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]: CMS proposed new regs, released a new guide, and approved 2 SPAs – all designed to make it easier to bill for Medicaid services provided at schools.

Clipped from: https://www.hhs.gov/about/news/2023/05/18/biden-harris-administration-takes-action-help-schools-deliver-critical-health-care-services-millions-students.html

Biden-Harris Administration Takes Action to Help Schools Deliver Critical Health Care Services to Millions of Students

New resources and proposed regulations from U.S. Departments of Education and Health and Human Services advance Administration’s commitment to expanding health care access and fighting youth mental health crisis 

Today, on the Mental Health Awareness Day of Action, the Biden-Harris Administration is taking bold action to make it easier for schools to provide critical health care services, especially mental health services, for millions of students across the nation. These three significant actions support President Biden’s comprehensive national mental health strategy and deliver on his commitment to tackle the nation’s mental health crisis as part of his Unity Agenda.  Through a series of new announcements from the U.S. Departments of Education (ED) and Health and Human Services (HHS), the Administration is continuing to take a whole-of-government approach to meet families where they are and ensure that children have access to the health care they need – especially mental health services.  

Specifically, ED is proposing a new rule that would streamline Medicaid billing permissions for students with disabilities. ED predicts of the 500,000 new students who are found eligible under the Individuals with Disabilities Education Act (IDEA) Part B each year, nearly 300,000 are likely to be eligible for Medicaid and impacted by this rule. HHS is issuing new guidance to make it easier for schools to bill Medicaid. HHS also is approving requests from New Mexico and Oregon to expand health care services that schools can deliver to Medicaid enrolled students.

“Students are six times more likely to access mental health when these services are offered in school, and that’s one important reason why making it easier for schools to provide health care is at the heart of the Biden-Harris Administration’s efforts to address the youth mental health crisis and raise the bar for learning conditions in our schools,” said U.S. Secretary of Education Miguel Cardona. “These new resources and proposed rules will help schools live up to the promise that all students, including those with disabilities, receive a free, appropriate public education. We need to continue breaking down barriers that have long undermined state and local efforts to provide health care services to students, including those covered by Medicaid. Ultimately, more children and youth will gain access to the physical and mental health services they need to succeed in school and in life as a result of the actions the Biden-Harris Administration is taking today.” 

“We are taking bold actions to strengthen school-based health care services through our Medicaid program so that children in every community have the support they need,” said HHS Secretary Xavier Becerra. “President Biden has made clear that strengthening youth mental health is a top priority of this Administration. We are working across the federal government, as well as with all states, territories and tribes, to meet families where they are and provide students with the services and supports they need to be healthy and thrive.”

IDEA Act Notice of Proposed Rulemaking

ED is releasing a Notice of Proposed Rulemaking under IDEA that would streamline consent provisions when billing for Medicaid services provided through a student’s individualized education program (IEP). This would result in a uniform process applicable to all Medicaid enrolled children, regardless of disability.  

Many children with disabilities receiving services under the IDEA are also enrolled in Medicaid either due to their disability status and/or based on their family income. Children with disabilities and are more likely to have low income, and those covered by Medicaid are more likely to have greater health care needs than those who are covered by private insurance. Further, the COVID-19 pandemic reduced access to critical services for children with disabilities and other vulnerable populations. To meet the Administration’s goal of increasing access to health and mental health services, and in fulfillment of the Bipartisan Safer Communities Act (BSCA) provision of expanding access to crucial school-based services for mental health and other care needs, it is crucial to remove barriers for schools so they can more easily provide Medicaid covered services to their students enrolled in Medicaid.

Importantly, the proposed changes announced today do not alter any of the critical parental consent provisions required by IDEA nor do they impact the parental consent obligations under the Family Educational Records and Privacy Act (FERPA). Additionally, the proposed rule does not alter the requirement that IEP services must be delivered at no cost to the child’s family, the requirement that IEP services cannot diminish other Medicaid-reimbursable services, nor Medicaid’s position as payor of first resort for IEP and Individualized Family Service Plan services. Rather, this regulatory change would help cut unnecessary red tape that schools and districts face in billing Medicaid and meet their obligations to ensure students with disabilities receive a free, appropriate public education in accordance with their IEP.

