Tag: State News

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OREGON- Sen. Ron Wyden pledges Medicaid funding for air conditioners

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In response to 115 deaths tied to an extreme heat wave, OR Medicaid will likely pay for window AC units moving forward.

 
 

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.

 
 

 
 

Sen. Ron Wyden pledges Medicaid funding for air conditioners during a press conference held near Lents Park on Aug. 16, 2021.

Following Oregon’s third heat wave of the summer, U.S. Sen. Ron Wyden stood in the sun near Portland’s Lents Park Monday morning to announce his intention to fight for more hot weather resources for low-income individuals.

Many of the 115 people who died during Oregon’s extreme heat spell in late June were low-income individuals without air conditioning. At least seven lived in public housing and at least 19 in mobile home parks.

Residents who lived in buildings owned and operated by Portland housing authority Home Forward, where nearly all of the public housing deaths occurred, want the agency to provide air conditioning in each apartment. The roughly $200 price tag of a window unit can be far out of reach for the many public housing residents who live on slim disability or Social Security checks.

Michael Buonocore, the agency’s executive director, said that isn’t financially feasible.

Wyden, who in 2019 successfully pushed for a new rule allowing Medicare Advantage plans to cover fans, air conditioners and air filters for patients with chronic conditions affecting their need for clean, cool air, said he will fight to get that equipment distributed to those who need it.

“I will make sure there is help for folks on Medicaid,” Wyden said. “Air conditioning in a deadly heat wave is life or death. It is not just moral, but economically smart to avoid unnecessary hospitalizations or the tragedy of people dying.”

When asked specifically to respond to the Home Forward deaths, Wyden broadly stated that “every one of the deaths from the heat wave is a tragedy and preventable.”

Wyden said he plans to push for federal funding to pay for air conditioners for the county’s most vulnerable population and for shade trees to be planted in urban heat islands, such as Lents.

 
 

Under the Medicare Advantage rule Wyden pushed through in 2019, insurers are allowed but not required to cover air cooling systems.

“We got that (Medicare) law passed but a lot of the health plans didn’t get the communication from D.C.” that they should be covering air conditioner units, Wyden said.

In his new effort, Wyden wants to expand that allowance to all Medicaid patients, who he says are some of the state’s most vulnerable individuals.

Under proposed changes to the Clean Energy for America bill coming this fall, Wyden said there will be funding for outreach to inform both insurance providers and Medicaid patients about the available resource and how to utilize it. Wyden said while the bill will bolster funding for cooling equipment, it will be local organizations and grassroots efforts that will provide education about how to access the free air conditioners.

Home Forward residents say that in addition to being provided air conditioners, they should be allowed to install them. Currently, residents who live above the fifth floor are not allowed to install window units for liability reasons.

Rep. Khanh Pham, D-Portland, said she wants to create rules that wouldn’t allow landlords to ban air conditioning units.

Given a future guaranteed to have more deadly heat waves as the climate crisis continues, Multnomah County Commissioner Jessica Vega Pederson said only the federal government has the resources to create the magnitude of change needed to prevent heat-related deaths in low-income homes.

Nicole Hayden reports on homelessness for The Oregonian|OregonLive. She can be reached at nhayden@oregonian.com or on Twitter @Nicole_A_Hayden.

 
 

Clipped from: https://www.oregonlive.com/weather/2021/08/sen-ron-wyden-pledges-medicaid-funding-for-air-conditioners.html

 
 

 
 

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State to expand Medicaid eligibility following court ruling

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Medicaid expansion eligibles can apply for Medicaid in MO, but will have to submit expense reimbursement requests until the legislature actually funds the expansion.

 
 

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

 
 


The Missouri Department of Social Services (DSS) will begin allowing individuals to apply for the MO HealthNet program under Article IV, Section 36(c) of the Missouri Constitution following an August 10 ruling by the Cole County Circuit Court.

Although the federal government began providing funding to expand Medicaid in 2014, Missouri is one of 13 states that had continued to reject Medicaid expansion. That will soon change as a result of a unanimous Missouri Supreme Court ruling that was issued in July 2021.

