Tag: State News

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Some Illinois Medicaid patients in Chicago have limited pharmacy access

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The Aetna decision to block CVS competitor Walgreens from Medicaid payments has left members with less options for filling prescriptions near their home.

 
 

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.

 
 

CHICAGO (WLS) — A recent change to the Illinois Medicaid prescription plan is making it difficult for many to get medications, especially on Chicago’s South and West sides.

It is a potential dilemma for millions in Illinois. Two months ago, Medicaid clients were told they could no longer use Walgreens unless they wanted to pay full price for their prescriptions.
 


New legislation is calling for Medicaid recipients to be able to use any pharmacy. But in the meantime, some patients are struggling to access what could be life-saving drugs.

Aetna provides coverage for Illinois Medicaid patients. In December, Aetna changed the prescription plan, dropping Walgreens as a provider. Walgreens makes up 30% of all Chicago’s drugstores. Because Aetna is owned by CVS, Medicaid patients now have to get their medications at CVS and other in-network pharmacies.

“These patients already have a restricted network of pharmacies where they can get their medications, and we’re already in a pharmacy desert, and unfortunately this is being restricted even more,” said Dr. Thomas Huggett, Lawndale Christian Health Center.

There are more than 11,000 Medicaid patients who live on the West Side of Chicago, according to health equity experts. Most West Side neighborhoods do not have a CVS.

“We really need a corporation like CVS/Aetna to really look at its own practices and policies or we’re never going to get to an equitable society,” said Dr. David Ansell, Rush University Medical Center.

State Representative La Shawn Ford sponsored a bill that would allow Medicaid patients access to the pharmacy of their choice, discussing it at news conference on Thursday.
 

“We have to pass legislation, put pressure on HFS and Aetna to reverse that administrative rule, but right now Aetna and CVS believe that they’re right. They believe that there are enough pharmacies in the boundaries of their clients, and they don’t see a problem with their new rule,” said State Representative Ford.

In a statement to the I-Team, Aetna said:

Aetna Better Health of Illinois is committed to helping Medicaid recipients obtain access to affordable prescription drugs when they need them. Criticism about the access to pharmacy services we provide in our Medicaid network are not accurate and seem to be based on incomplete information.

Across Illinois, nearly 2,000 pharmacies participate in our Medicaid network. In Chicago, our members live – on average – just six blocks or a half-mile from one of 271 in-network Chicago pharmacies, including CVS Pharmacy, Jewel-Osco, HY-VEE, Kroger/Mariano’s, Meijer, Walmart, Target, and importantly – many independently-owned community drugstores. None of the pharmacy chains in our network is designated a preferred pharmacy, and the fact is that many of our members choose to support locally-owned independent pharmacies in their neighborhood. Support of these small businesses is an important long-term solution to addressing pharmacy deserts and stimulating local economies.

We regularly review our network and geographic access points to ensure we are meeting the needs of our members and maintaining network adequacy. We continue to meet or exceed all of the state’s access requirements for managed care organizations. Our strategy to address greater access for members living near pharmacy deserts includes free delivery from many chain and independent pharmacies and 90-day prescriptions shipped directly to members’ homes. We continue to invest in partnerships to drive innovation and community-based solutions to address this issue.

 
 

Clipped from: https://abc7chicago.com/illinois-medicaid-pharmacy-plan-walgreens/10315664/

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Nevada Medicaid provides same-day transportation for testing and vaccines

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Nevada Medicaid is getting members to their vaccination appointments and also providing gas costs reimbursement for those with a ride already.

 
 

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

 
 

 
 

File of the COVID-19 vaccine(KOLO)

RENO, Nev. (KOLO) – Nevada Medicaid is now offering same-day transportation on COVID-19 vaccines and tests for its recipients.

Kirsten Coulombe with Nevada Medicaid said with the pandemic, many people’s situations have changed, and more people are on Medicaid.

“We really wanted to make sure that our recipients who are on Nevada Medicaid would have the opportunity to go to those testing sites as well as receive the vaccine,” Coulombe said.

