Tag: State News

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]: Most of the states that will need to cough up more for vaxxes are non-expansion states.

 
 

Clipped from: https://healthpayerintelligence.com/news/19-states-must-change-medicaid-vaccine-coverage-policies-to-comply-with-ira

Both fee-for-service programs and Medicaid managed care plans will have to review their Medicaid vaccine coverage policies.

 
 

Source: Getty Images

 
 

By Kelsey Waddill

December 06, 2022 – Almost two-fifths of US states—particularly those that have avoided Medicaid expansion—will need to change their Medicaid vaccine coverage policies in order to align with the Inflation Reduction Act, an Avalere white paper found.

The Inflation Reduction Act passed through Congress and received the presidential signature on August 16, 2022.

The law requires states to cover all recommended vaccines for adult Medicaid enrollees with zero cost-sharing by the beginning of October 2023. Coverage will be similar to commercial market requirements.

Avalere examined the difference between vaccine coverage pre-implementation of the Inflation Reduction Act and post-implementation. The white paper received funding but no editorial input from Pfizer.

The researchers used publicly available data to observe changes for five recommended vaccines: influenza, tetanus/diptheria/acellular pertussis (Tdap), human papillomavirus (HPV), pneumococcal polysaccharide vaccine (PPSV23), and pneumococcal conjugate vaccine (PCV13). Avalere conducted this research from April through December 2021.

There were 11 fee-for-service programs and 6 Medicaid managed care plans that did not cover at least one of the recommended vaccines. The researchers noted that states that did not adopt Medicaid expansion were more likely not to cover one or more of the recommended vaccines.

States were most likely not to cover vaccines that involved risk-based or shared clinical decision-making. Across the states that had coverage gaps, eight fee-for-service and Medicaid managed care plans did not cover the HPV vaccine. Six plans—five fee-for-service programs and one Medicaid managed care plan—did not cover the PCV13 vaccine. Every plan covered the influenza vaccine.

Additionally, five fee-for-service programs and one Medicaid managed care plan covered a vaccine but required cost-sharing, which could range from $0.65 to $4.00.

These findings are critical for the 19 states that need to adjust their Medicaid coverage policies or review Medicaid managed care plans’ coverage to align with the Inflation Reduction Act.

“Although IRA requirements will not take effect until October 1, 2023, states that do not already cover all ACIP-recommended vaccines without cost sharing for their full adult Medicaid populations will need to act quickly and modify coverage policies in the coming months to meet the IRA timeline,” Avalere researchers noted.

Avalere anticipated that CMS would offer guidance to help Medicaid programs and stakeholders understand their obligations.

The researchers warned that the law could be pursued in a way that increases care disparities. The Inflation Reduction Act did not fix low provider reimbursement rates for vaccinations that disincentivize this form of preventive care, and the law may not reimburse pharmacists and set up billing barriers.

“These barriers may also extend to safety net providers which disproportionally serve vulnerable individuals and families, like Federally Qualified Health Centers. These barriers could lead to increased health disparities for patients. Some Medicaid-related vaccine topics are likely to be addressed in forthcoming implementation guidance; interested stakeholders should consider whether and how to engage CMS to shape that guidance,” Avalere recommended.

During the coronavirus pandemic, health equity in coronavirus vaccine distribution was a critical issue, but the challenges proved to have a presence beyond the coronavirus vaccine as well.

 
 

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 state is moving forward with its work requirements program, despite Biden’s best efforts to stop it.

 
 

Clipped from: https://www.medpagetoday.com/publichealthpolicy/medicaid/101982

— Demonstration program expected to add 50,000 recipients to the state’s Medicaid rolls

 
 

Georgia’s new Medicaid demonstration program that requires recipients to be working, going to school, or volunteering is expected to start up next year, but critics say it will be expensive to administer and will result in far fewer people added to the Medicaid rolls compared with a regular Medicaid expansion.

“The systems being set up for work requirements are very costly to implement for states,” said Laura Harker, a senior policy analyst at the Center on Budget and Policy Priorities, a left-leaning think tank in Washington, D.C. She noted that a 2019 Government Accountability Office report found that the cost of administering work requirements could cost a state millions to hundreds of millions of dollars; it requires adding more staff people to keep up with who is and who is not reporting their hours, among other costs.