Missouri voters approved Medicaid Expansion in August 2020 by a vote of 53.25% to 46.75%. It required the state to submit a Medicaid expansion state plan amendment to the federal government by March 2021, and for Medicaid expansion to take effect by July 1, 2021.

However, when state lawmakers passed the 2022 fiscal year budget, they failed to include funding for the state’s portion of the cost of Medicaid expansion. Lawmakers did allocate normal funding for MO HealthNet, but the DSS indicated that it would not change the eligibility criteria for Medicaid coverage, since lawmakers had not expressly allocated funding for that purpose. The state withdrew the Medicaid expansion state plan amendment that it had submitted to HHS earlier in the year.

A lawsuit was brought by Missouri residents who would gain eligibility under the expansion. Missouri DSS argued that the ballot initiative was unconstitutional since the state constitution says ballot measures can’t be used to appropriate state funds. In June a circuit court judge ruled that Missouri’s Medicaid expansion ballot measure was unconstitutional because it didn’t include a funding mechanism.

The case was appealed, and the Missouri Supreme Court vacated the lower court’s ruling, and noted that the Medicaid expansion eligibility criteria outlined in Missouri Article IV, Section 36(c) are “now in effect.”

The ruling means that MO HealthNet eligibility must be expanded to include adults under age 65 with household incomes up to 138% of the poverty level. In 2021, that amounts to about $17,774 for a single individual, and $36,570 for a household of four – children are already eligible for Medicaid at higher income levels. Once implemented, this is expected to result in 275,000 Missouri residents becoming eligible for MO HealthNet.

The expansion amendment also legally requires the state to maximize federal funding. DSS will continue to work towards fulfilling the state’s legal obligations under the Constitution and court order, Parson announced following the ruling.

“My administration is always going to follow the law and yesterday’s court order is no exception,” Governor Mike Parson said Wednesday. “The necessary funding to cover the health care costs of the expanded population remains the issue. We will continue to work with the General Assembly and DSS to chart a path forward to comply with the court order and keep the MO HealthNet program solvent.”

The governor’s office said the required system update is anticipated to take up to 60 days, citing “staffing capacity and funding restraints.” The state is currently working through administrative hurdles, including adequate appropriations, staffing capacity, and computer software changes in order to begin enrolling the expanded population.

Governor Parson included funding in his FY22 budget proposal to the General Assembly to cover both the health care costs of the expanded population and for 75 additional employees to administer the expanded program. The proposed funds were not included in the final FY 22 budget. As a result, DSS is limited to administering the expanded MO HealthNet program without sufficient staffing or appropriations.

Missourians who believe they are eligible for MO HealthNet benefits under the expanded Medicaid eligibility may go to MyDSS.MO.Gov to apply. DSS will begin making eligibility determinations once MO HealthNet’s software is updated to reflect the court order. In order to comply with the court order and until the necessary funds can be appropriated, DSS will reassign existing employees from their current assignments and responsibilities in order to receive and evaluate MO HealthNet applications.

Qualifying health care costs that are incurred by eligible Missourians between the time they apply and when DSS is able to verify their eligibility may be reimbursed at a later date.

Healthcare for Missouri, a coalition that educated voters on the need to expand the state’s Medicaid eligibility requirements as prescribed in Amendment 2.

“We’re delighted that Judge Beetem has ruled that the State must begin enrollment immediately,” a statement from Healthcare for Missouri read. “Our coalition urges the State to take action and we stand ready to work with all involved to ensure Missourians’ ability to receive the medical care they deserve.”

Particularly at a time when the state is seeing an alarming increase in COVID cases and deaths, access to healthcare is lifesaving, vital, and past due, considering funding is already available, the organization said.

“State after state has shown that in addition to providing insurance to those eligible, expansion is a fiscal and economic boon to state economies and budgets,” according to the organization’s response. “Not only do states save money on existing health services, but federal funds from expansion create jobs and increase economic activity, generating additional tax revenue to fund the state’s share of expansion.”

In states that expand Medicaid, the federal government paid the full cost of expansion through 2016. Starting in 2017, the states gradually started to pay a share of the expansion cost, which will remain at 10%. From 2013 through 2022, Missouri was projected to give up $17.8 billion in federal funding by not expanding Medicaid.

