Tag: State News

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[MM Curator Summary]: This is what the details of planning for the dwindling extra PHE FMAP looks like in one state.

Clipped from: https://indepthnh.org/2023/02/17/fiscal-committee-votes-to-accept-51-5m-in-federal-medicaid-money/

Health and Human Services Medicaid Director Harry Lipman, left, and chief financial officer, Nathan White, discuss accepting $51.5 million in federal money to cover the cost of about 100,000 Medicaid recipients who may no longer qualify after the federal health emergency declaration ends March 31.

By GARRY RAYNO, InDepthNH.org

CONCORD — The state will have $51.5 million in additional federal funds to support Medicaid recipients who qualified under relaxed guidelines due to the COVID-19 pandemic.

The Joint Legislative Fiscal Committee Friday approved accepting the federal enhancement money as the state begins the process of determining if about 100,000 people who were added to the Medicaid rolls due to the pandemic qualify for the program under normal eligibility requirements.

After the federal COVID-19 Emergency Declaration ends March 31, the state will begin the process and have up to a year to complete it.

Under the emergency declaration, those on Medicaid, the state-federal health insurance program, were automatically re-enrolled.

During the pandemic the federal Medicaid match was increased by 6.2 percent, which ends March 31, and then is 5 percent through June, 2.5 percent through October and 1 percent until the end of the year.

The $51.5 million is what the state expects to receive from the federal enhancement through this calendar year.

At the fiscal meeting, Harry Lipman, state Medicaid Director, said his agency anticipates it will need almost all of the federal money to cover the additional people added to the Medicaid rolls during the pandemic.

“We are carrying 102,000 people who would not be on the program under normal circumstances,” he said, “and this allows us to cover this extra (enrollees).”

He noted the state has one of the lowest bases in the country.

Both Lipman and Nathan White, the Health and Human Services Chief Financial Officer told the committee the agency has never attempted an “unwinding” like this before and they are unsure how it will go.

Lipman noted the federal poverty level changed recently and that added 1,700 people who will now qualify under normal eligibility for Medicaid.

White noted the agency will work in phases to disenroll thousands of people.

“You don’t know how many will appeal,” he said, “and if they do, they stay on Medicaid until it’s resolved. It’s a big unknown.”

The agency has been contacting people who are on Medicaid under the emergency declaration to set up appointments to see if they qualify under the normal requirements.

According to information given to the committee, “the department is diligently developing an unwind plan with the goal of ensuring that there are no gaps in medical coverage, whether that coverage is continued Medicaid or other sources of private or Marketplace coverage, and which is consistent with the budget in managing coverage transfer or disenrollment within a three-to-four-month timeframe.”

Committee member state Sen. Cindy Rosenwald, D-Nashua, noted the department lapsed federal Medicaid funds last year and wanted to know if they would be doing the same thing with this money.

Lapse is money appropriated, but not spent by the end of the fiscal year.

Lipman said last year the agency thought the federal government might end the declaration in October, and carrying the money forward has allowed the department to cover the additional Medicaid costs through March 3 of this year through the continuous enrollment provision.

He said if everything goes perfectly as they unwind the additional recipients, there could be a small lapse, “but if there is some bumpiness, we’ll need the money to cover people.”
The pandemic emergency resulted in an increase of income- based eligibility that was highest in Rockingham County at 29.3 percent and lowest in Belknap County at 20.3 percent.

Increase in Medicaid covering the disabled, elderly and foster care was highest in Rockingham County at 18.8 percent and lowest in Coos County at 10.4 percent according to information distributed to the fiscal committee.

Winter Maintenance

The committee also approved the transfer of $3.6 million from the Highway Fund Surplus Account to cover winter maintenance of the highway system.

The biggest increases department officials told the committee are the price of salt and overtime and leased and contracted services to plow and treat the roads, due to a workforce shortage.

The money will cover the remaining winter season for the department.

Garry Rayno may be reached at garry.rayno@yahoo.com.

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

[MM Curator Summary]: Florida is moving towards relaxing prior auth for those with SMI.

Clipped from: https://floridapolitics.com/archives/589626-senate-panel-oks-bill-exempting-medicaid-patients-with-mental-health-disorders-from-step-therapy/

A Senate panel approved a measure allowing Medicaid beneficiaries with serious mental illness to bypass “fail first” procedures, which require people to try less expensive options before “stepping up” to drugs that cost more.

