo the rulemaking process in the Legislature next spring. If passed, enrollment could begin in January 2025. 

DHHS is holding a Lifespan Waiver informational tour throughout the state, with sessions planned in Caribou, Bangor, Lewiston, and South Portland next week. People can also register for Zoom sessions.

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MM Curator summary

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.

 
 

[MM Curator Summary]: WA leads the way with one of the first-ever programs that actually gets critical services to incarcerated members BEFORE they are released.

 
 

 
 

Clipped from: https://stateofreform.com/featured/2023/09/medicaid-mtp-waivers-component-allows-for-re-entry-coverage-for-washingtonians-leaving-incarceration/

 
 

Shane Ersland | Sep 21, 2023 | Washington

Experts weighed in on Washington’s Section 1115 Medicaid Transformation Project (MTP) waiver and the availability of new services it will offer residents at the Inland Northwest State of Reform Health Policy Conference last week.

The Centers for Medicare & Medicaid Services (CMS) recently approved the Washington State Health Care Authority’s (HCA) request to extend and amend its MTP waiver. The extension will allow the state to implement new programs using federal Medicaid funds to improve Apple Health (Washington’s Medicaid program).

 
 

 
 

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“Not everything was approved, but we see it as a success,” HCA MTP Director Chase Napier said. “There are a few programs we’re going to keep talking with CMS about. We are thrilled with what was approved.” 

CMS denied Washington’s request to cover postpartum care for non-citizens. The state therefore cannot use waiver funds to support the initiative, but plans to use other funding resources to provide postpartum care for non-citizens.

The waiver extension will allow for re-entry coverage for individuals who are leaving a jail or prison and re-entering communities. The program will provide pre-release services up to 90 days prior to an individual’s expected date of release from a jail or prison.

“Re-entry is a part of our system that is as fragmented as you can get,” HCA Assistant Director of Medicaid Programs Jason McGill said. “This waiver starts to get at how we can connect that pre-release period with services in the community. It starts to get services in jails for people who need it. It is not a full-coverage benefit. It is a targeted, limited benefit. But it gets at a lot of the gaps in the system that we clearly see today.”

The waiver provides for a mandatory and a secondary set of benefits, McGill said. Some mandatory benefits include pre-release care coordination and medication-assisted treatment (MAT).

“The secondary set of services is really intriguing too, particularly the full set of pharmacy benefits. Not just pharmacy for MAT, but the full pharmacy formulary. Pharmacy formulary has to be the Medicaid formulary. It’s not only the drug, but the treatment.”

— McGill

Caitlin Safford, plan chief of staff at Amerigroup Washington, said the re-entry program will be intense from a managed care organization (MCO) perspective.

“We’ve been working with jails, all the MCOs have,” Safford said. “We work together as MCOs to connect with every jail in our state. We have also been trying to connect with the tribal jails where we’re able to. And that’s our next process. We have a wonderful process with the Department of Corrections.”

The program will represent a major change in the state’s healthcare system, Safford said.

“But this is the missing piece,” Safford said. “Having and being able to do Medicaid [services for individuals] actually in jail is going to be incredible. We’re trying to think about what infrastructure investments we need to make internally to be able to work with jails on a one-to-one basis. We’re looking forward to being able to help guide jails through this process.”

Courtney Smith Jiles, chief strategy officer at the Washington Association for Community Health, discussed the program from the perspective of federally qualified community health centers (FQHCs). The association represents 27 FQHCs in the state.

“Our health centers are some of the most qualified centers to be able to provide services for these folks just coming out of jails. And, frankly, to anyone with a health-related social need. I feel very proud to work on behalf of FQHCs because I have not seen a group of people who take every single opportunity to connect with [their] community in the way that they do.” 

— Smith Jiles

McGill said the state’s initial plan is for prisons and jails to begin offering services in July 2025. They will have to complete a readiness review first, which includes ensuring access to medications and drug prescriptions. 

“All these things have to be done in order to make sure a jail or a prison facility is ready,” McGill said. “We’re planning for a year in advance of that July 2025 timeline to build capacity funding opportunities for our local jails and prisons. And, fortunately, we do have significant funding for that through the waiver to help with those supports.”

The waiver extension will also allow for programs that address health-related social needs (HRSN), including community-based payment through community/Native hubs, rental subsidies for up to six months, and HRSN services for nutrition, housing, medical respite, and transportation. Napier discussed the six-month rental subsidies.

“Of course, we wanted more than six months and are going to continue that conversation with CMS. But we’re thrilled we were able to get six months as a starting point.

— Napier

Safford also spoke about the waiver’s housing component, as Amerigroup serves as a contractor for some related services, including community support services. 

“When we started this program, the housing component started really slow,” Safford said. “That has really shifted, and we have seen, even in just the last year, a significant increase in assessments for supportive housing going up. Which leads to those people being able to access the services. We have a fantastic network of providers. We’re still adding providers to the services network.

When we think about the new components of the waiver, we really see it from a supportive housing standpoint. We’ve had these supportive housing services for five years. And we’ve seen the impact they’ve made. And the legislature added in transition assistance. That transition assistance led to people being able to get into a place to rent. Having first and last month’s rent, having help with utilities, having help with moving costs, that was always identified as a major barrier, even if they had access to supportive housing services themselves.”