Wider Eligibility Criteria

Georgia’s demonstration program, known as Pathways to Coverage, would widen the state’s Medicaid eligibility criteria to include individuals with annual incomes up to 100% of the Federal Poverty Level, or $13,590 for a single person. Currently, adults in Georgia are only eligible for Medicaid if their incomes are less than 35% of the poverty level, or $4,757, although eligibility criteria for children are more generous.

To stay eligible for the program, beneficiaries must continue to spend at least 80 hours per month working, volunteering, or going to school, according to the state’s application with the Centers for Medicare & Medicaid Services (CMS). “If a member does not meet the hours and activities threshold, they will be suspended from Medicaid and no longer able to receive the Medicaid benefit,” the application noted. “The member has 3 months to meet the hours and activities threshold for Georgia Pathways for the suspension to be lifted. If the member does not meet the requirement, after 3 months of suspension, then the member will be disenrolled from Medicaid,” although they can be reinstated later if they achieve the 80 hours.

State officials estimate that the demonstration program, which will last for 5 years, will add 50,000 people to Georgia’s Medicaid rolls. This is in contrast to the approximately 448,000 people that could be added if Georgia agreed to a more traditional Medicaid expansion as outlined in the Affordable Care Act (ACA), Harker said.

In addition, the Pathways program is eligible for reimbursement at the standard federal Medicaid matching rate for Georgia of 67%, whereas under an ACA expansion, the federal government would reimburse at a 90% rate. As a result, under the Pathways program, “it’s much more expensive to cover a lot fewer people,” she said.

Debate Over Work Requirements

Why did the state go for a work requirements demonstration program instead? “The foundation of the Georgia Pathways to Coverage program is incentivizing and promoting employment and employment-related activities,” according to the application. “Research shows the various positive effects of employment on an individual. Employed individuals are both physically and mentally healthier than those who are unemployed. Work improves various measures of general health and wellbeing, such as self-esteem, self-rated health, and self-satisfaction. Employed individuals are also more financially stable.”

Chris Denson, director of policy and research at the Georgia Public Policy Foundation, a right-leaning think tank in Atlanta, pointed out in an email that the 50,000 people potentially being added to the Medicaid rolls “would not be the same 50,000 recipients at any given time. Whereas traditional Medicaid discourages recipients from earning more money to avoid losing eligibility and thus their coverage, the [demonstration project] proposal is designed to create a more seamless transition from Medicaid eligibility for many workers.” For instance, if the enrollee has a job with a health insurance benefit, the Pathways program would pay the premium for the employer plan if it was financially advantageous for Pathways.

In addition, “in the event their income rises above the eligibility threshold, they could keep their coverage and not have to move from one plan to another,” he said.

But critics of the program say other motives are involved. “The motivation behind work requirements comes from a misguided ‘poor law’ mindset that sees Medicaid as something that people don’t ‘deserve’ unless they fit one of the categorical eligibility groups like disability or pregnancy,” Katherine Hempstead, PhD, senior policy advisor at the Robert Wood Johnson Foundation, said in an email. “According to this line of thinking, those who are merely poor should work for their benefits. Repeatedly courts have found that this framework is inappropriate and inconsistent with the purpose of the Medicaid program, which is to provide access to healthcare services.”

“The purpose of a work requirement is not to promote work so much as it is to deter enrollment,” she added. “The vast majority of those eligible for Medicaid under the expansion are already working or face significant barriers to work such as health problems or family caregiving responsibilities. Studies of Medicaid expansion in other states have shown that expansion supports work by allowing people to manage health issues that can sometimes present a barrier to work. It stands to reason that healthy people are better able to work and be productive.”

Rocky History

CMS approved the Pathways program in October 2020 during the Trump administration. Since then, however, it has been the subject of several administrative and federal court actions, beginning in February 2021 when CMS notified Georgia officials that the agency was considering withdrawing its approval of the Pathways program because the COVID-19 pandemic made it difficult for some potential beneficiaries to fulfill the work requirement. Georgia officials responded that the pandemic “provides no basis to excise the [work requirements] from the Georgia Pathways program.”