The Senate Health Policy Committee on Monday passed SB 112 unanimously. Its counterpart (HB 183) has been referenced to the House Healthcare Regulation Subcommittee.

The bill defines serious mental illness as “psychiatric disorders as bipolar disorders, including hypomanic, manic, depressive, and mixed-feature episodes; depression in childhood or adolescence; and major depressive disorders, including single and recurrent depressive episodes.”

Before agreeing to pass the bill, the Senate health panel agreed to tag on an amendment that requires the state to take the policy change into effect when setting the next round of Medicaid managed care rates for the traditional managed medical assistance program, as well as the long-term care program.

While the Legislature has been more willing to embrace access to mental health services and drugs, there has been an uphill battle getting bills passed. So much so that the bills currently only apply to the state’s Medicaid managed care plans and not to commercial health policies or policies sold in the state group insurance program.

SB 112 builds off a 2022 law that allows recipients with schizophrenia to bypass step therapy. The 2023 bill broadens the existing law to apply to Medicaid beneficiaries with serious mental illness. The Legislature in 2022 passed a law that requires Medicaid to allow recipients with schizophrenia to bypass.

SB 112 had broad support from the health care industry — from the Florida Hospital Association to AARP Florida to the Florida Medical and Florida Osteopathic Medical Association — among others.

OBGYN Dr. Sujatha Prabhakaran said the bill will go a long way to help women with postpartum depression. A member of the Florida Chapter of the American College of OBGYNs, she traveled to Tallahassee from Sarasota to lobby in support of the bill on behalf of her patients. But she said she also appeared before the committee as a mother and a daughter.

“I also am a mother who knows how difficult pregnancy and motherhood can be without mental illness, so I want to do everything I can to help my fellow mothers who are struggling with mental illness get the care their physicians and caregivers know they need,” she said, fighting back tears.

“And finally, I stand here before you today as a woman who was once a child who lost her own mother to untreated postpartum depression. Deaths like my mother’s are tragic in so many ways, but especially because we know that with timely and appropriately prescribed treatment, these deaths are so preventable.”

Prabhakaran was one of two physicians to testify on behalf of the bill Monday. Orange Park psychiatrist Ted Bosi also spoke in support of the proposal. 

“Individual patients need individual treatments. That’s why I support SB 112,” Bosi said.

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

[MM Curator Summary]: Home care agencies in Ohio are claiming they lose about $800 every time they start helping a Medicaid member.

Clipped from: https://www.businesswire.com/news/home/20230220005022/en/Ohio-Home-Care-Agencies-to-Seek-Boost-in-Medicaid-Reimbursement-Rates-in-Biennial-State-Budget

Rates still at Y2K levels; Home care for older and disabled Ohioans in crisis

COLUMBUS, Ohio–(BUSINESS WIRE)–Ohio’s outdated Medicaid reimbursement model for home-based care has reached a crisis point, collapsing as reimbursement rates no longer cover the cost of providing care and preventing agencies from paying a competitive wage for the important work caregivers perform.

“We lose about $800 per patient every time we admit a Medicaid patient. Over a two-year period, we lost hundreds of thousands of dollars providing care for Medicaid patients”

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As such, the Ohio Council for Home Care and Hospice today announced that the association would be seeking long overdue and critically needed Medicaid rate increases to address the severe worker shortage and cover the cost of these critical health services.

While receiving health care at home is less costly and can be more effective than institutional care, state residents on Medicaid are increasingly added to waiting lists and go without proper care as the industry experiences an exodus of workers. As a result:

• Home health agencies have closed, can’t hire workers and many no longer accept Medicaid patients – the state’s most vulnerable residents, with the worst impact being felt in underserved and rural communities.
  
• Thousands of Ohioans are on waiting lists for home care services because there are not enough providers. These individuals are getting no care, inadequate care or use more costly emergency rooms or nursing homes, where they pay a further price in lost quality of life, independence, social interaction and well-being.
  

“This issue isn’t going away,” said Joe Russell, Executive Director of the Ohio Council for Home Care and Hospice (OCHCH). “Within the next two decades, the population of those 60 and older is expected to grow more than four times faster than the state’s overall population. If we want to care for the influx of older adults to allow them to age in place, and to help others who are struggling with disabilities, chronic illness or recovering from surgery, we need to address the worker shortage and cover the costs of these services.”

Lisa Von Lehmden-Zidek, Cleveland-based chair of the OCHCH board, said Medicaid reimbursement rates today are essentially the same as they were in 2000, a time period during which inflation rose more than 75 percent. For context, one agency could not take 1,693 Medicaid referrals in a single month last year due to staffing difficulties.