She explained one in four Nevadans are now recipients and it is important to make sure people are able to get to their tests and vaccination appointments.

Nevada Medicaid was already offering non-emergency transportation services, however Coulombe said they wanted to make services more versatile.

“What we have done differently is that we’re making it more flexible for COVID and response to COVID and the demand that may be there so those flexibilities include same-day service,” Coulombe said.

Nevada Medicaid will also provide gas reimbursement if you have a family member or friend that can take you, or a bank card to ride public transportation.

“If they do have some barriers with transportation, we did not want a Medicaid recipient to not receive a vaccine or test because they didn’t have the option for transportation,” Coulome said.

If you are a Medicaid recipient and are interested in the same-day transportation services, you can call 1-844-879-7341 and they will send one of their independent contractors, usually an Uber or Lyft, to come and bring you to your appointment.

 
 

Clipped from: https://www.kolotv.com/2021/02/05/nevada-medicaid-provides-same-day-transportation-for-testing-and-vaccines/

 
 

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Florida Medicaid website hacked for 7 years, hundreds of thousands affected

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The website that hosts the application for multiple Florida Medicaid programs had a data vulnerability for 7 years that exposed personal identity and financial information.

 
 

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.

 
 

Tallahassee-based children Medicaid health plan Florida Healthy Kids Corp. began notifying members Jan. 27 of a 7-year data breach that exposed the personal information of hundreds of thousands of  health plan applicants. 

The health plan was notified Dec. 9 of the security breach  and launched an investigation, which found there had been “significant vulnerabilities” since 2013 on its website and databases that support the online children health insurance application. The vulnerabilities lasted from November 2013 to December 2020, when the health plan temporarily shut down its website. 

The health plan said it discovered that several thousand applicants’ information was inappropriately accessed and tampered with as a result of the breach. Information of applicants and enrollees that was exposed included Social Security numbers, dates of birth, names, addresses and financial information. 

During the time of the breach, Jelly Bean Communications Design was maintaining the health plan’s website and databases. The health plan said it is  speeding efforts to move the website to a new vendor. The health plan incorporates four programs that offer health insurance for children from birth to age 18: Medicaid, MediKids, Florida Healthy Kids and the Children’s Medical Services program, according to local CBS affiliate WPEC. 

The health plan said it has not confirmed that  personal information was removed from the system as a result of the incident and recommended  that individuals who applied for or enrolled with the health plan between November 2013 and December 2020 set up fraud alerts or security freezes. 

 
 

Clipped from: https://www.beckershospitalreview.com/cybersecurity/florida-medicaid-website-hacked-7-years-hundreds-of-thousands-of-health-plan-applicants-enrollees-affected.html

 
 

 
 

 
 

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DHHS approves Legal Aid of N.C. as Medicaid transformation ombudsman services

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NC awards Legal Aid contract to help members navigate issues during the transition to managed care.

 
 

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

 
 

The N.C. Department of Health and Human Services said Wednesday that Legal Aid of N.C. will provide Medicaid Managed Care ombudsman services for Medicaid beneficiaries.

Legal Aid will partner with the Charlotte Center for Legal Advocacy and Pisgah Legal Services to educate and inform beneficiaries about the state’s move to Medicaid Managed Care through outreach events, a public website and a toll-free phone number.

The ombudsman will help resolve issues within the Medicaid Managed Care delivery system. The ombudsman services will begin in the spring.

The ombudsman will be available to address specific Medicaid-related questions from beneficiaries, make referrals to applicable resources and assist in resolving issues with managed care.

In addition, the ombudsman will help track crucial information regarding access to care for ongoing reporting and analysis. This will help identify trends across Medicaid Managed Care to ensure timely attention to potentially systemic issues.

The services provided by Legal Aid are not a replacement for the Grievance and Appeals processes required of each Prepaid Health Plan, nor do the services replace the right of a member to appeal through any State-administered appeals system.

These services are distinct from North Carolina’s existing Long-Term Care Ombudsman Program that assists residents of long-term care facilities.