The American Rescue Plan Act included additional funds to support states in expanding Medicaid. That incentive will provide Missouri with an additional $1.2 billion over the next two years to support the existing Medicaid program, freeing up state funds that can be used to support additional priorities.

“Hardworking Missourians like me have waited and waited for this,” said Nina Canaleo, a 38-year-old Kansas City mother with Multiple Sclerosis who will benefit from Medicaid expansion being fully and expeditiously implemented. “We deserve and need access to healthcare to care for ourselves, our families, and our communities. It’s time for the State to do its job so I can get back to doing mine.”

Until Medicaid expansion actually takes effect in Missouri, non-disabled adults without children are not eligible for MO HealthNet regardless of how low their income is, and parents with dependent children are only eligible with incomes that don’t exceed 22% of the poverty level. Only Texas and Alabama have lower Medicaid eligibility caps, at 18%.

According to insurance company IHC Specialty Benefits, 127,000 people remain in the coverage gap in Missouri, unable to qualify for Medicaid because the state still has not expanded eligibility for Medicaid coverage and unable to qualify for premium subsidies in the exchange/marketplace because they earn less than the poverty level. As of April 2020, 887,433 Missourians are covered by Medicaid/CHIP, and another 230,000 are expected to gain coverage.

Clipped from: http://northeastnews.net/pages/state-to-expand-medicaid-eligibility-following-court-ruling/

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Centene’s Nevada Health Plan Awarded Medicaid Managed Care Contract

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The renewal keeps 77,000 Medicaid members on the Centene rolls.

 
 

 
 

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.

 
 

ST. LOUIS, Aug. 18, 2021 /PRNewswire/ — Centene Corporation (NYSE: CNC) announced today that its Nevada subsidiary, SilverSummit Healthplan, Inc., has been awarded a contract from the Nevada Department of Health and Human Services – Health Care Financing and Policy to continue providing managed care services for its Medicaid Managed Care program in both Clark and Washoe Counties.

“Centene is pleased to continue our important work with the state of Nevada to expand on innovation and value-based care for Nevada residents,” said Brent Layton, President of US Markets, Products and International, and Executive Vice President, for Centene. “Centene’s local approach to care leverages our strong provider partnerships to ensure we are delivering better health outcomes for our members at a lower cost to the state.”

SilverSummit Healthplan has served Nevada Medicaid members since 2017 and currently serves more than 77,000 members. The Nevada Medicaid program provides physical and behavioral healthcare as well as pharmacy benefits to over 760,000 TANF, SCHIP and Medicaid Expansion beneficiaries. Nevada’s Medicaid managed care program will advance the State’s goals through increased focus on Care Management, Member engagement, access and continued progress towards integration of services and efficiency.

“We are honored to continue serving Nevada Medicaid beneficiaries with quality healthcare services and programs,” said Eric Schmacker, Plan President and CEO for SilverSummit Healthplan. “We look forward to our continued partnership with the state of Nevada, local providers and community partners to provide services that address health equity and social determinants of health and remove barriers to ensure our members receive the high-quality care they deserve.”

Pending regulatory approval, SilverSummit’s contract will commence on January 1, 2022.Clipped from: https://www.prnewswire.com/news-releases/centenes-nevada-health-plan-awarded-medicaid-managed-care-contract-301357405.html

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Molina Healthcare Awarded Nevada Medicaid Contract

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The award will allow Molina to add 630,000 members to its Medicaid footprint.

 
 

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.

 
 

 
 

LAS VEGAS, August 17, 2021–(BUSINESS WIRE)–Molina Healthcare, Inc. (NYSE: MOH) (“Molina”) today announced its Nevada health plan subsidiary was awarded a Medicaid managed care contract from the Nevada Department of Health and Human Services – Division of Health Care Financing and Policy (“DHCFP”).

The new four-year Medicaid contract, with a potential two-year extension, will commence on January 1, 2022. Molina’s Nevada health plan is one of four Managed Care Organizations offering health care coverage to approximately 630,000 Medicaid beneficiaries in Clark County (Las Vegas area) and Washoe County (Reno area) through the TANF, CHIP, and Medicaid Expansion programs. Molina will also participate in the state-based Affordable Care Act Exchange.