Guide to Expand School-Based Services for Millions of Students 

Today, HHS, through the Centers for Medicare & Medicaid Services (CMS) is releasing a comprehensive guide for Medicaid school-based services to make it easier for schools to deliver and receive payment for health care services to millions of eligible students. Developed in consultation with ED, the Comprehensive Guide to Medicaid Services and Administrative Claiming – PDF represents an important part of the Biden-Harris Administration’s implementation of the BSCA.   

In addition to providing billions in funding for school-based mental health personnel and supports to create safe and welcoming school environments, BSCA charged ED and HHS to expand access to school-based health and behavioral health services. The guide released today outlines flexibilities states can adopt to make it easier for schools to get paid for these critical health services delivered to children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), which together provide health coverage to more than half of all children in the United States.    

“With this guide, we are helping states and schools bring health care to kids where they are, rather than the other way around,” said CMS Administrator Chiquita Brooks-LaSure. “Children spend most of their waking hours in school. We also know that children have suffered serious declines in access to mental and behavioral health care services during the COVID-19 pandemic. We’re making it easier for states and schools to maximize Medicaid coverage to grow connections to care.”  

Medicaid and CHIP cover more than half of all children in this country.  That’s more than 41 million children spending over 30 hours weekly in school during most of the year. This comprehensive policy guide helps states and schools leverage Medicaid and CHIP and offers a roadmap of how they can build a bridge between education and health care, including mental health care, to support children enrolled in these programs and help them thrive.  

The guide clarifies, consolidates, and expands on a wealth of CMS guidance on how schools can receive payment for providing care for Medicaid- and CHIP-enrolled students, and how states can ease the administrative burden on school-based health providers to promote their participation in Medicaid and CHIP while meeting federal statutory and regulatory requirements. This includes helping states and schools operationalize: 

• How payments can be made for school-based services under Medicaid and CHIP; 
  
• How states can simplify billing for school-based services, including in rural and small or under-resourced communities, where care may be particularly challenging. 
  
• Examples of approved methods that state agencies have used to pay for covered services; and  
  
• How to enroll qualified health care providers to participate in Medicaid and furnish services within school settings. 
  

In the months to come, CMS plans to release more resources to help ensure states can optimize children’s access to school-based services. As outlined by BSCA, these resources include $50 million in grant opportunities and a school-based services technical assistance center, in partnership with ED. For more information on the guide, visit Medicaid.gov. 

New Mexico and Oregon School-based Services Expansion Approval

HHS, through CMS, also approved state plan amendments (SPAs) for both New Mexico and Oregon that will allow Medicaid to pay for health care services schools delivered to more of their Medicaid-enrolled students. Specifically, these SPAs will allow New Mexico and Oregon to receive Medicaid funding for services provided to all children covered by Medicaid, rather than only those children with an IEP. These approvals expand access to school-based health services, a key priority for the Biden-Harris Administration, that will strengthen Medicaid and help provide resources to combat the youth mental health crisis. New Mexico and Oregon join 12 other states that have already expanded Medicaid payment for school-based health care services under their state plans. These states include: Arizona, California, Colorado, Connecticut, Georgia, Illinois, Kentucky, Louisiana, Massachusetts, Michigan, Nevada, and North Carolina.  

These announcements collectively are part of the Biden-Harris Administration’s commitment to addressing the nation’s mental health crisis by providing more school-based resources and supports to help address students’ mental health needs. Today’s announcement comes on the heels of ED’s announcement earlier this week on the latest tranche of awards to train school-based mental health professionals through the Mental Health Service Professionals demonstration program, which provided another nearly $100 million in awards as part of an overall appropriation of $1 billion in BSCA for school-based mental health services and supports. 