 
 

 
 

Clipped from: https://journalnow.com/news/local/dhhs-approves-legal-aid-of-n-c-as-medicaid-transformation-ombudsman-services/article_33e62b20-5b3e-11eb-bd10-fff0a64a33fd.html

 
 

 
 

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Sweeney, Greenstein Initiative to Improve Medicaid Prescription Drug Services Wins Committee Approval

 
 

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NJ is looking to contract with a third party entity to address risks of polypharmacy.

 
 

 
 

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.


 

Trenton– Legislation sponsored by Senate President Steve Sweeney and Senator Linda Greenstein designed to improve the quality of care in the Medicaid program by identifying multi-drug medication risk and reducing adverse drug effects was passed by the Senate Budget and Appropriations Committee today.

 
 

The bill, S-887, would push the state to initiate reforms that improve prescription safety and quality by requiring the Division of Medical Assistance and Health Services in the Department of Human Services to contract with a third-party entity to apply a risk reduction model to prescription drug services under the Medicaid program.

 

“We need to ensure that Medicaid funds are used appropriately and efficiently, and that the pharmaceutical services we provide are appropriate and safe,” said Senator Sweeney (D-Gloucester/Salem/Cumberland). “Putting in the proper controls will save lives and avert unnecessary hospital and doctor visits caused by adverse drug events.”

 

“People today are on multiple medications. We must do everything we can to ensure that prescribers and patients understand how these medications work together in the safest and most effective way,” said Senator Greenstein (D-Middlesex/Mercer). “By implementing various strategies that have proven successful in other markets, we can reduce the risk of adverse drug events for those in the Medicaid program.”

  

Nationwide, adverse drug events cause health problems that contribute to more than 3.5 million physician office visits, 1.3 million emergency room visits and 350,000 hospitalizations, cause extended lengths of stay and are the leading preventable cause of hospital readmissions, Dr. Calvin Knowlton, CEO of Tabula Rasa HealthCare, testified before the Senate Health Committee last September.

 
 

Clipped from: https://www.insidernj.com/press-release/sweeney-greenstein-initiative-improve-medicaid-prescription-drug-services-wins-committee-approval/

 
 

 
 

 
 

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Medicaid, education numbers most notable in Gov. Sisolak’s proposed 2021-2023 executive budget

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Nevada Medicaid enrollment grew 18.7% more than expected, and now the bill is coming due.

 
 

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.

 
 

CARSON CITY, Nev. (KLAS) — The COVID-19 pandemic devastated Nevada’s economy which relies so heavily on tourism. Gov. Steve Sisolak’s 2021-2023 proposal reveals the financial challenges the state continues to face. Medicaid and education numbers were of the most notable in his plan.

When the state legislature first approved budget cuts, it was for a devastating 12%. That will not be the case, however, due to higher December revenue projections than predicted.

“My Executive Budget for 2021-2023 recognizes the emergency we are
experiencing as a result of the COVID-19 pandemic while also setting forth a clear plan to revitalize, innovate, and grow Nevada’s economy,” Sisolak said in a news release. “I am committed to remaining flexible and working closely with the legislature in this unprecedented and evolving fiscal situation.”

Full 2021-23 executive budget highlightsDownload

Moving into Medicaid, the proposal preview shows that during the current biennium, 2019-2021, the number of enrollees increased by 18.7% more than projected. An additional increase of 2.2% is projected for 2021-2023. These numbers are due in part to job losses.

The budget predicts by the end of the upcoming biennium, one in four Nevadans will be enrolled in Medicaid.

Education is also highlighted, with $331 million in supplemental appropriations designated to K-12. In the current biennium, K-12 and Nevada System of Higher Education (NSHE) state expenditures total $7 billion. Federal aid is expected to be a large part of funding for education.

A state official also noted no school will receive less than they did coming into this budget, which includes revenue from marijuana excise taxes.

Another big item to note is that state employee furloughs that went into effect on January 1, 2021 will not continue in fiscal year 2022-23.

Sisolak says his priorities are still recovering from the ongoing crisis, creating jobs, educating children, promoting justice and equality and protecting citizens’ health.

The proposal lists general fund expenditures $8,688,624,000, a 2% reduction from 2019-2020.