“The cost of home care greatly exceeds what Medicaid covers, and it makes no sense because receiving home care is significantly less costly than institutional care. If this continues, home care will be untenable and the costs for all Ohioans will increase with institutional care and more hospitalizations,” she said.

The statistics are alarming. Almost 144,000 Ohioans on Medicaid were enrolled in a home or community-based program as of August 2022, with thousands more on waiting lists. Older Ohioans are waiting from months to two years for supportive personal care services so they can live independently in their communities.

Greg Davis, a founder and co-owner of Patriot at Home, one of the largest providers of skilled home care in the Youngstown market, said at his agency, Medicare is subsidizing Medicaid. “We lose about $800 per patient every time we admit a Medicaid patient. Over a two-year period, we lost hundreds of thousands of dollars providing care for Medicaid patients,” he said.

Russell said the problem can be addressed in the State’s biennial budget.

“We should value the health and safety of Ohio’s most vulnerable in a way that’s on par with Medicare and private pay. Ohio Medicare payments can be more than 300% what Ohio Medicaid pays for the exact same service. Our goal is for state Medicaid reimbursements to cover the actual costs for care,” he said.

Advocates are seeking reasonable increases to achieve average market wages for the profession to both increase the wages and help cover overhead costs. The chart above reflects both wages and overhead, but the rate increases would allow agencies to pay RNs the market wage of $35 per hour (currently $22.20/hour) and pay aides the market rate of $20 per hour (currently only $10.10/hour).

About the Ohio Council of Home Care and Hospice

OCHCH represents over 600 home care and hospice and palliative care agencies from across the state of Ohio. Our members care for medically fragile children; those recovering at home from surgeries, and mental health and addiction treatment; older Ohioans who wish to age in place and many more.

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

[MM Curator Summary]: More details on one state’s plan to triage the redetermination experience for members based on a calculation of the impact it will have on each member (and their family if in a Medicaid household).

Clipped from: https://news.bloomberglaw.com/health-law-and-business/women-chronically-ill-shielded-as-oklahoma-medicaid-checks-near

Examination equipment hangs on the wall in a hospital’s trauma exam room.

Photographer: Daniel Acker/Bloomberg

Mothers, children, and patients with chronic health conditions will be last to lose Medicaid coverage in Oklahoma once checks on income eligibility resume in the spring.

The initiative from the Oklahoma Medicaid Authority aims to take advantage of the Biden administration’s 14-month window for eligibility checks by evaluating Medicaid beneficiaries based on need, targeting people who rarely use Medicaid services early in the unwinding schedule while delaying the cancellation of coverage for vulnerable populations.

Since the start of the Covid-19 public health emergency, state Medicaid programs have been prevented from conducting income eligibility checks as a part of a continuous enrollment provision passed by Congress that required states to keep beneficiaries enrolled in order to receive federal matching funds. The Consolidated Appropriations Act (Public Law 117-328) signed in December by President Joe Biden effectively did away with that provision, allowing states to resume eligibility checks after March 31.

The initiative is one of several “population prioritization” plans introduced in states aiming to soften the blow of the redetermination process, which could see an estimated 6.8 million “churn” in and out of Medicaid eligibility and another 8.2 million exceed program income limits over the long term. Nearly 300,000 of those individuals are likely to come from Oklahoma.

The Sooner State’s Medicaid enrollment has grown from about 808,000 in the early months of the Covid-19 pandemic to more than 1.2 million. The state added nearly 290,000 members since it expanded its Medicaid program in July 2021.

Although several states, including Utah and California, have introduced phased redeterminations based on individuals’ Medicaid use, Oklahoma takes things a step further by introducing a risk-based approach to redetermining Medicaid eligibility. According to the state’s plan, each Medicaid case will be processed and evaluated based on the level of burden imposed on a beneficiary if coverage were lost.

People with children under 5, those with chronic health conditions, and those with higher financial needs will see their individual cases evaluated near the end of the 14-month unwinding window, while those with no children, lower financial needs, and no recent claims will be evaluated earlier.

In the case of families with varying levels of needs, the state will disenroll children and parents at the same time, Traylor Rains, Oklahoma Medicaid director, said in January testimony before the Medicaid and CHIP Payment and Access Commission.