Collectively, these announcements build on actions HHS, CMS and ED have taken over the last year to expand access to school-based health care and trauma informed services.  Last summer, CMS released guidance for states on to strengthen the delivery of Medicaid and Children Health Insurance Program (CHIP) youth behavioral health services and school-based services. Last fall, ED announced the Stronger Connections Grant program, which provided awards totaling $1 billion to 56 states and territories through BSCA to help schools in high-need districts provide students with safe, welcoming, and supportive learning opportunities and environments that are critical for their success. Last winter, HHS also awarded nearly $245 million to expand trauma informed services and supports for students and their families, including grants to State and Local Education Activities to bolster school-based services.

And at the beginning of the 2022 – 2023 school year, Secretary of Education Dr. Miguel Cardona and Secretary of Health and Human Services Xavier Becerra sent a letter to governors across the country to highlight federal resources available to states and schools to invest in mental health services for students. ED also awarded $122 billion in American Rescue Plan Elementary and Secondary School Emergency Relief funds to help schools reopen and recover, and experts indicate more than $2 billion has been directed to hire more school psychologists, counselors, and other mental health professionals in K-12 schools. With the help of these funds, as of March 2023, compared with the pre-pandemic period, the number of school social workers is up 48%, the number of school nurses is up 42%, and the numbers of school counselors and school psychologists are each up 10%.

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]: There will be no reductions in Medicaid payments. If you ask again, I will send Cornpop to your house.

Clipped from: https://www.foxnews.com/politics/biden-refuses-accept-work-requirements-medicaid-gop-debt-ceiling-talks

Biden said he ‘voted years ago’ for work requirements but is now opposing the new Republican plan for Medicaid

President Biden said Wednesday that he will not accept any of the Medicaid work requirements in the Republican debt ceiling plan, leaving no room for negotiation even as he admitted to supporting work requirements in the past.

“I’m not going to accept any work requirements that’s going to impact on medical health needs of people,” Biden told reporters Wednesday. “I’m not going to accept any work requirements that go much beyond what is already – well, I voted years ago for the work requirements that exist, but it’s possible there could be a few others, but not anything of any consequence.” 

House GOP lawmakers included new work requirements for able-bodied adults to qualify for Medicaid in the Limit, Save, Grow Act. The Congressional Budget Office has estimated these requirements would save $109 billion in the next decade. Still, Democrats oppose the measure because they say it will make it harder for poor people to access benefits. 

House Speaker Kevin McCarthy, R-Calif., has said requiring Americans to work before they receive government benefits will “help lift millions of Americans out of poverty.” 

MCCARTHY NOT OPTIMISTIC ABOUT DEBT CEILING NEGOTIATIONS, SAYS ‘THERE IS NO MOVEMENT’

“Right now, there are more job openings than people looking for work, in part because the Biden administration has weakened some of the very work requirements that then-Sen. Biden previously supported,” McCarthy said during a floor speech on April 19. 

“Our plan ensures adults without dependents earn a paycheck and learn new skills. By restoring these common sense measures, we can help more Americans earn a paycheck, learn new skills, reduce childhood poverty, and rebuild the workforce,” the speaker said. “It will also protect and preserve Medicare and Social Security because more people will be paying into it.” 

MCCARTHY SAYS BIDEN DRAGGING HIS FEET ON DEBT CEILING: ‘THEY WANT A DEFAULT MORE THAN THEY WANT A DEAL’

The White House and cleaders are engaged in tense negotiations as an early June deadline to raise the debt ceiling quickly approaches. Biden has issued a veto threat against the current GOP plan, which passed the House in April. 

McCarthy said Monday there’s been “no movement” as Republicans seek spending cuts in any deal while Democrats want a clean debt ceiling increase and the president has demanded spending talks be kept separate from debt limit talks. 

BIDEN GETS HEATED WITH REPORTER AFTER ASKED ABOUT DEBT CEILING: ‘YOU DIDN’T LISTEN’

“If you look at the timeline to pass something in the House and pass something in the Senate, you’ve got to have something done by this week, and we are nowhere near any of that,” McCarthy told reporters.

Nevertheless, Biden expressed confidence Wednesday that a deal will be reached in time. 