In December 2021, the Biden administration rescinded CMS’s approval of Pathways. The state of Georgia sued the Biden administration in federal court, and in August, Judge Lisa Godbey Wood of the U.S. District Court for the Southern District of Georgia ruled in favor of the state, saying that the Biden administration’s rescission of the program “was arbitrary and capricious on numerous, independent grounds.”

The government decided not to appeal the decision, possibly because it was worried about what would happen next, Leonardo Cuello, a research professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families, told Kaiser Health News. “The decision not to appeal may have been based on fear that the result would get confirmed on appeal, since most of the appellate judges in the [federal] 11th Circuit are Republican-appointed,” he said. That confirmation could set a stronger precedent for similar programs.

Arkansas was the first state to implement a Medicaid work requirement, but that program — later halted by a federal judge — resulted in about 18,000 beneficiaries losing their Medicaid coverage, often because they couldn’t comply with the reporting requirements. In addition, “many faced negative consequences such as medical debt,” said Hempstead. “It did not improve employment.”

Denson, on the other hand, noted that the Georgia program differs from the Arkansas program because it “imposed this [work] requirement on potential recipients rather than existing Medicaid beneficiaries … Because Georgia is expanding healthcare coverage for previously uncovered applicants, there is no reduction in the legally mandated Medicaid coverage for current enrollees.”

• Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow
  

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]: While this op-ed is guaranteed to make most of you furious, there are some decent points about the new CMS reg on Medicaid eligibility if you can see past the bombastic tone.

 
 

Clipped from: https://amac.us/biden-turning-medicaid-into-welfare-for-all/

AMAC Exclusive – By Sam Adolphsen

 
 

The nation’s largest welfare program, Medicaid, is a total mess. We are fast approaching 100 million people on the program, mostly because of expansions to able-bodied adults. States spend one of every three state budget dollars on the program – and more than one of every five of those dollars is spent in error. On top of that, states have been banned from removing ineligible people since early 2020 because of the so-called public health emergency that President Joe Biden keeps extending.

If Medicaid were a person, they would be drowning.

Now, the Biden administration’s Centers for Medicare & Medicaid Services (CMS) is proposing a new regulation that would make things much worse. The rule would make significant changes to state welfare eligibility processes, adding millions to welfare and adding $100 billion in new costs to taxpayers.

This latest proposed Medicaid rule would be like helping that poor drowning person by throwing them a cement block.

If President Biden is looking to finish off the program and send it to the bottom, he nailed it.

Of course, the administration isn’t really hiding its plan. The stated goal of the rule is to “maximize enrollment.” They talk about “retention rates” as if it’s a for-profit business, and how they need to “remove barriers to enrollment,” as if that’s a problem, with nearly a third of the country already on the program.

Biden’s 300-plus-page regulation has so many terrible welfare eligibility policies that it’s difficult to pick just a few on which to focus. But there are some that stand out as especially damaging to the integrity of the country’s safety net.

First, the new rule would prohibit all states from checking eligibility more than once a year. Under President Obama, CMS had already banned states from more frequent checks for certain populations. This proposed rule would expand that bad policy by making the previous minimum level of eligibility checks (once a year) the new maximum for everyone in the program. Some states check more often than once a year right now, and they should, because there are at least 16 million ineligible people on the program.

Second, the rule would ban states from requiring face-to-face interviews for any eligibility groups. This change comes despite the constant news about the significant problems with identity theft across all welfare benefits and COVID-19 unemployment programs. It is common sense that if states are going to hand out a costly welfare benefit, they should require one simple office visit before awarding that benefit. President Biden wants to ban that common-sense check.

Third, the rule creates an entirely new eligibility process for states, requiring them to keep cases open for months even after they determine someone is ineligible. This new “reconsideration period” would also force states to handhold someone to apply for alternative coverage before they can remove them from Medicaid. This also contradicts the entire stated justification for the rule, that it will “reduce the administrative burden” on states.