“Ultimately, State revenues, while still severely impacted by the economic crisis, never dropped as low as our worst expectations and this budget reflects that inconsistent, if not positive, ending point,” the news release says.

Sisolak will discuss his proposal during the State of the State address, slated to air at 6 p.m. on Tuesday, Jan. 19. Channel 8 will carry coverage of the speech and it will also be livestreamed on 8NewNow.com as well as the governor’s Facebook page.

 
 

 
 

Clipped from: https://www.8newsnow.com/news/local-news/medicaid-education-numbers-most-notable-in-gov-sisolaks-proposed-2021-2023-executive-budget/

 
 

 
 

 
 

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Key MS House leader offers bill to restructure authority over Division of Medicaid

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Mississippi wants to take away Medicaid from the Governor.

 
 

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.

 
 

Rep. Trey Lamar

A new bill from the Mississippi House of Representatives, HB 1013 authored by House Ways and Means Chairman Trey Lamar (R) would establish a Medicaid Commission to oversee the Division of Medicaid currently operated under the instruction of the Governor’s office.

The proposed Commission would be made up of seven members. Three would be appointed by the Governor and four by the Lt. Governor initially, with later appointments made with the advice and consent of the state Senate. The Speaker of the House would have the ability to nominate two of the Lt. Governor’s appointees.

This marks a departure from the current circumstance as Medicaid is part of the executive branch with the Executive Director appointed by and reporting to the Governor.

The bill further clarifies the qualifications of the members and what experience they bring to the table, requiring some be a representative of Medicaid providers or from each Supreme Court or Congressional District.

It will then be up to the Commission of seven to appoint an Executive Director, who is required to either be a physician with administrative experience or a person holding a graduate degree in medical care administration, public health, hospital administration or something similar. The individual can also hold a bachelor’s degree with at least three years experience in management-level administration for policy development for Medicaid.

“House bill 1013 would essentially remove the Division of Medicaid from underneath the Governor and place a seven member board over the Division of Medicaid,” said Representative Lamar.

The language of the bill could cause some confusion when it states that it would “Abolish the Division of Medicaid and transfer the powers, duties, property and Employees of the Division to the Medicaid Commission.”

However, Lamar said this language is a matter of semantics. In laymen’s terms the bill would take the infrastructure and operations of the Division of Medicaid and rename the program under the Medicaid Commission within Mississippi Law. The substantive change would be that the authority would be moved from the Governor to the commission.

Rep. Lamar said with this change you would have seven sets of eyes over what has become a $6 billion industry. Medicaid is the largest budget in the state. There is roughly $1 billion of state dollars that go into the program and $5 billion of federal. While much of how those dollars is dictated by the federal government, the new board would also have input.

He said this commission would function similarly to the Department of Education, Institutions of Higher Learning, and Department of Health.

This would go into effect by July 1, 2021.

The appointment of the Medicaid Executive Director is at this time reserved for the Governor.

Currently, Medicaid is led by Executive Director Drew Snyder who was first appointed to the position by Governor Phil Bryant. The team also consists of a Deputy Executive Director, with several offices that work in conjunction with each other to accomplish regular work.

Medicaid serves roughly 720,000 Mississippians.

Mississippi’s Division of Medicaid was established in 1969 by the Mississippi Legislature.  It is housed within the Office of the Governor and is designated by state statute as the single state agency responsible for administering Medicaid. It currently employs over 1,300 people with 30 regional offices and over 80 outstations.

Lamar said this bill would not impact those jobs, but simply remove the division from under the Governor’s purview.

While tensions have been high in the past concerning Medicaid spending, the Division of Medicaid has made great strides fiscally since Snyder took over. For FY 2022, Medicaid did not request the typical $50 million deficit that the Legislature has become accustomed to in recent years.

Prior to the COVID-19 pandemic, the Division had roughly $40 million in special funds due to safe budgeting for the last few years. They have also continued to expand telemedicine opportunities, a program that was being prepped before the necessity of at home doctor visits due to social distancing.