“I’m confident that we’ll get the agreement on the budget. America will not default, and every leader in the room understands the consequences if we fail to pay our bills, and it would be catastrophic for the American economy, the American people, if we didn’t pay our bills,” he said. 

Fox News’ Greg Wehner contributed to this report.

Chris Pandolfo is a writer for Fox News Digital. Send tips to chris.pandolfo@fox.com and follow him on Twitter @ChrisCPandolfo.

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” are already trotting out the Boogeyman that “uncertainty” over debt ceiling talks could maybe someday impact state payments to Medicaid providers. This has never happened and it will not happen.

Clipped from: https://news.bloomberglaw.com/health-law-and-business/debt-breach-risks-71-billion-in-medicare-medicaid-pay-delays

It’s still early, by Washington standards, in negotiations to raise the debt ceiling.

But as the once-routine process continues to devolve into a high-stakes game of chicken, the real-life impact of a debt limit breach on Medicare and Medicaid is already causing angst for policy watchers. President Joe Biden was scheduled to meet with House Speaker Kevin McCarthy (R-Calif.) and other congressional leaders at the White House Tuesday hoping to avoid a looming default.

The Bipartisan Policy Center projects that without action on the debt limit, the “X Date”—when the Treasury is unable to meet all of its financial obligations—will probably occur sometime between early June and early August. That could affect or delay some $49 billion in Medicare payments to medical providers and suppliers and $22 billion in Medicaid payments to states that are both due by June 9, according to the BPC.

For hospitals, doctors, and other health-care providers still working to regain patients amid rising labor and supply costs due to Covid-19, a debt ceiling standoff adds unwelcome uncertainty to their usually reliable Medicare reimbursements. And while reserve funds in most states have swelled during the pandemic, a debt-ceiling stalemate could require using that money to cover delayed federal Medicaid payments, which would leave less to help soften the effects of declining tax revenue and a possible recession.

“A state may say ‘we have sufficient state funds set aside that will cover 100%'” of the federal Medicaid matching payment “with the understanding that we will be reimbursed once this issue is settled,” said G. William Hoagland, a senior vice president at the Bipartisan Policy Center.

But because “all of the different federal sources of funding that states depend on could potentially be jeopardized at the same time” in a debt-limit breach, “I don’t think it’s safe to assume that states would automatically jump in and pay their Medicaid providers,” said Allison Orris, a senior fellow at the Center on Budget and Policy Priorities.

‘A Lot of Lawsuits’

“If the states did not pay, I’m sure there will be a lot of lawsuits,” said Margaret A. Murray, CEO of the Association for Community Affiliated Plans, which represents 79 safety-net health plans nationwide. Medical providers who serve Medicaid patients “don’t always have great reserves to be able to afford to see patients that they’re not being paid for. So I think it’s going to cause a lot of chaos,” Murray said.

Delaying payments could also reduce beneficiary access by pushing providers “over the edge” and causing them to see fewer Medicare and Medicaid patients, said Tricia Neuman, senior vice president of KFF and executive director of its program on Medicare policy.

“It’s hard to say, for sure, what would happen because a debt-limit breach has never happened,” Neuman said. “But failure to raise the debt limit for a prolonged period of time could be hugely destabilizing for Medicare and Medicaid. And it could be disruptive for hospitals, physicians, and other health-care providers.”

Hospitals faced their worst year of the pandemic in 2022, and now face new fiscal challenges related to the May 11 end of the public health emergency. Uncompensated care costs for hospitals are likely to rise this year as the Medicaid “unwinding” increases the numbers of uninsured and underinsured.

And continued medical inflation and other cost pressures are projected to $98 billion in additional costs for hospitals from 2022 to 2023, according to a study by McKinsey. Delayed Medicare and Medicaid payments would only add to their struggle.

Impact on Managed Care Plans

Slow payments would also have downstream effects for private Medicare Advantage plans and Medicaid managed care plans, which “could in turn, have problems meeting their own obligations, paying their staff, and covering their bills,” Neuman said.

The nursing home industry is especially sensitive to that possibility.