MM Curator summary

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.

 
 

[MM Curator Summary]: Hard to believe the Trump-approved NC Healthy Opportunities program is going on 6 years old. An in-depth report on results is expected to be released soon.

 
 

 
 

Clipped from: https://www.statnews.com/2023/09/22/healthy-food-access-medicaid/

 
 

Elizabeth Jacques and her daughter Elena shop from the Caja Solidaria bicycle delivery. Allison Joyce for STAT

Late last summer, Elizabeth Jacques brought her youngest daughter, Elena, for a medical checkup. At the time, Jacques and her family were experiencing housing instability after a two-year legal battle with their former landlord, who refused to clean up their unsanitary, unlivable conditions.

For Jacques, it was obvious she had to leave a housing situation that was putting her family’s health at risk. Black mold was growing on the walls of the trailer in which Jacques and her family had lived for five years. The mold caused everyone — Jacques, her husband, and her three younger daughters — to get more frequent headaches and stomachaches. It also impacted Jacques’ breathing because she is immune-compromised. “My ability to function as a normal human got worse and worse,” she said. Meanwhile, there were gaping holes in the trailer’s floor; Jacques fell through them in the bathroom twice.

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Starting around September 2022, Jacques and her family hopped between three different hotels around Fletcher, in western North Carolina. But choosing to leave their trailer for safer living conditions meant making trade-offs. “In order to make sure we had someplace safe to sleep and to take showers, we chose hotels, and then the food was either given to us [there] or we went to a pantry,” she recalled.

At the physician’s office, the doctor diagnosed Elena, now 7, with ADHD, and said she needed to have her tonsils removed. Knowing that Jacques’ family was unhoused, the doctor also asked a simple question: What else do you need? Without missing a beat, Jacques said: food.

As it turned out, a North Carolina program designed to help families like Jacques’ was well underway.

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That program, the Healthy Opportunities Pilot (HOP), is the first of its kind in the United States. With $650 million in federal funding secured in 2018, HOP aims to comprehensively test and evaluate how addressing the social determinants of health — access to healthy food, transportation, safe and clean housing, and interpersonal safety — can improve health outcomes, all the while reducing health care utilization rates and emergency services for Medicaid members. Elena was enrolled in Medicaid, which meant Jacques’ family was eligible.

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In North Carolina, nearly 13,000 individuals are enrolled in HOP to date, and the food delivery services — which offer fresh produce, grains, and meat on a weekly basis — were the first to launch in earnest. So far, early results from the pilot suggest that food delivery programs associated with HOP are more effective in providing food security than those provided by food subsidies, like food stamps. A more comprehensive report was submitted in March 2023, said Seth A. Berkowitz, the lead evaluator of the HOP program at the University of North Carolina in Chapel Hill, and will be made public soon.

For Jacques and her family, even as they moved from hotel to hotel over a span of 10 months, HOP’s fresh produce deliveries were a constant. Some months, they also got food stamps, or would try pantries — but even some pantries were running out of supplies, Jacques said.

Every Tuesday, Jacques’ daughters would get excited to see the food delivery car pull up in front of their hotel. Elena was like a kid in a candy shop as she helped her mom pick out peaches, oranges, and snap peas during the summer.

Jacques said she lost 30 pounds because of her ability to access fresh fruits and vegetables from the program, even as she was unhoused. Eating well during a turbulent time was just one less thing for her to worry about, even though the rest of her life felt in flux.

 
 

A view of Hendersonville, N.C., where the nonprofit Caja Solidaria is based. Allison Joyce for STAT

The promise of produce prescriptions

North Carolina secured funding for the HOP pilot project in 2018 through 1115 Medicaid waivers, which refers to section 1115 of the Social Security Act. Such waivers give the secretary of health and human services the authority to approve pilot projects like HOP that will promote the objectives of the government’s Medicaid program. HOP, as it exists now, will run until 2024.

Impact Health executive director Laurie Stradley, who oversees Western North Carolina’s participation in HOP, said the larger goal is to demonstrate that pilot programs like HOP should be accessible not just to people on Medicaid, but to the general population. “We really believe that this network model that brings together both clinical and social health needs should be available regardless of payer model,” she said.

Since HOP’s approval, many other states, including California, New York, Arizona, Oregon, Massachusetts, and Washington have applied for and received similar 1115 waivers.

These new waivers are unique because they focus not only on food security, but also on nutrition security, noted Dariush Mozaffarian, a cardiologist and a professor of nutrition at Friedman School of Nutrition Science and Policy at Tufts University. And because these waivers are baked into the Social Security Act, they serve as a more sustainable way for states to continue providing such services.

That the food deliveries through HOP are regular constitutes them as produce prescriptions. Such prescriptions are a proven tool to help lower blood sugar levels in low-income individuals with diabetes, decrease obesity, and reduce hypertension. They also have shown to help keep patients out of the hospital, reducing both emergency room visits and hospitalizations in nursing homes, said Mozaffarian.