As if that weren’t bad enough, the rule would also require states to ignore returned mail if the new address is an in-state address. CMS outrageously claims that a change of address “does not indicate a change in circumstances.” Any reasonable person knows that isn’t true. A change in mailing address likely signals a meaningful shift in life circumstances that could affect eligibility.

Another crazy requirement in the Biden administration’s welfare proposal is that states will be required to accept as gospel certain government data sets. While this may seem smart at first glance, the policy only applies when the data indicates that the person is eligible for Medicaid. What happens if the data shows they are ineligible? Then the state must undertake a series of administrative-intensive follow-ups to ensure the person is ineligible. CMS only wants “administrative efficiency” when it will add someone to welfare, never when it would keep someone ineligible from being added.

One final bit of Medicaid madness is that the proposed rule would prohibit states from requiring ID verification as part of the process of reviewing an immigrant’s citizenship status when they apply for Medicaid. This is not surprising coming from Open Borders Biden, but it is alarming. There are many more problems with the proposal, including that it is probably illegal.

The bottom line is that one of the country’s chief safety net programs, Medicaid, has already been stretched and shredded by expansions to able-bodied adults and abysmal program integrity. Now Biden has doubled down, throwing program integrity completely out the window to push the country toward welfare for all. States need to step up and oppose this latest attack on Medicaid.

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MM Curator summary

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

 
 

[MM Curator Summary]: More details on what is really going on with pregnancy related death: There are a total of 700 in the US each year, 13% of them happen during childbirth- 65% occur in the year after childbirth and most of them have to do with substance abuse/ suicide.

 
 

 
 

Clipped from: https://theconversation.com/more-than-4-in-5-pregnancy-related-deaths-are-preventable-in-the-us-and-mental-health-is-the-leading-cause-193909

Rachel Diamond, Adler University

Author

 
 

Rachel Diamond

Clinical Training DIrector and Assistant Professor of Couple and Family Therapy, Adler University

Disclosure statement

Rachel Diamond does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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According to the CDC’s latest numbers, 65% of pregancy-related deaths occur in the first year following childbirth. Petri Oeschger/Moment via Getty Images

Preventable failures in U.S. maternal health care result in far too many pregnancy-related deaths. Each year, approximately 700 parents die from pregnancy and childbirth complications. As such, the U.S. maternal mortality rate is more than double that of most other developed countries.

The Department of Health and Human Services declared maternal deaths a public health crisis in December 2020. Such calls to action by the U.S. Surgeon General are reserved for only the most serious of public health crises.

In October 2022, the Centers for Disease Control and Prevention released new data gathered between 2017 and 2019 that further paints an alarming picture of maternal health in the U.S. The report concluded that a staggering 84% of pregnancy-related deaths are preventable.

However, these numbers don’t even reflect how widespread this problem could be. At present, only 39 states have dedicated committees in place to review maternal deaths and determine whether they were preventable; of those, 36 states were included in the latest CDC data.

I am a therapist and scholar specializing in mental health during the perinatal period, the time during pregnancy and postpartum. Research has long demonstrated significant mental health risks associated with pregnancy, childbirth and the year following childbirth. The CDC’s report now makes it clear that mental health conditions are an important factor in many of these preventable deaths.

A closer look at the numbers

The staggering number of preventable maternal deaths – 84% – from the CDC’s most recent report represents a 27% increase from the agency’s previous report, from 2008 to 2017. Of these pregnancy-related deaths, 22% occur during pregnancy, 13% during childbirth and 65% during the year following childbirth.

This raises the obvious question: Why are so many preventable pregnancy-related deaths occurring in the U.S., and why is the number rising?

For a pregnancy-related death to be categorized as preventable, a maternal mortality review committee must conclude there was some chance the death could have been avoided by at least one reasonable change related to the patient, community, provider, facility or systems of care.

The most commonly identified factors in these preventable deaths have been those directly related to the patient or their support networks, followed next by providers and systems of care. While patient factors may be most frequently identified, they are often dependent on providers and systems of care.