“We are honored that Nevada has awarded Molina the opportunity to serve the state’s most vulnerable citizens,” said Joe Zubretsky, president and chief executive officer of Molina Healthcare. “Molina looks forward to advancing the state’s goals of improving care management, member access, and overall health equity for its Medicaid members.”

Clipped from: https://finance.yahoo.com/news/molina-healthcare-awarded-nevada-medicaid-110000061.html

 
 

 
 

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Maryland Physicians Care Enlists Barbershops and Salons to Help Promote Medicaid Benefits

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MCOs are paying Baltimore barbershops to put up posters advertising Medicaid benefits.

 
 

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.

 
 

 
 

LINTHICUM, Md., Aug. 16, 2021 /PRNewswire/ — Maryland Physicians Care (MPC) – a statewide Medicaid managed care organization owned by Ascension Saint Agnes, Holy Cross Health, Meritus Health, and UPMC Western Maryland – is engaging Maryland barbershop and salon owners to help create awareness of Medicaid benefits.

MPC produced and distributed posters asking, “Do You Need Help Getting Free Medical Coverage?” The posters include a QR code that links to the MPC website, mpcMedicaid.com. There, people can check their Medicaid eligibility using a link to Maryland’s HealthChoice Program: MarylandHealthConnection.gov.

The posters, printed in English and Spanish, are currently placed in 75 barbershops and beauty salons throughout Prince George’s and Baltimore counties and Baltimore City.

Shop owners are compensated for displaying the posters and have expressed appreciation for the extra income as they work to recover from the financial hardships of COVID-19.

MPC’s outreach efforts in Maryland barbershops and salons were implemented June 1, 2021, the same week President Biden announced his “Shots at the Shop” initiative. Aiming for at least 70% of Americans to receive their first vaccination by July, Biden called on Black-owned barbershops to support COVID-19 vaccination practices.

Maryland Physicians Care provides free, quality health care services to Maryland’s HealthChoice enrollees by extending the full benefits of Medicaid through a comprehensive network of medical providers. Founded in 1996, MPC believes in helping its members make good decisions about their health through free, quality health care services.

Those interested in enrolling with MPC must first qualify for Medicaid at MarylandHealthConnection.gov.

Learn more about MPC by visiting mpcMedicaid.com

MEDIA CONTACT:

Marissa Bailey, BlaineTurner Advertising 

marissa@blaineturner.com

 
 

Clipped from: https://www.kpvi.com/news/national_news/maryland-physicians-care-enlists-barbershops-and-salons-to-help-promote-medicaid-benefits/article_c1d44b64-22c3-5ed7-b201-e88852c728a2.html

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Centene awarded Ohio Medicaid contract following $88M settlement

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The Ohio managed care contract valued at an estimated $1.5B was on hold while the AG negotiated the $88M settlement over PBM issues; once Centene agreed to pay the $88M, the managed care contract was awarded.

 
 

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.

 
 

Dive Brief:

  • On Tuesday, Centene — the largest Medicaid managed care organization in the country — announced its Ohio subsidiary, Buckeye Health Plan, was awarded a new Medicaid contract by the state’s health department, to begin early 2022.
  • Ohio Medicaid originally held off deciding on Buckeye’s proposal after the state’s attorney general sued Centene, alleging it breached its Medicaid contracts and used its pharmacy benefit managers to jack up prices for care, resulting in millions of dollars of overpayments by Ohio’s health department.
  • Also Tuesday, Molina reported its subsidiary had nabbed a new Medicaid contract win in Nevada, its first in the state. The new four-year contract, with a potential two-year extension, will begin Jan. 1.

Dive Insight:

Insurers have been ramping up their presence in government programs as the economic volatility created by COVID-19 has caused some millions to lose job-based insurance, swelling Medicaid rolls and membership in the exchanges set up by the Affordable Care Act.

And more states are contracting with payers to manage their Medicaid programs. Currently, seven out of every 10 Medicaid enrollees are in plans run by an insurer, according to the Kaiser Family Foundation.

That growth has especially benefited payers with large government books of business, like Centene and Molina.

Centene on Friday was added to six managed care organizations already awarded shares of the $20 billion contract in Ohio, despite its history in the state.

