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]: Taking the care to the patient instead of taking the patient to the care.

 
 

Clipped from: https://pennwatch.org/pa-to-provide-health-care-to-the-homeless-by-expanding-medicaid-coverage-for-street-medicine/

 
 

The Pennsylvania Department of Human Services announced a change in Medicaid, also known as Medical Assistance in Pennsylvania, that will allow certain enrolled medical providers to provide care outside a clinical setting to Medicaid beneficiaries who are experiencing homelessness – a practice known as street medicine. Street medicine uses physical and behavioral health services to address the unique needs and circumstances of people experiencing unsheltered homelessness that are delivered directly to them in their own lived environment.

“As a physician, I understand that people experiencing homelessness often have complex needs and face many barriers to health care,” said DHS Secretary Dr. Val Arkoosh. “At DHS, we are consistently working to improve access to care and to ensure that all Pennsylvanians receive high-quality and compassionate health care that can stabilize circumstances and help improve their overall quality of life. By creating a path for Medicaid to cover street medicine, we are making it easier for health care providers to meet people where they are, and to provide the care they need and deserve.”

Medical services are provided by health care professionals who are equipped with portable medical equipment and can be rendered to anyone covered by Medicaid who is experiencing homelessness. Services could include but are not limited to primary care, vaccine administration, wound care, preventive services, counseling, medication for the treatment of opioid use disorder (also referred to as medication assisted treatment), and diagnostic services, such as rapid blood screening for diabetes and high cholesterol, rapid COVID-19 and flu testing.

This change applies to Medicaid enrolled physicians, certified nurse midwives, certified registered nurse practitioners, physician assistants, psychologists, and mobile mental health treatment providers, who render services in the Medicaid Fee-for-Service or Managed Care delivery systems.

People experiencing homelessness in the United States die, on average, three decades earlier than their peers with housing, most commonly due to preventable and treatable chronic medical conditions. By allowing providers to bill for services rendered during visits with people experiencing homelessness, DHS aims to increase access to care for Medicaid beneficiaries and improve health outcomes.

Street medicine visits will provide low-cost, high-impact resources that will also divert people from costly visits to emergency rooms. Health care utilization costs for people experiencing homelessness are five times the national average, mainly due to an over reliance on the emergency room for routine medical care and increased hospitalization rates for illnesses presenting in advanced stages.

 
 

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]: Ruh roh. The journo says the quiet part out loud. Alternative summary: Cooper sees whats happening and asks pretty please for legislators to forfeit all leverage they have in this giant deal.

 
 

 
 

Clipped from: https://journalnow.com/news/local/government-politics/is-medicaid-expansion-in-trouble-cooper-urges-lawmakers-to-separate-expansion-from-state-budget/article_ff869d32-19d2-11ee-982d-e3e9154ab02b.html

 
 

Gov. Roy Cooper urged state Republican legislative leaders to separate funding for Medicaid expansion from the 2023-24 state budget.

Allison Lee Isley, Journal

Richard Craver

Gov. Roy Cooper urged state Republican legislative leaders on Monday to separate funding for Medicaid expansion from the 2023-24 state budget, even though that funding is those leaders’ primary leverage against a budget bill veto.

Cooper signed House Bill 76 into law on March 27, surrounded by a bipartisan group of state legislators, including bill sponsor Rep. Donny Lambeth, R-Forsyth.

The signing of HB76 means that between 450,000 and 650,000 North Carolinians are a step closer to having health coverage through Medicaid.

Yet, the expansion legislation has been stuck in limbo as Republican House and Senate budget negotiations have spilled over into July.

There are no new projections of when the 2023 regular session will end.

Without a signed state budget, the legislation in HB76 would expire on July 1, 2024, meaning North Carolina won’t become the 40th Medicaid expansion state.

Cooper said Monday that “making Medicaid expansion contingent on passing the budget was and is unnecessary.”

“Now, the failure of Republican legislators to pass the budget is ripping health care away from thousands of real people and costing our state and our hospitals millions of dollars.

“Tying it to the budget is tying our hands, and the legislature should decouple the two and start Medicaid expansion now.”

Legislative analysts have expressed concerns that Republican legislative leaders may insert controversial legislation into the budget, potentially causing Cooper not to sign it.

That would set up a potential veto override vote in both chambers.

Next steps

North Carolinians who would likely be eligible under an expanded program are those between the ages of 18 and 64 who earn too much to qualify for Medicaid coverage, but not enough to purchase coverage on the private insurance marketplace.

Once there is a signed 2023-24 state budget, the N.C. Department of Health and Human Services will submit a State Plan amendment to the federal Centers for Medicare and Medicaid Services.

“After a budget is enacted, we will determine a proposed go-live date,’ DHHS said Monday. “That is why the governor is seeking to separate the budget from our ability to go live.”

DHHS said on March 27 that “CMS has up to 90 days to review and approve the State Plan Amendment, or issue a Request for Additional Information that stops the 90-day clock.”

“When N.C. Medicaid submits a response to the Request for Additional Information, the 90-day clock for review and approval restarts.”

Medicaid expansion finally moved forward in March when the House chose to agree with the prominent Senate changes to HB76 that foremost addressed easing or eliminating several certificate-of-need provider restrictions.

Cooper acknowledged during a March 27 MSNBC interview the necessity of the CON reform measures, saying providing “more competition in the health care arena was incorporated into this final agreement.”

Lambeth focused on the economic impact of expansion, particularly the additional $1.7 billion in federal incentive funding coming to the state.