“With the long-term care industry already experiencing a historic workforce crisis and recovering from the pandemic, any disruption of lifeline reimbursements will result in devastating consequences for our nation’s most vulnerable individuals who need access to care,” said a statement from the American Health Care Association and the National Center for Assisted Living.

Medicaid’s role in the debt-ceiling debate is complicated by the House Republican bill to raise the debt limit, H.R. 2811. The legislation would cut federal spending by about $130 billion and require able-bodied adults without dependents to complete work-related activities each month or risk losing their Medicaid coverage.

The proposal has little chance to pass the Senate but nonetheless has made Medicaid an unlikely political cudgel as debt-limit negotiations continue.

“I don’t think Medicaid should be used as a bargaining chip right now, given all the other things we’re going through with Medicaid, in terms of staff reductions and redeterminations,” Hoagland said.

“This is just not the time to make work requirements part of the debt limit discussion,” he said. “It doesn’t save a lot of money, It’s more ideological than it is substantive in terms of budget.”

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]: WV will resume both its normal eligibility rules processing AND its enforcement of work requirements to get government food assistance.

Clipped from: https://www.thecentersquare.com/west_virginia/article_ae968d86-f35f-11ed-adb3-a726ade5333f.html

SNAP and Food Stamps provide nutrition benefits to supplement the budgets of disadvantaged families.

Jonathan Weiss | Shutterstock

(The Center Square) – The end of the federal COVID-19 emergency has led to two significant changes for those on assistance programs in West Virginia.

The state has re-started the redetermination program for those on Medicaid and WVCHIP. During the public health emergency, rules were suspended and those deemed eligible for programs remained eligible. As of March, the West Virginia Department of Health and Human Resources reported that 665,010 West Virginia residents were on the programs.

That’s part of the estimated 100 million on Medicaid in the United States, according to the Foundation for Government Accountability. The FGA estimates that 20 million of those are actually ineligible for the programs, which is estimated to cost the U.S. $16 billion per month.

The work requirements for those ages 18-49 without children or dependants for the Supplemental Nutrition Assistance Program for Able Bodied Adults Without Dependents will also resume statewide starting July 1.

“All potentially impacted individuals will receive a letter in mid-May with more information,” DHHR said. “Those who believe they should be exempted from this requirement are encouraged to speak with their caseworker.”

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]: CMS plans on collecting lots more data for all the different cells it wants to sort people into for use in new policy agenda items. And some rural health and high cost drugs stuff for good measure.

Clipped from: https://www.jdsupra.com/legalnews/cmmi-describes-progress-on-addressing-8654091/

In October of 2021, the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) unveiled its 2030 vision to achieve “equitable outcomes through high quality, affordable, and person-centered care.” One of the objectives to achieve this goal is to focus on “advancing health equity.”  Dr. Dora Hughes, the Chief Medical Officer of CMMI, recently outlined in a blog post the initiatives that CMMI has already conducted and is proposing to implement to advance health equity.

CMS defines health equity as “the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes.” In working to achieve health equity in testing its payment and service delivery models, CMMI has committed to the following:

1. Developing new models and revising existing models to promote and incentivize equitable care.
   
2. Increasing participation of safety net providers.
   
3. Increasing collection and analysis of equity data.
   
4. Monitoring and evaluating models for health equity impact.
   

Developing new models and revising existing models to promote and incentivize equitable care.

CMMI has revised the Medicare Advantage Value based Insurance Design Model, the ACO Realizing Equity, Access, and Community Heath (ACO REACH) Model, and the Maryland Primary Care Program, which is a component of the Maryland Total Cost of Care Model, to promote a more direct focus on health equity. Some of the revisions included providing supplemental benefits, such as food, transportation, and housing assistance to beneficiaries with chronic illness and unmet social needs, and providing payments to allow for additional support for care management services.  CMMI is also collecting better sociodemographic data, requiring model participants to create and implement health equity plans, and ensuring screening of beneficiaries for health-related social needs. CMMI also introduced the Enhancing Oncology Model (EOM) that focuses on cancers that disproportionately affect underserved populations and includes many of these same model policies.

Increasing participation of safety net providers.