In June, Centene agreed to pay the state $88 million to settle the dispute, and set aside more than $1.1 billion to to resolve similar claims in other states. Centene didn’t admit fault in any of the deals.

As a result of the settlement, Ohio Attorney General Dave Yost dropped his lawsuit against the St. Louis-based payer. Yost’s suit, originally filed in March, comes as legislators and regulators increasingly target pharmacy benefit managers to drive down pharmaceutical costs, especially as said PBMs merge with major health plans, complicating market incentives.

Centene said at the time of the settlement that it had restructured its PBM operations and aligned its Medicaid, Medicare and exchange products on more transparent pharmacy networks to eliminate “spread pricing,” a practice where PBMs eke out more money from taxpayer-funded health plans by charging the health plans one price for drugs but reimbursing the pharmacies differently.

Under the new contract, Buckeye will launch new technologies and local programs in partnership with providers and community groups to meet members health needs, Centene said. The subsidiary has been active in Ohio since 2004, and in 2020 was the state’s fastest-growing Medicaid plan according to market share, with more than 420,000 members, according to a release.

As for Molina, the Long Beach, California-based payer is now one of four managed care organizations offering coverage to roughly 630,000 Medicaid beneficiaries in Clark County and Washoe County. The addition of Nevada brings Molina’s Medicaid footprint to 19 states.

Nevada’s Medicaid and Children’s Health Insurance programs released a request for proposals for 2022 contract bids for the service area covering two urban counties of the state, Clark and Washoe, in March.

Contracts are worth about over $2 billion annually, according to consultancy Health Management Associates.

As part of the contacts, Molina will also participate in Nevada’s state-based ACA exchange. The state stipulates the payer must provide at least one silver and one gold qualified health plan by 2024 to ensure continuity of care for individuals and families that might experience a change in Medicaid or CHIP eligibility status.

Previously, Nevada only had three MCOs: Anthem, UnitedHealthcare’s Health Plan of Nevada and Centene’s SilverSummit Health Plan, according to the state health department.

 
 

Clipped from: https://www.healthcaredive.com/news/centene-awarded-ohio-medicaid-contract-following-88m-settlement/605104/

 
 

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Ohio’s Medicaid work requirement approved by Trump now overturned by Biden

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One of the last remaining approved work requirements waivers got nullified by CMS memo this week.

 
 

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.

 
 

COLUMBUS (WCMH) — The Biden administration today overturned the Trump-era approval of Ohio’s Medicaid Work Requirement Waiver.

In a letter from The Department of Health and Human Services to the Medicaid director in Ohio, the administration wrote:

“… In light of the ongoing disruptions caused by the COVID-19 pandemic, Ohio’s community engagement requirement risks significant coverage losses and harm to beneficiaries.”

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The letter goes on to explain that people who need help might be harmed. The COVID-19 pandemic means that people who might be looking for job skills training and work in the future might not be able to find it, and may also have problems with access to transportation and child care.

That means they might lose their healthcare coverage to circumstances beyond their control.

The agency believed it was risky to tie work requirements to Medicaid eligibility since no one knows what long-term effects the COVID-19 pandemic will have on the economy. 

Coronavirus in Ohio Wednesday update: a new recent high of 3,393 new cases

Also, the letter indicates, people who are dealing with COVID-19 infections and long-term illness as a result of the coronavirus might really be harmed by losing Medicaid benefits.

U.S. Sen. Sherrod Brown (D-OH) agreed with the end of the policy. Brown said it had the potential to force thousands of people off of their health insurance coverage.

“We should be making it easier for Ohioans to access care, not harder – especially at a time when Ohioans are fighting against the COVID-19 global pandemic,” stated Brown in a media release. “Medicaid is a program that helps working families and burdensome work requirements create a barrier to health care for those who need it most, especially those who suffer with addiction.”

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Brown says Medicaid is an essential safety net program, and the implementation of work requirements would have made it harder for Ohioans to access it in a time when overdose deaths are rising.

But, being in a recovery program is one of the requirements, as Gov. Mike DeWine (R) pointed out in a statement:

“By requiring an individual to work, learn new job skills, or be involved in a recovery program, Ohioans would be providing critical assistance to individuals when they needed it while laying the groundwork for their success in the future.”