“We know that when you invest upstream, that our health care dollars go down and our health outcomes go up,” said Stradley. Alongside the food prescriptions, which were the first service that HOP launched in March 2022, the program also helps individuals find stable, long-term housing, have reliable transportation, and get out of unsafe and violent living situations.

 
 

People work at Clem’s Organic Gardens, which supplies organic produce to Caja Solidaria. Allison Joyce for STAT

 
 

Sonya Jones makes deliveries from the Caja Solidaria SUV. The nonprofit currently serves 150 households. Allison Joyce for STAT

A mobile farmers market

The food delivery services that Jacques and hundreds of other families benefit from in western North Carolina have been spearheaded by a nonprofit called Caja Solidaria based in Hendersonville.

Caja Solidaria, or Caja for short, was founded by Sonya Jones, a former public health professor at the University of South Carolina. Jones left her academic post in the wake of the Covid-19 pandemic and began working for a local mutual aid organization looking to start a food bank in Hendersonville, where she grew up. Eventually, that food bank grew in members and funding.

By the time the pilot program in North Carolina launched, Caja was an obvious partner in western North Carolina. “No [Henderson County] organization was stepping into the shoes of distributing food or healthy food prescription services,” said Jones. “I know how to buy food, I have a nutrition background. It seemed like a really amazing fit.”

Caja Solidaria sources produce, grains, and meat from local farms or distributors, and prioritizes purchasing culturally relevant foods for the families that they serve.

Caja Solidaria sources produce, grains, and meat from local farms or distributors, and prioritizes purchasing culturally relevant foods for the families that they serve. Jacques’ husband, who is Mexican, gets excited over the spice mixes that they have the option of choosing as part of their food deliveries.

The funding from HOP also enables the nonprofit to buy directly from farmers in their communities. The family that Caja Solidaria sources chicken and pork from was struggling to find a customer base in the early days of the pandemic, said Jones, but they have since been able to increase their production every single month to meet Caja’s demand. “We’ve financially stabilized their farm and really helped them get started.”

Caja started out with a pick-up market and added bike deliveries: The food for the week would get loaded up into pink coolers and put on a wagon, hooked to a black commuter bike. With funding from HOP, the organization was able to buy a four-wheel drive van to drive to families with a mobile farmers market in tow.

Now, Jones and her staff drive two or three routes a day, meeting up to a dozen families on a given route. Families also have the option to pick up their week’s share of produce from their stationary market on Thursdays. Currently, Caja serves 150 households, with 75% of those being families of three or more people.

 
 

The Jacques family makes guacamole. Elizabeth and her family were recently helped by the Healthy Opportunities Pilot and relocated to a permanent home. Allison Joyce for STAT

How food deliveries foster community

For DeBorah Ogiste, 65, of Hendersonville, the produce deliveries have not only relieved the financial burden of feeding her family, but also improved her grandson Elian’s health.

Ogiste’s daughter passed away two months after Ogiste retired. Elian, now 8, has a compromised immune system and, as a result, is particularly sensitive to environmental allergies and asthma. He’s been hospitalized several times due to RSV and breathing issues. “If he catches a cold, it’s always more than a cold,” Ogiste said. Having to take Elian out of school for sickness was a common occurrence — at least once or twice a month.

Food stamps, which covered up to $98 a month, were simply not enough for her and a growing boy. “We were definitely food insecure,” Ogiste said. But since they started receiving deliveries from Caja in spring 2022, Elian has been eating healthier, staying in school for longer, and enjoying the avocado tacos from the food deliveries. Fresh fruits and vegetables help regulate her grandson’s allergies and reactions to environmental triggers.

HOP and Caja have also helped Christal Whitmire, 65, of Hendersonville, to wean off her long list of medications. She has long been diagnosed with degenerative disk diseases, spinal stenosis, and fibromyalgia. At one point, Whitmire said that she was prescribed to take dozens of pills each day for her neural conditions, depression, insomnia, migraines, mood stabilizers, high cholesterol, and beyond.

With access to Caja’s food deliveries, she said she’s lost over 100 pounds. “My whole digestive system is better, and then that helps with my sleep. Then, that helps with my headaches,” she said, which in turn reduces her incidence of seizures.

Recently, Whitmire tossed out her prescription for trazodone, a pill meant to help her sleep.

“If there’s going to be a food that’s going to help me rather than a pill, I would do that over a pill every day.”

Christal Whitmire

Beyond the health improvements experienced by many families is a deeper, more emotional benefit of the program: Having someone deliver food to you every single week creates familiarity, trust, and community. Some families list Jones as an emergency contact. The pandemic may have bred loneliness and isolation, but nonprofits like Caja are working to rebuild a community fabric.

“It’s not really [about] the vegetables,” Jones said. “The vegetables open the door to addressing social isolation and community cohesion, which we think are also social determinants of health.”