To increase model participation among safety net providers, CMMI conducted external and internal analyses. The external analysis included engaging in interviews and listening sessions with safety-net provider stakeholders to identify any barriers to safety-net provider participation. The internal analysis looked at qualitative data related to model application requirements to see if they provided any barriers to participation. This data will be used to operationalize strategies for including more providers that serve Medicaid beneficiaries, as well as federally qualified health centers in CMMI Models.

Increasing collection and analysis of equity data.

CMMI uses data to evaluate findings and inform future model design. CMMI would like to collect equity data to “better stratify and evaluate model outcomes for beneficiary populations defined by factors such as race, ethnicity, gender, geography, disability, sexual orientation, and gender identity.” CMMI has already started to collect equity data in the ACO REACH Model, which requires ACOs to collect sociodemographic data and health-related social needs data. CMMI is also working with other federal agencies and states to obtain equity data in the Integrated Care for Kids Model and the Maternal Opioid Misuse Model.

Monitoring and evaluating models for health equity impact.

CMMI is following a two-pronged approach to evaluate models and measure their impacts on underserved populations. CMMI will publish findings from a retrospective, cross-model review focused on underserved populations for older models. Additionally, this includes current models that will have expanded analytic work to capture health equity impact. For new or modified models, CMMI is designing multiple new forms of analyses to provide a thorough understanding of the health equity impact of the models. In addition to evaluations, CMMI is developing analysis such as “leading indicators” to provide early signals of a model’s performance.

Looking ahead in 2023

For the rest of 2023, CMMI is continuing to refine and improve their current efforts to address health equity. One expectation is that all new models will include health-related social needs screenings and referral components when feasible. CMMI has also, in alignment with cross-agency efforts, developed recommendations for measuring quality of care for underserved populations. Additional efforts CMMI would like to apply in 2023 include:

1. Sharpening the focus on the needs of other underserved populations that are not well represented in models.
   
2. Exploring options to build upon and support earlier investments in rural health, to address the unique access and health care needs of rural and geographically isolated communities.
   
3. Continuing to explore mechanisms for social risk adjustment of payment, such as the use of dual eligibility status to better account for social risk.
   
4. Addressing the high cost of drugs, in response to the Executive Order on Lowering Prescription Drugs.
   
5. Identifying and remedying model designs that may lead to inequities.
   

Dr. Hughes said that CMMI’s equity to-do list is “ambitious but necessary… to ensure that our long-term transformational work equitably benefits all beneficiaries we serve.”

We will keep you informed of new CMMI models and their focus on addressing health equity as the agency provides more updates.

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]: Initial estimates were off by $880M in state only costs compared to the estimate the Good Guvn’r used to originally sell the idea. 30% more noncitizens have already signed up than originally projected.

Clipped from: https://www.theintelligencer.com/news/article/expected-cost-illinois-noncitizen-health-care-18083866.php

SPRINGFIELD  — The estimated cost for Illinois to continue providing health care coverage to noncitizens who are otherwise ineligible for Medicaid benefits has been revised upward to $1.1 billion for the upcoming fiscal year.

As of the end of March, the Illinois Department of Healthcare and Family Services estimated it would cost $990 million to fund the program that provides state-funded health care to individuals age 42 and older who would otherwise qualify for Medicaid if not for their citizenship status.

The new estimate, shared by IDHFS Director Theresa Eagleson in testimony to a Senate appropriations committee on Wednesday, is now $880 million beyond the $220 million estimate included in Gov. J.B. Pritzker’s February budget proposal.

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IDHFS Chief of Staff Ben Winick told the committee the original estimate relied on the Census Bureau’s American Community Survey data to estimate the eligible population, then assumed a certain percentage would enroll.

But both the cost of providing care and the number of enrollees have far outpaced estimates.

“Because of the unreliability of that data, the projections for enrollment are really just focused on month-over-month growth based on the trends that we’re seeing and not tied to the universe of eligibles,” Winick said. 

10 percent monthly growth

The projections are now based on the program’s current month-over-month growth rate of roughly 10 percent. The number of enrollees is expected to grow to over 120,000 in Fiscal Year 2024. The previous estimate was 98,500 enrollees.