U.S. Sen. Rob Portman (R-OH) also thought the work requirement was a good thing that should remain in place. He pointed out the waiver was approved by the Trump administration in March 2019.

“Work requirements provide much-needed flexibility in the Medicaid system to provide greater well-being and self-sufficiency to individuals who are able to work while slowing the growth rate of Medicaid and thus the burden on taxpayers,” Portman said in a media statement.

Sen. Rand Paul calls suspension from YouTube a ‘badge of honor’

 
 

Clipped from: https://www.nbc4i.com/news/state-news/ohios-medicaid-work-requirement-approved-by-trump-now-overturned-by-biden/

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Biden to reopen public comment on TennCare block grant

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The new CMS administration has begun a federal comment period after the state already had theirs on the approved waiver.

 
 

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.

 
 

NASHVILLE, Tenn. (AP) — President Joe Biden’s administration says it will keep a drastic overhaul of Tennessee’s Medicaid program in place while it seeks more public comment and considers what to do with the plan approved under former President Donald Trump.

In a federal court filing this week, Acting Assistant Attorney General Brian Boynton asked a judge to put a lawsuit challenging the TennCare block grant program on hold while the government reopens a 30-day public comment period. The judge signed off on the litigation pause.

The filing says the previous approval of the program under Trump remains in effect during the process. It says the federal government doesn’t know yet whether it will reverse or modify the previous decision.

Tennessee is the first state approved to receive lump sum block grant funding for its Medicaid program. But the overhaul’s fate remains unclear under Biden. The Democrat who has opposed Medicaid block-grant efforts can rescind the change, but has not taken any action on it to date. Democrats in the state, including U.S. Rep. Jim Cooper of Nashville, have urged Biden to scrap the block grant change.

“While the agency does not yet know whether the new decision will modify that prior approval decision, or the extent of any such modification, the agency believes that this procedure may narrow the issues in the case,” the Biden administration’s filing states.

In the federal lawsuit, the Tennessee Justice Center and several Medicaid recipients claim the federal government under Trump exceeded its authority in approving the proposal. The complaint also argues Trump’s administration failed to provide enough time for the public to provide feedback on the plan.

“Federal officials are now willing to reconsider, and they are inviting the public to comment,” said Michele Johnson, executive director of the Tennessee Justice Center. “It is rare that citizens have such an opportunity to affect government policy. That makes it really important that everyone who cares about health care in Tennessee take a few minutes to share their concerns about access to affordable care, medical debt, rural health, care for children with chronic illness or Tennesseans’ other health care needs.”

A TennCare official on Friday noted that the organization held its own public comment period, but also said its leaders “welcome additional input.”

“We are encouraged that CMS’ (the Centers for Medicare and Medicaid Services) action in no way delays or prevents implementation of TennCare III, and we remain full steam ahead,” said TennCare spokesperson Connor Tapp.

Supporters had pushed for the block grant, claiming it would produce flexibility and savings inside TennCare that would then fuel additional health coverage offerings. Lee, and other supporters, said the new plan would do all of this without cutting benefits or eligibility.

Currently, the federal government pays a percentage of each state’s Medicaid costs, regardless of cost increases in any given year. In Tennessee, the government pays 66%, which currently is $7.5 billion of its $12.1 billion Medicaid program.

Republicans argue the current system gives states little incentive to control expenses because no state pays more than half the total cost.

However, Democrats and health advocates have expressed concern that spending caps might cause states to purge their rolls or reduce services. They instead want to expand Medicaid eligibility, which Tennessee’s Republican leaders have declined to do under former President Barack Obama’s health care law.

Tennessee’s General Assembly passed a resolution in 2019 calling for the submission of a block grant plan for federal consideration.

Lee declared in January that Tennessee had become the first state in the nation approved for the plan. Trump’s administration signed off on the idea shortly before the president left office.

 
 

Clipped from: https://apnews.com/article/joe-biden-health-67887ccddd276783fc03c01592fce0fc

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Court places Tennessee’s Medicaid block grant lawsuit on hold

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The local lawsuit opposing the approved shared-savings waiver is on hold while CMS holds another comment period in addition to the comment period the state already conducted.