“These funds can be used for much-needed reform of our mental-health system, improving access to care sites across the state that provides care to our citizens when needed rather than being in one of our emergency rooms awaiting care,” Lambeth said.

“The impact of federal funds to North Carolina’s economy is $6 billion per year.”

Lapsing coverage

An accompanying statement from the governor’s office said that by not having a 2023-24 state budget in place, “this failure could result in more work for counties, less money for hospitals and people losing care in the interim for no reason.”

“If Medicaid Expansion and HASP (Healthcare Access and Stabilization Program that reimburses hospitals) don’t go live at the same time, it will cost the hospitals as much at $60 million more than necessary.”

The statement from the governor’s office stressed that about 9,000 people will lose their Medicaid coverage during July alone who would have been able to keep it under expansion.

There are estimates that nearly 300,000 North Carolinians receiving COVID-19 pandemic-related Medicaid coverage could face being removed as a recipient over the next 12 months.

However, NCDHHS said it is working “to ensure people eligible for Medicaid do not lose coverage, and those no longer eligible are transitioned smoothly to affordable health plans or other health care options.”

“Many of these beneficiaries will be eligible for health care coverage under Medicaid expansion, which the legislature recently passed, but cannot start until after CMS approves North Carolina’s changes and a (state) budget is enacted.”

NCDHHS said its goal during unwinding “is to ensure people who remain eligible for Medicaid continue to be covered and those who are no longer eligible know their potential options, such as buying coverage, often at a reduced cost, through the federal Health Insurance Marketplace.”

State Medicaid officials have been working with county Departments of Social Services and other partners to reach as many beneficiaries as possible “to explain what they can expect and their potential options to obtain health coverage.”

Beneficiaries have the right to appeal the decision by their local DSS, and information on this process is included in their notice of termination or reduced benefits.

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]: Cue Bowie song.

 
 

 
 

Clipped from: https://www.nbcrightnow.com/news/state-to-continue-medicaid-waiver-for-five-years/article_e25f3f1a-178a-11ee-a494-2fea92477108.html

 
 

OLYMPIA, Wash.-
Washington state’s Medicaid demonstration waiver renewal has been approved.

The Washington State Health Care Authority (HCA) announced the renewal on June 30, it will go into effect on July 1 and run for the next five years.The Medicaid Transformation Project (MTP) is an agreement between HCA and CMS that allows Washington to implement new policies and use federal Medicaid funds to improve Apple Health, Washington’s Medicaid program.

What’s included in MTP renewal:

• Medicaid Alternative Care (MAC) which expands  care options for older people so they can stay at home and delay or avoid more intensive services, such as moving to a nursing facility.
  
• Assists unpaid family caregivers.
  
• Continued Apple Health coverage for children ages 0-5.
  
• Apple Health postpartum coverage expansion.
  
• Re-entry coverage for individuals leaving a prison, jail, or youth correctional facility.
  
• Program innovations that support older adults, including expanded eligibility and presumptive eligibility to support access and enrollment.
  
• Programs that address health-related social needs (HRSN), including:
  
• Community-based workforce payment through Community Hubs and the Native Hub.
  
• HRSN services (e.g., nutrition, housing, medical respite, transportation).
  
• Rental subsidies up to six months.
  

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]: Because reasons. Not very confident the reasons given mean much.

 
 

 
 

Clipped from: https://www.news5cleveland.com/news/local-news/governor-explains-why-medicaid-coverage-of-doulas-was-vetoed-from-budget-backers-of-the-program-react

 
 

COLUMBUS — Ohio Governor Mike DeWine made dozens of line-item vetoes before signing the state’s $191 billion budget on Monday.

One of those line items dealt with being able to use Medicaid funding to cover doulas for expectant mothers.

News 5 Evening Anchor Courtney Gousman dug into the issue to find out why the governor nixed the issue and how those backing the bill feel about it.

That line item was originally introduced in the state house by former State Representative Erica Crawley from Columbus.

Crawley, who authored the bill, which was introduced in 2019, would create a program that would allow doulas for pregnant women to be covered by Medicaid funding.

Doulas are trained professionals who serve as social and emotional support for pregnant women, as well as advocates during pre and postnatal care.

Studies show when doulas are involved, maternal and infant mortality rates dramatically decrease, saving lives.

Crawley told Courtney Medicaid pays for 51% of the births in the state, and it makes sense for Medicaid to pay for doula coverage for pregnant women.

Crawley is now a Franklin County Commissioner and is actively advocating for this piece of legislation, which she tells Courtney, has bipartisan support.

“The funding has not been there. If it was, then you wouldn’t hear me trying to push legislation asking for more funding to be available through Medicaid, and so I think this continues to be smoke and mirrors to continue to kick the can down the road,” Crawley said.

Courtney reached out to the governor’s office to find out why he chose to remove the item from the state budget. She was told it was a technical amendment due to the bill’s language.

DeWine, along with the state’s Medicaid Director, Maureen Corcoran, addressed the issue during Wednesday’s budget briefing.

“We’re very much in favor of doulas; in fact, we provide that for that and intended to provide that for that. I’ll let the director take the rationale, but the policy is we understand doulas can be very helpful, very effective. We’re for that,” DeWine said.

Corcoran said it was a technical amendment.

“Governor, so you got it right on the nose. It was a technical amendment. It finally establishes for us a regular framework so we can expand the coverage and the ability to utilize doulas that we’re already using on a smaller scale in Medicaid,” Corcoran said.

Corcoran said the state is still working to implement a doula program statewide that would be covered by Medicaid, and they are still working to piece together the framework with the nursing board.

The hope is to have something by January or soon thereafter, Corcoran said.

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