Winick noted the program currently covers about 56,000 individuals while the department oversees health care for about 3.9 million people through its various programs statewide.

State Sen. Dave Syverson, R-Cherry Valley, raised concerns over the fact that no other states offer the same level of health care coverage for noncitizens as Illinois. That, he said, could result in ever-increasing enrollment and upward adjustments to cost estimates.

“As Illinois is the only state in the nation that fully covers health care for undocumenteds from age 42 and older, when they’re crossing the border, and they realize they have health conditions, they know there’s one state to come to if you have health issues,” he said at a Thursday news conference. “Illinois now, because of the policies of this state of being a welcoming state, is now being inundated with every sick individual from around the country that’s coming here.”

The same Senate committee heard a proposal from Sen. Omar Aquino, D-Chicago, that would further expand Medicaid coverage to noncitizens age 19 and older. That would cost another $380 million, per IDHFS estimates.

“We were the first (state) in this country to provide care to populations like this from 42 and above. We are a welcoming state, I say that with a sense of pride,” Aquino said.

He said the expansion means people who were “living in the shadows” are now able to seek care, and the pace of the program’s growth shows the need for it.

“Some of this is highlighting, again, a lot of the untreated medical issues that they have from Type 2 diabetes, cancers and so forth,” he said.

Eagleson noted that the per-patient cost for individuals age 65 and older has been leveling off since that population was first made eligible for the state-run health care program in 2021. The program has since been expanded twice to cover those 42 and older.

“I think it’s important to say that we are seeing people get those diagnostic services and drugs to help them manage chronic conditions and things like that,” Eagleson said. “So on the senior population that started sooner … those costs grew pretty rapidly in the first years, and then they actually decreased and now are just normal inflationary, so they start to level off as people get the treatment.”

Winick said a large portion of the program’s enrollees live in Cook County, and its results have been born out in decreased reliance on the county-run health system.

“A lot of that’s because those conditions are now being managed,” he said. “People are getting proper treatment and now they’re getting more preventive services than the higher-end stuff and they are using their coverage to access a wider variety of providers.” 

Defraying the cost

The department’s all-funds budget request as of February was $37.2 billion, with just over $9 billion from the General Revenue Fund.

The Pritzker administration estimated that the IDHFS budget as proposed could cover about $300 million of the greater-than-expected costs.

“The governor’s focus remains on investing in priorities he outlined during his budget address,” Pritzker spokesperson Jordan Abudayyeh said in a statement. “His administration is working closely with the General Assembly to ensure that additional priorities fit within a balanced budget framework.”

Department officials noted that they were looking into other ways to defray costs as well.

Because the individuals are not citizens, the federal government does not match the state’s contributions to the program. But Eagleson said the federal Medicaid program “does fund the emergency services for undocumented residents.”

“And so we have already gotten a verbal commitment for – it’s about $67 million in (federal) match for the money that we’ve already spent on the program,” she said of discussions with the federal government. “And then we think the estimate based on the cost…for emergency services will be in the neighborhood of $100 to $120 million going forward.”

The Republican senators also noted that the noncitizens are part of a fee-for-service Medicaid program instead of the Medicaid managed care program in which most other recipients are enrolled.

That managed care system uses private insurance companies known as managed care organizations, or MCOs, to coordinate care for Medicaid recipients. The state releases funds to MCOs at a statute-specified rate. Those MCOs are charged an “assessment,” a type of tax on providers designed to bring more federal funds into the state’s Medicaid program.

Eagleson said putting the noncitizen recipients in the managed care program wouldn’t necessarily decrease costs, but it would subject the recipients to the assessment via the MCO, thereby increasing revenues.

Winick said the reason the noncitizens were not included in managed care was because the department anticipated the group would be much smaller than it has become.

“Obviously now that we’re looking at much higher enrollment numbers, we are considering our options about maybe expediting the rollout of managed care for this population,” he said.