 
 

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.

 
 

 
 

Tennessee Attorney General Herbert Slatery

Manuel Balce Ceneta / AP

(The Center Square) – A lawsuit challenging Tennessee’s TennCare III Medicaid block grant has been put on hold by a federal judge while a public comment period on the funding occurs.

The state became the first to have a Medicaid block grant approved when the Trump Administration endorsed the grant in its final weeks. It was then authorized quickly by the Tennessee Legislature and signed into law in January by Gov. Bill Lee.

Under the block grant, Tennessee would receive federal money for the state’s Medicaid program in one lump sum instead of periodically. State officials said doing so would allow the state more autonomy in running the program and save the state money.

The lawsuit, filed by The National Health Law Program, the Tennessee Justice Center, and King & Spalding LLP on behalf of 13 Tennessee Medicaid recipients, claimed, in part, the rushed federal approval did not allow for a required public comment period.

The U.S. Department of Health and Human Services recently reopened that federal comment period until Sept. 9. HHS granted an experimental waiver when the program was approved and did not use the full public comment period.

“By rushing the approval of the TennCare III, the Trump administration neglected to open the required public comment period, depriving Tennesseans and other interested parties the opportunity to oppose the project,” said Michele Johnson, Executive Director of the Tennessee Justice Center. “The State’s decision to radically restructure our Medicaid program would harm many low-income individuals and families, including our plaintiffs.”

Tennessee Attorney General Herbert Slatery filed a motion in May to intervene in the case to protect the interests of the state, which was granted. The matter was filed in U.S. District Court in Washington, D.C., naming the U.S. Department of Health and Human Services, the Centers for Medicaid and Medicare Services and several individuals as defendants.

“The corporate plaintiffs behind this lawsuit, who consistently sue the State, are trying to stop a significant and beneficial policy reform for our state with a federal lawsuit filed in D.C.,” Slatery said in a statement when the state intervened. “Our office is intervening to make sure Tennessee’s unique healthcare infrastructure is appropriately defended.”

The complaint is based on the block grant allowing the state to restrict prescription drug coverage, eliminate the three months’ retroactive coverage and require beneficiaries to enroll in managed-care plans, which the state has used since 1994 and more than two-thirds of Medicaid recipients nationally use.

Around 1.2 million low-income and disabled Tennesseans receive TennCare.

“As approved by the Trump administration, the TennCare III waiver contains a number of features that are at odds with how Congress has designed Medicaid coverage, affecting everything from financing and retroactive coverage to prescription drug services and managed care arrangements,” said Jane Perkins, Legal Director at the National Health Law Program. “We think the approval is rife with legal errors – including that the Trump administration approved this waiver without allowing the public to comment as required under the law. Transparency in government is critical, and we welcome this step by HHS to allow the public to be heard.”

The block grant allows Tennessee to keep half of the savings it would get from spending less than the federal allotment, money that could be used on future health care savings initiatives. Over the past five years, Tennessee saved $6 billion compared to the federal cap and will be allowed to use that funding as well.

Those savings previously could be used only against future overages of the federal Medicaid funding cap. The TennCare III funding cap will then reset in 2026 based upon how much the state has spent, per capita, between 2021-24.

“Our State has a lengthy history of mismanaging Medicaid, and the hastily approved changes to TennCare III would make it worse,” Johnson said. “That is why we are heartened by the opening of the federal comment period and the opportunity for our clients and other key stakeholders to make their voices heard regarding the harmful changes to our Medicaid program.”

Clipped from: https://www.murfreesboropost.com/news/state/court-places-tennessees-medicaid-block-grant-lawsuit-on-hold/article_8d1c74e9-7bdb-539c-bc2f-c56cf8eb3642.html

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PENNSYLVANIA- Wolf Administration Announces Plans to Expand Medicaid Postpartum Coverage Period for Mothers

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PA joins the list of states that will take additional federal money to extend post-partum care to a full year.

 
 

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.

 
 

Harrisburg, PA – The Wolf Administration today joined leadership from the legislative Women’s Health Caucus, the Maternity Care Coalition, and the Pennsylvania Health Access Network to announce Pennsylvania’s intent to extend the postpartum coverage period for mothers eligible for Medicaid because of their pregnancy.