Take, for instance, the example of a new mother dying by suicide from a mental health condition, such as depression. Patient factors could include her lack of awareness about the warning signs of clinical depression, which she may have mistaken for difficulties with the transition to parenthood and perceived personal failures as a new parent.

As is often the case, these factors would have directly related to the inaction of health care providers, such as a failure to screen for mental health concerns, delays in diagnosis and ineffective treatment. This type of breakdown – which is common – would have been made worse by poor coordination of care between providers across the health care system.

This example illustrates the complexities of the failures and preventable outcomes in the maternal health care system.

The U.S. has a far higher rate of pregnancy-related deaths than other developed nations.

The role of mental health

In the CDC’s latest report, mental health conditions are the overall most frequent cause of pregnancy-related death. Approximately 23% of deaths are attributed to suicide, substance use disorder or are otherwise associated with a mental health condition. The next two leading causes are hemorrhage and cardiac conditions, which combined contribute to only slightly more deaths than mental health conditions, at about 14 and 13%, respectively.

Research has long shown that 1 in 5 women suffer from mental health conditions during pregnancy and the postpartum period, and that this is also a time of increased risk for suicide. Yet, mental illness – namely, depression – is the most underdiagnosed obstetric complication in America. Despite some promising reductions in U.S. suicide rates in the general population over the last decade, maternal suicide has tripled during this same time period.

As it relates to maternal substance use, this issue is also worsening. In recent years, almost all deaths from drug overdose during pregnancy and the postpartum period involved opioids. A review from 2007 to 2016 found that pregnancy-related deaths involving opioids more than doubled.

Many of these issues stem from the fact that up to 80% of women with maternal mental health concerns are undiagnosed or untreated.

Barriers to care

In 2021, the first national data set of its kind showed that less than 20% of prenatal and postpartum patients were screened for depression. Only half of those who screened positive received follow-up care.

Research has long demonstrated widespread barriers and gaps in maternal mental health care. Many health care providers do not screen for mental health concerns because they do not know where to refer a patient or how to treat the condition. In addition, only about 40% of new mothers even attend their postpartum visit to have the opportunity for detection. Non-attendance is more common among higher-risk populations of postpartum women, such as those who are socially and economically vulnerable and whose births are covered by Medicaid.

Medicaid covers around 4 in 10 births. Through Medicaid benefits, pregnant women are covered for care related to pregnancy, birth and associated complications, but only up to 60 days postpartum. Not until 2021 did the American Rescue Plan Act begin extending Medicaid coverage up to one year postpartum.

But as of November 2022, only 27 states have adopted the Medicaid extension. In the other states, new mothers lose postpartum coverage after just 60 days. This matters a great deal because low-income mothers are at a greater risk for postpartum depression, with reported rates as high as 40% to 60%.

In addition, the recent CDC report showed that 30% of preventable pregnancy-related deaths happened between 43 and 365 days postpartum – which is also the time frame suicide most commonly occurs. Continued Medicaid expansion would reduce the number of uninsured new parents and rates of maternal mortality.

Another challenging barrier to addressing maternal mental health is the criminalization of substance use during pregnancy. If seeking care exposes a pregnant person to the possibility of criminal or civil pentalties – including incarceration, involvement with child protective services and the prospect of separation from their baby – it will naturally dissuade them from seeking treatment.

At this time, 24 states consider substance use during pregnancy to be child abuse, and 25 states require health care professionals to report suspected prenatal drug use. Likewise, there are also tremendous barriers in the postpartum period for mothers seeking substance use treatment, due in part to the lack of family-centered options.

With all these barriers, many pregnant and new mothers may make the difficult decision to not engage in treatment during a critical window for intervention.

Looking ahead

While the information described above already paints a dire picture, the CDC data was collected prior to two major events: the COVID-19 pandemic and the fall of Roe v. Wade, which overturned nearly 50 years of abortion rights. Both of these events have exacerbated existing cracks in the health care system and, subsequently, worsened the maternal health in the U.S.

In my view, without radical changes to maternal health care in the U.S., starting with how mental health is treated throughout pregnancy and postpartum, it’s likely parents will continue to die from causes that could otherwise be prevented.