Sen. Chapin Rose, R-Mahomet, pointed out that the money spent on the expansion could have fully funded 20 percent Medicaid base rate expansion for hospitals that has been requested or adequate funding for services provided to individuals with developmental disabilities. 

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 move to have a national Medicaid work requirement could save federal taxpayers $10.3B, but still let states who want to not have work requirements the ability to pay for them on their own.

Clipped from: https://www.healthcarefinancenews.com/news/medicaid-work-requirements-may-result-17m-coverage-losses

The requirements would result in federal savings, but would pass costs on to states and cause large coverage losses, data showed.

Photo: Thomas Barwick/Getty Images

At the tail end of April, Republicans in the House of Representatives passed a debt ceiling bill that includes a stipulation for states to implement work requirements for certain Medicaid enrollees. A new analysis from the Kaiser Family Foundation determined that if the work requirement was fully implemented in 2024 and the rate of Medicaid eligibility loss was as the Congressional Budget Office estimated, then 1.7 million enrollees would not meet work or reporting requirements and potentially face disenrollment.

Data showed that 91% of non-elderly Medicaid enrollees who are not on Supplemental Security Income or Medicare are working or face barriers to work.

States could continue to provide Medicaid to those enrollees but would not receive federal matching funds for doing so. It’s unclear if any states would choose to do it, although the CBO estimated that more than half of enrollees would continue to be covered at the states’ expense.

If states chose to keep all 1.7 million people enrolled, $10.3 billion of Medicaid spending would shift from the federal to state governments in 2024. A small number of states with the largest share of enrollees under the Affordable Care Act Medicaid expansion would account for almost half of the increased state spending or coverage losses.

WHAT’S THE IMPACT

The Medicaid work requirement plan would require that certain enrollees between the ages of 19-55 work or participate in other qualifying activities for at least 80 hours per month. Those could include community service or job training. Those deemed mentally or physically unfit for employment would be exempted, as would pregnant people, those caring for a dependent child or incapacitated person, those in drug or alcohol treatment programs, or people who are in school.

If enrollees fail to meet those requirements for three months or more, the federal government would cease paying the federal share of Medicaid for their expenses. States could disenroll them or continue their coverage but pay 100% of the costs. Eligibility for federal funds could resume at the start of the following calendar year.

The Congressional Budget Office has estimated that if the work requirements are enacted, about 15 million enrollees per year would be subject to the new requirements, and about 1.5 million of them would lose eligibility for federal funding. That would result in federal savings of about $109 billion over a 10-year period, but that cost would shift to states that elected to maintain coverage. About 60% of those who lost federal eligibility would become uninsured because they live in states that did not maintain coverage; for the states that did, costs would increase $65 billion from 2023 to 2033.

In summary, “under those requirements, federal costs would decrease, the number of people without health insurance would increase, the employment status of and hours worked by Medicaid recipients would be unchanged, and state costs would increase,” the CBO said.

KFF estimated 16.7 million enrollees in the expansion group would be between ages 19 and 55 in May 2024 using the age distribution of expansion adults in administrative data. This estimate includes some parents of dependent children, who would be exempt from the work requirement but still potentially subject to reporting requirements. If 10% fail to meet the work or reporting requirements, as CBO assumed, 1.7 million enrollees could lose eligibility for federal matching funds in 2024.

THE LARGER TREND

The Biden administration first began taking steps to roll back Medicaid work requirements in 2021, citing the economic and health impacts of the COVID-19 pandemic, which it said could make it more difficult for Medicaid recipients to fulfill the requirements.

“Uncertainty regarding the current crisis and the pandemic’s aftermath, and the potential impact on economic opportunities (including job skills training and other activities used to satisfy community engagement requirements, i.e., work and other similar activities), access to transportation and to affordable child care have greatly increased the risk that implementation of the community engagement requirement approved in this demonstration will result in unintended coverage loss,” CMS said in letters to states at the time.

Hospitals in states that implement Medicaid work requirements could see their Medicaid revenues decrease by as much as 21%, their uncompensated care costs increase as much as 133% and their operating margins fall by upward of 2%, according to estimates by The Commonwealth Fund.

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com