 
 

Elizabeth Jacques and her husband, Luis, eat dinner with their family. Allison Joyce for STAT

The limits of the Healthy Opportunities Pilot

Despite the good intentions of the Healthy Opportunities Pilot, some participants still fall through the cracks. For instance, individuals who turn 65 and roll off of Medicaid and onto Medicare will no longer be registered for HOP, as the program currently serves only Medicaid patients. (However, if someone else in their household is enrolled in Medicaid, they remain eligible.) Stradley, HOP’s executive director, said that the program will be able to offer services to patients who are eligible for Medicaid and Medicare as early as 2024.

Peggy Cummins, who recently turned 65, learned this the hard way. She was food insecure and received deliveries from Caja for the last two years. She also registered for housing help through HOP as her living situation was, in her words, “decrepit and rotten.”

“It’s not fit for humans to live in. But it’s all I’ve got.”

Peggy Cummins

“I can see the ground through the siding. A piece of drywall broke. I had a snake in here and rats,” she said. “It’s not fit for humans to live in. But it’s all I’ve got.” She hoped that HOP could help her, but now that she is no longer a registered member because her health insurance changed, “I don’t have any hope.”

Stradley recognizes other challenges and limitations of HOP’s housing program, especially because vacancy rates across the country for affordable housing are so low. In geographical areas where finding new housing is especially challenging, Stradley said that HOP is able to allocate funds to help families improve their current homes.

Jacques, who also expressed a need for housing when her family got enrolled in HOP, had a long-awaited but happy ending to her saga. In July, she finally received a call from a local nonprofit: They found a new, safe place for her and her family to rent.

The transformative power of social health care

Tracking the results of the pilot program could help change health policy in the U.S., especially “if the interventions are shown to improve health and do so in a way that’s cost saving or cost equivalent to other medical interventions,” said Mozzafarian of Tufts University.

“We are aware that many eyes are on us,” said Stradley. “We are working hard to generate the evidence that could persuade other payer groups to invest in social and clinical health care, including Medicare, private payers, and more.”

The Biden administration is also pushing to strengthen Medicaid and the Affordable Care Act. An executive order in January 2021 emphasized that states should utilize waivers like the 1115 that expand Medicaid coverage and access to care.

Jacques, who has seen how a pilot program like HOP can help her family’s physical health and psychological safety, believes that programs like this should eventually become a permanent fixture in our health systems. “Some people get stuck and they don’t know how to get out of whatever the situation may be,” she said. “This program is so important, not just to me, but to many. It’s a lifeline.”

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.

Correction: An earlier version of this story misstated Laurie Stradley’s title and the form in which Caja Solidaria started out.

MM Curator summary

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.

 
 

[MM Curator Summary]: The new OR waiver will get members AC unit, food and help with rent. It puts $1B towards health-related social needs (HRSN- that’s the new SDH password ICYMI).

 
 

 
 

Clipped from: https://www.cannonbeachgazette.com/news/historic-move-oregons-medically-necessary-medicaid-benefit/article_45f64ecb-852a-5a17-974b-c22730188e27.html

 
 

Oregon is moving to leverage Medicaid benefits to prevent homelessness, support behavioral health services, mitigate the impacts of climate change, pending federal approval.

Metro Creative Connection

The Oregon Health Authority (OHA is moving to leverage Medicaid benefits to prevent homelessness, support behavioral health services, mitigate the impacts of climate change, pending federal approval.

The OHA, in collaboration with Oregon Housing and Community Services (OHCS), has announced proposed timelines to begin offering new Medicaid benefits that eligible Oregon Health Plan (OHP/Medicaid) members would receive under Oregon’s ground-breaking 1115 Medicaid waiver agreement with the federal government.

If the federal government agrees to the proposal, eligible OHP members would start receiving benefits for climate-related supports in January 2024, housing insecurity in November 2024, and food insecurity in January 2025.

Oregon would be the first state in the nation to gain federal approval to offer six months of temporary rent assistance as a medically necessary Medicaid benefit. These benefits would first roll-out to people who are at risk of losing their current housing, beginning on Nov. 1, 2024, if the federal government approves the plan.

In lockstep with Governor Tina Kotek’s priority to reduce homelessness, state health officials have determined that the most immediate and effective way to implement Oregon’s new short-term Medicaid housing benefit is to help people who are medically and economically vulnerable avoid becoming homeless in the first place, according to a release from the OHA.

The rate of Oregonians losing housing is increasing faster than state and local programs can rehouse them, due to a critical statewide shortage in affordable housing, state housing experts said.

The short-term Medicaid rent assistance benefit will help prevent people from losing housing due to a health issue that disrupts their ability to stay current on their housing payments, or because they need to be connected to mental health or substance use services to maintain stable housing. The OHA said this preventive approach should help slow the rate of growth in the homeless population.

State officials estimate approximately 125,000 OHP members currently meet the federal housing definition of “at risk for homelessness” and could be eligible for the short-term housing benefit if they have health and housing needs that would require up to six months of rent assistance or other housing supports.

While assuring that these benefits help keep people housed, OHA will continue to have a strong focus on assisting OHP members that have a significant mental health or substance use disorder that exacerbates their housing insecurity.