“If there is a family and they have different circumstances that would put them in a different bucket towards unenrollment, we are combining that case,” Rains said. “So let’s say Mom doesn’t have a severe need but the child does. We are putting that together as a case so they would unenroll at the same time.”

Minimizing ‘Needless Loss of Coverage’

Oklahoma’s unwinding strategy gives the most vulnerable populations enough time to prepare for eligibility checks, reducing the risk of coverage loss due to administrative snafu, Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, said in an interview.

“A lot of these programs are really trying to minimize needless loss of coverage, especially for groups for whom an interruption of coverage would be the most consequential like children, disabled people, and those in an episode of care,” she said.

Oklahoma’s operation plan also lays out a strategy to actively coordinate and refer those who have lost coverage to the Obamacare marketplace. In the event that private insurance is unattainable, the state plans to work with a coalition of charitable clinics and safety-net providers to provide continuity of care.

One such network is the Health Alliance for the Uninsured, which serves 535,000 Oklahomans without health insurance. Jeanean Yanish Jones, executive director of the alliance, said the state’s partnership will be essential in weathering the storm of coverage loss once the income eligibility checks are completed.

“Safety-net providers, like the free and charitable clinics represented by Health Alliance for the Uninsured, are resilient and can absorb many of these patients if additional resources are provided,” she said in a statement to Bloomberg Law. “In Oklahoma, we have 94 free and charitable clinics statewide that stand ready to serve however they can provide access to healthcare for our most vulnerable populations.”

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

[MM Curator Summary]: Those NY counties that normally complain about the taxes they pay for Medicaid are now up in arms about getting less of that sweet, sweet federal match under a new plan in the Good Guvn’rs budget this year.

Clipped from: https://spectrumlocalnews.com/nys/jamestown/ny-state-of-politics/2023/02/15/county-governments-in-ny-push-back-on-medicaid-shift

County governments on Wednesday protested a potential cost shift in Gov. Kathy Hochul’s $227 billion budget they warn could make it harder to keep property taxes down. 

The New York State Association of Counties pointed to a provision that could withhold $625 million in federal funds, which has been counted on for a decade to avoid tax hikes. 

At issue is cost sharing under the federal Medicaid program, which counties help administer. If approved as proposed, counties would lose $281 million in the first year and $345 million would be lost in New York City. 

At issue is money provided to states as part of the federal Affordable Care Act. The money has been used in New York to help fund Medicaid and to help counties offset the cost of expanding the program. 

“Not only does this proposal harm New York’s local taxpayers, but it also subverts Congress’ intent for this funding to be shared with the local governments that contribute to the state’s Medicaid program,” said Clinton County Administrator Michael E. Zurlo, president of NYSAC. “At $7.6 billion a year, counties in New York contribute more than all other counties in the nation combined.”

In a letter, the 19 county executives in New York urged state lawmakers to reject the proposal.  

“As a former county official, you can appreciate that new costs imposed on local governments eventually come out of all New Yorkers’ pockets in the form of increased property taxes which make our state a less affordable place to live, work, or start a business,” said the letter signed by New York’s bi-partisan group of county executives.

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

[MM Curator Summary]: A nice tidy look at the major MCO players in 3 Texas counties.

Clipped from: https://www.businesswire.com/news/home/20230215005712/en/Mark-Farrah-Associates-Assessed-Medicaid-Market-Share-in-Texas

MCMURRAY, Penn.–(BUSINESS WIRE)–Mark Farrah Associates (MFA) analyzed Medicaid enrollment figures from its County Health Coverage^TM database product for three counties in Texas, with a focus on health plan market position. Prior to the COVID-19 Pandemic, Texas Medicaid enrollment was approximately 3.1 million (as of December 31, 2019). Since then, the program has expanded 75% to cover nearly 5.3 million Texans, as of September 30, 2022. MFA’s analysis covers the top three counties in Texas, based on Medicaid enrollment: Harris, Dallas, and Bexar.

• As of 3Q22, over 35% of Texas’s Medicaid enrollment is in three counties: Harris, Dallas, and Bexar.
  
• Harris County (Houston area) had the largest Medicaid enrollment in the state as of 3Q22, with Texas Children’s Health Plan providing coverage for over 42% of the county’s market.
  

• Dallas County had the second largest Medicaid enrollment in the state as of 3Q22, with Elevance Health, Inc. (formerly Anthem) comprising 46% share of the market.
  
• Bexar County, San Antonio area, is the third largest county in Texas for Medicaid enrollment, with Centene accounting for 46% of the county’s market as of 3Q22.