In late 2020 Medicaid hearings, even providers complimented Snyder on the job he was doing to re-vamp the program, applauding his “open door” policy with everyone. Lamar echoed many of these sentiments, saying Snyder has done a great job over the Division.

The current concerns over Medicaid in Mississippi seem to revolve around Managed Care, the five percent reimbursement for providers and the difficult credentialing process. Many providers told lawmakers in October that they would like to see a more streamlined credentialing process.

Over the years there have been unsuccessful attempts by Legislative Democrats to expand Medicaid in Mississippi.  Republicans have fought the measure believing that the long term impact of substantially higher Medicaid enrollments would have a devastating effect on the state’s budget.  Many lawmakers believe that Snyder and his team have demonstrated Medicaid expansion is not necessary to run an efficient and effective program.

Lamar said a change like this is not unprecedented. It was only in the mid-80’s that the authority over the Division of Medicaid was handed over to the Governor.

“This would just be returning the state of Mississippi back to the way we use to do it and I think it makes sense,” said Lamar.

 
 

Clipped from: https://yallpolitics.com/2021/01/22/key-house-leader-offers-bill-to-restructure-authority-over-division-of-medicaid/

 
 

 
 

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Senators negotiate first steps in funding Missouri’s mandated Medicaid expansion

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Lawmakers are looking for ideas on how to pay for what the voters decided.

 
 

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.

 
 

Republican state Sen. Dan Hegeman, of Missouri, discusses voter approval of a ballot measure he sponsored during an interview on Thursday, Nov. 5, 2020, in his state Capitol office in Jefferson City, Mo. 

AP Photo/David A. Lieb

(The Center Square) — Missouri voters in August approved a constitutional amendment that expanded Medicaid despite fierce opposition by the Legislature’s GOP majority and Republican Gov. Mike Parson. 

Now, those same lawmakers and governor must execute the will of the people when they approved Amendment 2 by a 53-percent margin, meaning they must find a way to fund healthcare coverage for an additional 200,000 people now potentially Medicaid eligible this session, which began Jan. 6 and ends May 31.

Amendment 2 expands Medicaid eligibility under the 2010 Affordable Care Act (ACA), which provides a higher federal funding share for states that extend Medicaid to adults earning up to 138 percent of the federal poverty level.

State Auditor Nicole Galloway, the Democratic gubernatorial candidate defeated by Parson Nov. 5, estimates expanding Medicaid under the ACA could cost the state at least $200 million or save it as much as $1 billion annually by 2026.

But it will require upfront investment and some Republicans vow not to fund it. A more common goal among Republicans is to restrict its growth by imposing work requirements and creating a stringent enrollment-verification process.

“Amendment 2 will be a knockout blow to the state budget as more services will be cut or eliminated to pay for the healthcare of able-bodied adults,” state House Budget Chairman Rep. Cody Smith, R-Carthage, said before the session began.

Parson and legislative leaders, however, say they will push for Medicaid expansion as approved by voters less than six months ago under Amendment 2.

As part of that effort, the Senate Appropriations Committee got its first look at a bill that would extend the state’s federal match program — the Federal Reimbursement Allowance (FRA) — for Medicaid payments.

Senate Bill 1, filed by committee chair Sen. Dan Hegeman, R-Cosby, would extend the FRA for another year as state lawmakers have done every year since 2005.

The state’s FRA program was established as voluntary before being enacted into law as a provider tax in 1992. Hospitals contribute to the FRA and Missouri’s Medicaid program — MO HealthNet — uses the funds to earn higher returns in federal matching dollars. 

The FRA has grown to surpass all but two general revenue sources in the state budget. Nearly 85 percent of all payments to Missouri hospitals through MO HealthNet are covered by the FRA.

SB 1 would continue maximizing federal matching dollars and reducing the burden on state general revenues, Hegeman told the panel Wednesday.

“As most of you know, the FRA is how we fund over $1 billion of our state Medicaid program, and it is vitally important to our state budget,” Hegeman said. 