“As a first step, we want to use these new and innovative Medicaid housing benefits to make sure that someone with a health problem stays in stable housing,” OHA’s interim Director Dave Baden said. “We can’t let more people wind up on the streets, where their health issues will worsen and get harder to treat, making sustainable, long-term housing harder to find, especially given the lack of affordable housing across the state.”

Medically necessary temporary rent assistance and other housing supports would become available to other OHP members, including people who are already homeless, later in the state’s five-year waiver implementation. That date has not been specified as state health and housing officials continue to work with federal partners to address barriers to housing access and other questions.

Input from housing providers, coordinated care organizations (CCOs) and other community voices informed the state’s strategy to focus on preventing homelessness in this first phase.

“Today’s actions build upon a longstanding commitment to addressing the social determinants of health in action,” OHCS Director Andrea said. “This historic rent assistance provision is a tangible pathway to deliver rent assistance as a health intervention. Housing and health barriers are connected. The solutions should be reflective of that reality.”

State officials also announced that climate-related supports for some OHP members will become available starting Jan. 1, 2024, if federal officials approve the proposed timelines. Under this benefit, eligible OHP members could qualify to receive air conditioners to help reduce health risks during extreme heat emergencies (if medically necessary) or air filters to protect from the respiratory effects of wildfire smoke.

Nutrition benefits, such as medically tailored meals, would become available starting Jan. 1, 2025.

Oregon’s five-year 1115 Medicaid waiver provides OHP coverage and more than $1 billion in federal funding to address the health-related social needs (HRSN) of people whose health is affected by the most pressing problems affecting Oregon communities, including homelessness, climate change and poverty. Under the state’s agreement with CMS, Oregon is required to begin making health-related social needs benefits available no later than Jan. 1, 2025.

1115 Medicaid waivers allow states flexibility to test new ways to deliver and pay for Medicaid benefits. A state must receive CMS approval to implement a waiver.

Medicaid provides health coverage to income-eligible people. Currently, more than 1.4 million Oregonians – or 1 in 3 state residents – are covered by OHP. Most people who qualify for Medicaid in Oregon are covered by OHP. Approximately nine in 10 OHP members have their care coordinated through one of 16 CCOs which operate in defined regions across the state.

Follow this developing story at curry.com and in the Wednesday print editions of The Pilot.

MM Curator summary

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.

 
 

[MM Curator Summary]: Reminder- the maternal mortality crisis in Medicaid is NOT during labor and delivery. We need to be more accurate and address it as a broader MH/SUD problem if we want to start impacting this tragedy.

 
 

 
 

Clipped from: https://fox2now.com/news/missouri/report-nearly-85-maternal-deaths-in-missouri-were-preventable/

JEFFERSON CITY, Mo. – The state is making a historic investment in a maternal mortality prevention plan after learning Missouri has one of the highest rates of pregnancy-related deaths in the country.

In a new report, an average of 70 Missouri women died while pregnant or within one year after giving birth between 2018 and 2020. The Missouri Hospital Association (MHA) said Tuesday the most sobering piece of the report is nearly 85% of those deaths were preventable.

“Maternal mortality rates in Missouri are not great,” MHA spokesperson Renee Wilde said. “We are well below the national average, and we know that’s something we need to improve on.”

Missouri is looking at new ways to help save new moms. According to a recent report from the state’s Pregnancy-Associated Mortality Review (PAMR) Board, the number one cause of pregnancy-related deaths was mental health conditions, including substance use disorders.

“One thing that this report shows is that the highest occurrence of these deaths happen between 43 days and 365 days postpartum,” Wilde said. “So, it’s not that we’re even seeing these deaths during pregnancy, during childbirth, or even immediately after childbirth.”

The second leading cause is cardiovascular disease, like high blood pressure, followed by homicides. The number of suicide deaths doubled when compared to 2017-2019 with 2018-2020.

The PAMR Board found that the pregnancy-related mortality ratio was 32 deaths per 100,000 live births, which is up from 25.2 deaths in the 2017-2019 time frame. The report found the highest number of pregnancy-related deaths happened in 2020, at 85 deaths.

“The report also showed Black women have a three-times higher instance of maternal mortality than white women,” Wilde said.

Last week, a new law went into effect, extending Medicaid coverage for new moms four up to one year after the baby is born. By extending the coverage for up to one year after giving birth, the legislation is estimated to help more than 4,200 new moms a year.

“We know that health care access is critical and if you don’t have insurance, you probably are a lot less likely to receive prenatal care to continue seeking care postpartum and really getting those conditions treated,” Wilde said.

More than half of the country has already extended Medicaid coverage for new moms and the bipartisan legislation approved by the General Assembly this year is not only expected to save lives but cover thousands of women who would otherwise go uninsured two months after giving birth. Due to a provision in the federal American Rescue Plan Act of 2021, each state is allowed to expand Medicaid coverage to women up to 12 months. The state recently started Medicaid eligibility renewals again after the federal government prohibited states from removing people from Medicaid for three years.

Since the governor has signed the bill, the Department of Social Services (DSS) is reviewing to see which Medicaid patients recently gave birth or if currently pregnant, are eligible for the postpartum program. DSS said you’re a new mom on Medicaid who gave birth back in May, you will still receive extended postpartum care for up to 12 months.