This historic investment in the health and well-being of new mothers and their babies will allow thousands of birthing parents to continue to access physical and behavioral health care necessary to keep themselves healthy and their families on a path to good health and well-being.

“Access to health care is essential to well-being. Ending pregnancy-related coverage for mothers covered through Medicaid just 60 days after birth risks mothers going without necessary and potentially life-saving care,” said Department of Human Services Acting Secretary Meg Snead. “The first year post-birth is a critical time for the entire family’s health and well-being and this expansion will help mothers maintain relationships with care providers undisrupted. As our nation seeks to reverse rising trends in maternal mortality, this coverage can help us save lives and is a necessary investment in maternal-child health across Pennsylvania.”

Federal law requires Medicaid – or Medical Assistance in Pennsylvania – to extend eligibility for pregnant women with incomes up to 138 percent of the federal poverty level for 60 days following the birth of a baby. Under the American Rescue Plan Act, states are able to implement a new state plan option beginning April 1, 2022, to expand the Medicaid postpartum coverage period for mothers to one year following the birth of a baby.

“The expansion of postpartum Medical Assistance coverage will help improve long-term health outcomes for entire families and will help decrease the number of pregnancy-related deaths in Pennsylvania,” Acting Physician General Dr. Denise Johnson said. “Maternal mortality is devastating for families and communities worldwide, which is why maternal and child health is a priority for the state. This expansion is not only essential, but is critical to helping ensure mothers have access to important health care and is another step toward creating a healthy Pennsylvania for all.”

According to an analysisOpens In A New Window of 2018 data, the United States’ has the highest rate of maternal mortality among 10 similar nations. Maternal mortality data for 2019Opens In A New Window released earlier this year shows that the trend is growing – up to 20.1 deaths per 100,000 live births from 17.4 per 100,000 in 2018, and maternal mortality is significantly more common among Black women as compared to White and Latinx women.

Pennsylvania’s Department of Health released a report last year analyzing 457 deaths determined to be pregnancy-associated, which is defined as deaths that occurred while pregnant or within one year of the end of a pregnancy, that occurred in Pennsylvania from 2013-2018. According to the report, pregnancy-associated deaths in Pennsylvania grew by more than 20 percent from 2013 to 2018. Pennsylvania also followed national trends of higher maternal mortality among Black women and women whose births were covered through Medicaid. Medicaid covers 4 in 10 births nationally and about 3 in 10 in Pennsylvania. Medicaid was the primary payer in Pennsylvania in about 53 percent of pregnancy-associated deaths and nearly 60 percent of all pregnancy-associated deaths came between six weeks and one year after giving birth, largely outside of the 60-day limitation on coverage.

Expanding postpartum coverage for mothers covered through Medical Assistance will provide continuity in health care through a critical period in the mother’s life and a foundational time for the health and well-being of their children and furthers the Wolf Administration’s work to promote good health and strong starts for mothers and children across Pennsylvania. Since taking office, Governor Wolf has expanded access to home visiting services that support parents and young children through significant investments in home visiting program and an inclusion of home visiting services in Pennsylvania’s Medical Assistance program. This expansion will also support the work of Pennsylvania’s Perinatal Quality CollaborativeOpens In A New Window, a cross-system public-private partnership that seeks to advance maternal-child health, increasing screenings for and follow-up services for postpartum depression, and leverage perinatal health providers to improve health and wellbeing of pregnant and postpartum mothers and their children.

“Maternity Care Coalition is thrilled Pennsylvania is pursuing the American Rescue Plan’s option to extend postpartum coverage,” said Marianne Fray, CEO of the Maternity Care Coalition. “This is a significant step forward for perinatal health equity in our Commonwealth and brings us one step closer to making Pennsylvania a place where parents can birth with dignity, parent with autonomy and raise babies who are healthy, growing and thriving.”

The postpartum expansion will be available to states to take effect in April 2022. A formal declaration of intent to expand the postpartum coverage period will be submitted to the federal government once guidance is issued to states from the Centers for Medicare and Medicaid Services.

 
 

Clipped from: https://www.media.pa.gov/pages/dhs_details.aspx?newsid=735