Among extensions is continuing to allow the Missouri Department of Health (DOH) to collect approximately $1.28 billion in Hospital Tax in Fiscal Year 2022 (FY22), which begins July 1, and in FY23. Hospital tax revenues will, in turn, draw approximately $2.391 billion in federal funds each year to the state.

Missouri Hospital Association (MHA) Executive Director Rob Monsees told the panel that adding 200,000 to the state’s Medicaid program will generate “a substantial amount of new FRA dollars. Some of those dollars can help provide an offset to the cost of expansion.”

If SB 1 fails, he said, it “would radically destabilize that funding mechanism.”

Sen. Bill Eigel, R-Weldon Spring, wondered why the FRA is approved each year with little debate when it is one the largest troughs of public money in the state budget.

“The FRA is a mechanism, which (funds) the largest government program we have, sees no reform,” he said. “We have thrown money at a broken program with no meaningful reform whatsoever.”

Clipped from: https://www.mdjonline.com/neighbor_newspapers/extra/news/senators-negotiate-first-steps-in-funding-missouri-s-mandated-medicaid-expansion/article_10d759f9-d05e-5959-9b60-0e229b969621.html

 
 

 
 

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Kentucky Medicaid bill would reduce managed care organization contracts to three

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Lawmakers frustrated with the court decision to squeeze in a sixth MCO are pushing back.

 
 

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.

  
 

Gov. Andy Beshear spoke out against a bill that would reduce the number of companies with Kentucky Medicaid contracts from six to three.

The bill, Senate Bill 56, includes language that would allow it to go into effect immediately if passed by the General Assembly and signed into law by the governor. That could have a significant bearing on a months-long, expanding legal fight over how the state awarded five contracts last May.

“We have had in our history, of having [Managed Care Organization], one quit,” Beshear said at a press conference on Tuesday, referring to Kentucky Spirit Health Plan abandoning its Medicaid contract in July 2013 with about a year left in the contract. “And if we only had three [Medicaid companies] and one quit, a huge number of people would be without service and would be in a very difficult spot that could be the difference between life and death.”

He acknowledged the potential frustration of lawmakers critical of the Medicaid program seeing a sixth Medicaid company added to the program through an order from the judge presiding over the Medicaid lawsuits.

The bill’s sponsor Sen. Stephen Meredith, a Republican from Leitchfield, Kentucky, said of Beshear’s response: “That’s a typical response from state government because we never approach things from a business model.

“If you truly apply the principles of the business world, there is no way that you would justify six [Medicaid] companies.”

 

Sen. Stephen Meredith, R-Leitchfield, is sponsoring a bill that would cut down the number of Medicaid companies in the state to three. There are six companies operating in Kentucky now.

LRC Public Information Office

Meredith, a retired hospital executive, said the bill would remove administrative redundancies and inefficiencies from the Medicaid program and for the health care providers that interact with Medicaid companies — especially small and rural health care providers.

Meredith has run a version of Senate Bill 56 every year since 2018. His first session was in 2017. He called his previous failed attempts to get the bill passed an “educational process” to help legislators understand the bill.

His case for passing the bill includes references to the importance and the plight of rural health care providers. He believes that reducing the number of Medicaid companies would bring them some financial relief, say that about 28 rural Kentucky hospitals are vulnerable to closure. Often, rural hospitals are major employers in rural communities and provide access to care that would not otherwise be easily accessible.

The legal foofaraw around the Medicaid contracts, in part, inspired Meredith to run the bill again in 2021, even after he told me he wouldn’t do so. In an October interview, he said there was a lack of interest from legislative leadership who he said “turned a deaf ear” on the matter.

He also said that the Medicaid lawsuits and the perceived expansion of bureaucracy with the sixth Medicaid company have Increased political buy-in for the bill, even while the General Assembly tackles other major pieces of legislation prompted by the coronavirus outbreak and the Beshear administration’s reaction to it.

The bill has been assigned to start its legislative journey in the Senate health and welfare committee, where Meredith is vice-chairman. He said the bill is slated to be heard in February.

“I think the Covid situation has actually kind of helped this bill and that [other legislators] recognize the challenges to hospitals, particularly rural hospitals, in trying to stay profitable, and literally survive, and that we can provide some kind of relief,” Meredith said.