“I thought if there was ever a time to spend money, what better way to spend it than on mothers and children,” Governor Mike Parson said. “We know we need to do a better job for it.”

The state is also spending more than $4.35 million to create a maternal mortality prevention plan. In addition, the General Assembly also funded four recommendations centered around improving the state’s maternal mortality.

• Provide funding for a statewide Perinatal Quality Collaborative by 2023
  
• Establish and fund a statewide Perinatal Health Access Project to aid healthcare providers in providing evidence-based mental health care, including substance use disorder treatment
  
• Extend Medicaid coverage to one year postpartum for all conditions, even if the woman did not start treatment prior to delivery
  
• Fund Medicaid expansion in 2023
  

“I think that’s why we did the appropriations this year. It’s one of the largest investments in really trying to change the need in that,” Parson said. “Now just to go out there and kind of talk about it but how do we really help those moms and those babies out there to make sure we save lives.”

The report shows that before extending coverage, women on Medicaid were 10 times more likely to die within one year of pregnancy than new moms on private insurance.

Back in January during his annual State of the State Address, Parson called the state’s high maternal mortality rate “embarrassing.”

Wilde says it will take years for Missouri to improve from having the 12th highest maternal mortality rate in the nation.

“I would say it’s shocking that we’re not seeing some sort of improvement,” Wilde said. “You would think with modern medicine and better access to care that we would be seeing slight improvements. We really are optimistic that with all of these programs that are being put in place, the funding and the legislation that we will start to see that needle move in a positive direction.

The report also found that women living in metropolitan counties were almost twice as likely to die of a pregnancy-related death than women in rural counties.

Click here to see the full 2018-2020 PAMR Board report.

MM Curator summary

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.

 
 

[MM Curator Summary]: Advocates don’t see how managed care is gonna help the real problem- a shortage of direct care workers.

 
 

 
 

Clipped from: https://www.eastidahonews.com/2023/09/idaho-disability-advocates-stress-need-for-more-medicaid-staff-direct-care-workers/

 
 

Ruth Brown, Idaho Capital Sun

 
 

EastIdahoNews.com file photo

BOISE (Idaho Capital Sun) — Idaho lawmakers on the Medicaid Managed Care Task Force spent Thursday morning listening to representatives from disabilities communities in Idaho regarding their concerns about potential changes to the Medicaid system.

Most speakers pointed to the lack of staffing for direct care workers, as well as the lack of staff in the state’s Division of Medicaid. Multiple speakers referenced a report and recommendations from the Office of Performance Evaluations on the sustainability of the direct care workforce, released in February.

Christine Pisani, executive director of the Idaho Council on Developmental Disabilities, spoke on behalf of the Our Care Can’t Wait Coalition, which wrote to the task force in July about its concerns around changes to the Medicaid system.

She stressed the importance of adding staffing to the Division of Medicaid and increasing the number of home-based caregiver workers.

“Year after year, I observe the demoralizing effects on the staff at the Division of Medicaid who are repeatedly unable to meet the expectations of our state,” Pisani said. “I’ve watched countless quality staff leave the division because the workload is too tremendous due to too few staff.”

Recommendations are often proposed, but the division always says they don’t have the capacity to implement them, she said.

“If we are unable to maintain the home- and community-based service system, the cost to the state will be four to five times more through out of state placements and higher cost of institutional care,” Pisani said.

Staffing vacancies can lead to negative health outcomes, Idaho disability advocate says

David Lehman, representing the Idaho Association of Community Providers, told the committee that staffing vacancies for the association are at about 30% and that overtime makes up about 15-25% of payrolls. Asking employees to spend that much time working overtime while being paid about $15 an hour isn’t sustainable, he said. Even with the overtime, there is a significant waitlist of people that need to access services.

“We may see more institutionalization as a result of people not being able to access services in the community,” Lehman said. “Not only is it cheaper to provide services in community, but we don’t have to build facilities to do it.”

He hopes the Idaho Department of Health and Welfare would support training for direct care workers to help run those platforms. He also told committee members that he hopes to professionalize direct care and help people see it as a potential career with advancement options.

Legislators asked Lehman what he believes the result of switching to a managed care Medicaid system could mean for the association.

“There already is a management structure in place for individuals, whether they have a disability or not, [who] have the Healthy Connections provider and are referred out for services,” Lehman said. “So adding that next layer of complexity, I’m not sure it benefits at all individuals with disabilities. The system as it is now provides some of those protections for the taxpayer, making sure people are getting the right care at the right time.”

The goal of task force is to study cost-effective managed care after the 2023 budget request for Medicaid hit $4.7 billion. The Thursday meeting also included a review of other states’ Medicaid managed care plans.

After Idaho voters approved Medicaid expansion in 2018, eligible enrollees include people younger than 65 who are under 138% of the poverty level. Others who are eligible for Medicaid include pregnant women who are under 138 percent of the poverty level, people with disabilities, and people 65 years and older who meet certain income requirements.

The Medicaid Managed Care Task Force meets next on Sept. 11.

MM Curator summary

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.