 
 

 
 

Clipped from: https://www.bizjournals.com/louisville/news/2021/01/21/stephen-meredith-three-kentucky-medicaid-companies.html

 
 

 
 

 
 

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WI Submits Medicaid Demonstration Waiver, Health Savings Account Program

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Wisconsin has asked CMS to put all of the premium payments made by Medicaid members into an HSA regardless of whether they achieve healthy behavior requirements.

 
 

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

 
 

The Medicaid demonstration waiver, submitted to CMS in late December, seeks to leverage health savings accounts for childless Medicaid enrollees.

 
 

Source: Getty Images

 
 

By Hannah Nelson

January 21, 2021 – The Wisconsin Department of Health Services (DHS) has submitted an amendment to their section 1115 Medicaid demonstration waiver “BadgerCare Reform” for Centers for Medicare & Medicaid Services (CMS) approval to leverage a Medicaid health savings account (HSA) program for childless adults in the state.

Submitted on December 21, the amendment proposes that the full amount paid in premiums by individuals within the Medicaid/BadgerCare Plus program be deposited into a Medicaid HSA. Individuals could use then use the funds from their Medicaid HSA toward health expenses upon disenrollment from the BadgerCare Plus program.

This amendment would apply to enrollees aged 19 to 64 with incomes between 50-100 percent of the federal poverty line. Additionally, qualified members must not be pregnant or have dependent children under the age of 19 living in their home.

The federal public comment period will span from January 7, 2021 to February 6, 2021.

Under Wisconsin’s existing approved waiver, enrollees who fulfill healthy behavior incentives are charged lower premiums. However, this amendment would deposit additional funds to these enrollees’ HSAs so that regardless of whether an enrollee fulfills the healthy behavior incentives or not, the same amount of money would be deposited.

HSAs are considered an experimental approach in Medicaid programs. According to a 2018 Health Affairs study from Harvard T.H. Chan School of Public Health, there may be unintended consequences of an HSA program since these accounts are not commonly used. For instance, enrollees could be confused by the HSA program which may dissuade some people from enrolling.

“There’s been a lot of recent research showing that expanding Medicaid leads to improved access to care and better quality of care—which suggests that any expansion will be better for public health than not expanding. But our findings suggest that some of the benefits of expanding Medicaid may be at least partially compromised by some of the current innovations in use,” said Benjamin Sommers, associate professor of health policy and economics at Harvard T.H. Chan School and lead author of the study.

Under the Trump Administration, which prioritized increased state flexibility for Medicaid programs, some states have experimented with new approaches.

The researchers assessed views about new Medicaid policies approved by CMS in Ohio, Indiana, and Kansas through a telephone survey of 2,739 low-income adults. The survey gathered responses related to health savings accounts, financial well-being, access to care, experiences with the Affordable Care Act (ACA), work requirements, and private vs. public insurance coverage.

In 2015, Medicaid coverage was expanded in Indiana, but enrollees are required to pay premiums and contribute to HSAs, similar to what Wisconsin is proposing in their Medicaid demonstration waiver. On the other hand, Ohio expanded Medicaid coverage without premiums and with minimal cost-sharing.

The researchers found that cost-related barriers to care were more prevalent in Indiana, where enrollees were required to contribute to HSAs.

According to the survey respondents from Indiana, the health savings accounts caused confusion. Nearly 40 percent of those interviewed said they had never heard of the required accounts, and only 36 percent made regular required payments. This means that two-thirds of beneficiaries were at risk of losing benefits or coverage.

“For both work requirements and health savings accounts, the policies may operate as intended for modest numbers of Medicaid beneficiaries who understand or react to the incentives. But there’s a real risk that even greater numbers of low-income adults will be adversely affected because they don’t understand the new policies, can’t afford them, or get tied up in administrative complexity. For these reasons, it’s critical that there be ongoing independent monitoring of these approaches,” Sommers said.

 
 

Clipped from: https://healthpayerintelligence.com/news/wi-submits-medicaid-demonstration-waiver-health-savings-account-program