 
 

[MM Curator Summary]: Our annual pretend-fest that our “representatives” will honor a key part of the ACA deal from 13 years ago.

 
 

Clipped from: https://www.hfma.org/payment-reimbursement-and-managed-care/medicaid-payment-and-reimbursement/clock-ticks-toward-massive-medicaid-disproportionate-share-hospital-cuts/

Big Medicaid DSH cuts have been pending for almost a decade but have yet to be implemented. That will change soon if Congress does not act.

A congressional bill that would impose additional transparency requirements on providers also would offer a respite from a sizable cut to a key supplemental payment.

A $32 billion reduction to Medicaid disproportionate share hospital (DSH) payments is scheduled to span four years, beginning when federal FY24 gets underway Oct. 1. The Lower Costs, More Transparency Act would push back the start of the cut to FY26.

A scheduled House vote on the bill was postponed Sept. 18, with no immediate announcement of when the vote would take place. The bill apparently did not have the two-thirds support required to meet the threshold for fast-tracked legislation in the House.

The bill can still be considered anytime under normal rules, which would require only a simple majority but also allow for floor debate and amendments that could delay proceedings. Potential obstacles also include the distraction of the looming standoff between the parties over legislation to keep the federal government funded past Sept. 30, plus the need for the bill to ultimately clear the Senate.

Other provisions in the bill extend the graduate medical education program for academic medical centers through FY30, beginning with a $175 million allocation in FY24. Also included are two-year funding extensions, through CY25, for community health centers ($4.4 billion per year) and the National Health Service Corps ($350 million per year).

Sounding the alarm

The Medicaid DSH cuts would amount to 54% of scheduled Medicaid DSH payments in the upcoming fiscal year, according to estimates in a 2023 report by the Medicaid and CHIP Payment and Access Commission (MACPAC).

Such a decrease could “disrupt the financial viability of some safety-net hospitals,” MACPAC said. If the cuts aren’t delayed, they should be phased in more gradually than the current schedule allows, the commission wrote.

The Medicaid DSH cut would coincide with a $943 million reduction in Medicare uncompensated care payments as finalized in the FY24 rule for hospital inpatient payments.

Seeking a delay in the Medicaid cuts, America’s Essential Hospitals wrote a Sept. 14 letter to congressional leaders, with signatures from more than 250 member hospitals.

“These cuts would undermine America’s healthcare safety net and significantly reduce our hospitals’ ability to provide lifesaving services to the communities you represent,” the letter states.

In its own letter, Premier Inc. noted a large DSH cut especially would hamper hospitals amid the ongoing wave of Medicaid eligibility redeterminations that have accompanied the end to continuous-enrollment provisions after the COVID-19 public health emergency.

Members of Congress seem to understand the scenario. In August, a bipartisan group of 51 senators wrote to the chamber’s leadership asking that the looming cut be addressed, stating, “Cuts of this magnitude could undermine the financial viability of hospitals, threatening access to care for the most vulnerable Americans.”

What’s behind the cut

Medicaid DSH reductions totaling $18 billion initially were supposed to start in 2014 as a mechanism to pay for the coverage expansion in the Affordable Care Act (ACA). Subsequent delays have offered relief in the short term but also resulted in increases to the funding reduction target.

“Unfortunately, the projected coverage levels have not been realized and hospitals continue to care for patients for whom they are not receiving payment,” the American Hospital Association (AHA) wrote in an April letter supporting an earlier bill to delay the cut.

The cut would vary drastically by state based on factors such as uninsured rates and the degree to which a state’s DSH funding is targeted to hospitals with high volumes of Medicaid patients and uncompensated care. The percentage decrease in funding would range from 6.1% in South Dakota to 90% in Rhode Island, according to MACPAC.

In theory, the cuts would be especially adverse for safety net hospitals in the 10 states that have not expanded Medicaid as authorized by the ACA, since those hospitals would lose funding without having benefited from the anticipated increase in insured patients. However, MACPAC projects that non-expansion states would face lower percentage reductions (47.3%) in DSH funding compared with expansion states (59.9%), in part based on how uninsured rates would factor into the decrease.

The Medicaid DSH formula has been affected by a change included in 2021 funding legislation. In calculating a hospital’s payment, the 2021 provision calls for excluding costs and payments that are related to services furnished to Medicaid beneficiaries who also have Medicare or commercial insurance.

As detailed in a 2023 proposed rule, the change does not apply to hospitals in the 97^th percentile or higher of patients entitled to both Medicare Part A and Supplemental Security Income benefits.

Two sides of the same bill

While the Lower Costs, More Transparency legislation would maintain Medicaid DSH funding over the next two years, terms in the bill that expand site-neutral payments to cover all Medicare drug administration services are projected to create about $380 million per year in federal savings.

In reacting to the provisions as introduced several months ago in committee legislation, the AHA linked site-neutral payment policies with the proposed delay in the Medicaid DSH cuts. In other words, one was being used to help fund the other.

“Robbing Peter to pay Paul is not the way to achieve the objective and would add to the financial fragility of many hospitals,” the AHA said in a statement attributed to Stacey Hughes, executive vice president.

MM Curator summary

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.

 
 

[MM Curator Summary]: Axios points out that getting Medicaid cards converted to exchange-plan cards (subsidized by tax dollars) could mean higher payments to providers.

 
 

Clipped from: https://www.managedhealthcareexecutive.com/view/medicaid-redetermination-sanders-healthcare-spending-plans-ai-for-mental-health-the-news-cycle

Medicaid redetermination may result in a favorable payer mix for some providers if people switch to ACA and employer-based coverage that has higher payer rates. But that is a pretty big if.

Medicaid redetermination could be good for providers, hospitals | Axios

The Kaiser Family Foundation has estimated that 17 million people could lose Medicaid coverage as result of Medicaid redetermination and the end of the automatic re-enrollment into the public payer programs that was part of the government’s response to the COVID-19 pandemic. If people losing Medicaid coverage don’t switch to other kinds of coverage, the consequences could be dire for their access to healthcare. A growth in the number of uninsured Americans could also put a strain on health systems and providers, Axios reports this morning (full text available). But the news brevity website also mentions an alternative scenario whereby substantial number of people losing Medicaid coverage switch to employment-based and ACA coverage, which pay providers at a higher rate than Medicaid programs. “Redeterminations could change the payer mix in a revenue-positive way if patients for from Medicaid to employer-sponsored or ACA plans,” writer Axios’ Arielle Dreher.

MM Curator summary

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.

 
 

[MM Curator Summary]: In which the author criticizes Medicaid payments for testing of a disease that some sources say killed 15M people worldwide before we stopped counting. But we all know Joe Rogan has the real scoop..

 
 

Clipped from: https://www.washingtonexaminer.com/restoring-america/community-family/why-is-medicaid-still-treating-covid-19-as-a-public-health-emergency

The federal public health emergency for the COVID-19 pandemic came to an end Thursday, more than three years after it was first enacted in 2020. That comes on the heels of the World Health Organization’s declaration on May 5 that COVID-19 was no longer a global health emergency.

And on the same day, the Centers for Disease Control and Prevention announced it would stop tracking new cases. In other words, the pandemic is largely behind us. Yet Medicaid is still covering over-the-counter COVID-19 tests for beneficiaries free of charge. That makes little sense. No other payor is under the same obligation. Provisions requiring Medicare and private insurers to cover up to eight at-home tests per month for free expired along with the public health emergency.

THE LEFT’S NEW SCHOOLING SEGREGATION

But under the American Rescue Plan Act, which was passed in 2021, state Medicaid plans must continue offering at-home tests to enrollees free of charge. The requirement won’t sunset until the end of September 2024 — roughly a year and a half after the end of the public health emergency. Why are taxpayers covering the cost of tests for a virus that no longer constitutes a public health crisis? It’s not cheap. Medicaid and the Children’s Health Insurance Program cover 93 million people. Even assuming just one test per person over the next 16 months, the additional cost would run into the hundreds of millions of dollars.

CLICK HERE TO READ MORE FROM RESTORING AMERICA

But what’s a new nine-figure cost when Medicaid already accounts for $734 billion in annual spending each year? Even the public health establishment has declared that it’s time to move on from COVID-19. Medicaid should follow suit.

Sally C. Pipes is president, CEO, and Thomas W. Smith fellow in Health Care Policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All (Encounter 2020). Follow her on Twitter @sallypipes. 

MM Curator summary

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.

[MM Curator Summary]: The cost is now 500x what the politician who sold it originally said it would be. Shocked. I am shocked, I tell you. And its 100% state costs.

Clipped from: https://www.fairfieldsuntimes.com/opinion/il-to-spend-1b-on-medicaid-for-undocumented-seniors/article_964ed289-fc69-5310-9605-291a4e6ba38d.html

Illinois is forecasting that its program to provide healthcare to undocumented immigrants will cost the state $1 billion in 2024 – far more than the $2 million that Illinoisans were promised it would cost at the program’s inception, according to Wirepoints.  

In May 2020, Illinois became the first state to offer Medicaid for undocumented immigrants over the age of 65. Now-Congresswoman Delia Ramirez, then an Illinois state representative, sponsored the bill, and claimed the program would cost just $2 million per year. Unfortunately, this estimate was completely uninformed, with the program exceeding that in its first month.

At the time, she said the coverage will save the state money in the long run, and the cost of $2 million, “is nothing to a $2 billion Medicaid bill,” The State Journal-Register reported.

Since then, the program has grown to include people as young as 42, causing enrollment and costs to balloon. A closed door presentation to IL lawmakers (that has since been made public) reveals that the total cost of this program in 2024 is projected to be $990 million. Enrollments have far exceeded expectations — 51,914 compared to the estimated 33,500 in 2023, or 55% more.

“No portion of that cost is reimbursable by the federal government,” Wirepoints reported.

Illinois is being crushed by fleeing citizens and an ever-growing mountain of debt, which stands at more than $154 billion. This program would be an expensive investment for even the most fiscally sound states, but in Illinois, it’s unaffordable and pushes the state closer to the brink of economic ruin.

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