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Florida Medicaid enrollment tops 4.8 million, surpassing forecast growth


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Florida Medicaid enrollment continues to surge.


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 Florida State Capitol buildings (Old Capitol in foreground) in Tallahassee, Florida.  

Shutterstock photo

(The Center Square) – Florida’s Medicaid enrollment increased by 1% in June with 48,468 low-income residents qualifying for subsidized health care, according to the state’s Agency for Health Care Administration (AHCA).

As of June 30, there were 4,846,412 low-income, elderly and disabled Floridians enrolled in Medicaid, an increase of more than 730,000 since June 2020, AHCA documents in its June enrollment report.

Florida’s economy lost 1.1 million jobs during the peak of the pandemic last spring, hitting a peak unemployment rate of 14.2%.

Medicaid enrollment boosts quickly followed with more than 885,000 qualifying for full coverage between last March and this February, expanding the state’s Medicaid enrollment from 3.9 million to 4.6 million.

Since February, another 250,000 residents have qualified. In December, the Legislature’s Social Services Estimating Conference (SEC) economists forecast 4.588 million Floridians will be enrolled in Medicaid during Fiscal Year 2020 (FY22), which began July 1. That projection has already been eclipsed.

Using an economic forecasting model based on studies of post-pandemic economic recoveries, state economists project it could take 12-15 months to claw back to pre-pandemic employment levels and trim back the state’s Medicaid rolls.

The state’s $100 billion FY22 budget includes about $44 billion in health care spending largely subsidized by federal pandemic assistance, including about $34 billion for Medicaid, up from $31.6 billion the previous year.

June marked the 15th consecutive month in which Medicaid enrollment increased in Florida, the AHCA notes, and also sustained the state’s status as the nation’s leader in enrollment in subsided health insurance plans offered under the Affordable Care Act (ACA).

According to the federal Centers for Medicaid & Medicare Services’ (CMS) June Special Enrollment Period Report, 413,409 Floridians enrolled in plans available under the ACA between Feb. 15 and June 30.

Overall, about 2.3 million Floridians have purchased “Obamacare” policies, nearly 20% of the 8.5 million people nationwide who selected or were automatically re-enrolled in plans during the extended 2021 open-enrollment period, according to CMS.

After the Trump administration halved the yearly open enrollment period from 12 to six weeks in 2020, President Joe Biden signed an executive order in January authorizing a special enrollment period between Feb. 15 and Aug. 15 because of the COVID-19 pandemic.

According to the CMS, 1.5 million people in 36 states nationwide enrolled in ACA plans between Feb. 15 and June 30. Florida’s 413,409 boost accounted for 27% of that increase.

With average premiums through the ACA marketplace dipping by 25% in April with the adoption of American Rescue Plan tax subsidies, the CMS notes that 34% of new enrollees are paying $10 or less per month after tax credits are taken into account.

“When you make coverage affordable, when you make it easy for people to enroll, they will do so,” CMS Administrator Chiquita Brooks-LaSure said. “”The American Rescue Plan has made health coverage more affordable and accessible than ever – and people are signing up.”

In 2014, 983,775 Floridians signed onto the program in its first year. By 2019, 1.9 million Floridians were enrolled.

Florida’s nation-leading ACA insurance exchange enrollment is a product of the state’s growing population of more than 21 million and state lawmakers refusal to expand Medicaid. Florida is one of 12 states that has not done so.

“Let’s be clear – the monthly marketplace numbers show that across the country, there’s a demand for high-quality, low-cost health coverage,” Health & Human Services Secretary Xavier Becerra said. “Whether through expanded Medicaid or the Health Insurance Marketplace, the ACA is working for millions of Americans – and we’re committed to building on this historic progress.”

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Pax­ton Seeks Pre­lim­i­nary Injunc­tion After Biden Admin­is­tra­tion Ille­gal­ly Revoked Med­ic­aid Waiver

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Texas AG has filed a request to stop the Biden administration from un-approving the 1115 DSRIP 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.


Attorney General Ken Paxton sought a preliminary injunction to enjoin the Biden Administration’s illegal action rescinding the extension of the Medicaid Section 1115 waiver negotiated between Texas and the federal government. In a politically motivated move, the administration reversed its agreement to extend that waiver until 2030.   

“In an abuse of power, the Biden Administration blatantly ignored the needs of Texans when it revoked our Medicaid waiver,” Attorney General Paxton said. “Not only does this violate agency regulations, it was clearly intended to force our state into expanding Medicaid under the Patient Protection and Affordable Care Act. This flippant decision is illegal and cruel. Putting the lives of vulnerable Texans on the line for political gain is reprehensible.” 

After taking office, and acting through the Centers for Medicare and Medicaid Services, the Biden Administration purported to revoke that extension, with no warning to Texas. This will cause irreparable harm to Texans. 

Read the motion here.  


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Arkansas submits plan for overhauling Medicaid expansion

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Arkansas’ reworked waiver will not require work to be covered, but will require it to get a managed care plan.


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.


Arkansas submitted to the federal government on Tuesday a proposal to overhaul its Medicaid expansion after the program’s previous requirement that some recipients work was blocked by the courts.

The state Department of Human Services turned in its proposed waiver for the expansion program, and officials have said they hope to win approval by November or December.

As with the current program, the overhauled expansion would continue using Medicaid funds to place recipients on private health insurance. It also includes incentives aimed at encouraging participants to work or meet certain health goals.

Arkansas unveiled the proposal after the Biden administration moved to roll back Medicaid work requirements in Arkansas and several other states. A federal judge blocked the Arkansas work requirement.


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Hyde Amendment fight just the first step in changing abortion coverage

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Dems continue to push for Medicaid to pay for abortions.


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 fight over abortion restrictions will likely be a major flashpoint in appropriations debates and on the campaign trail


Demonstrators rally outside the Supreme Court in June 2016. The fight over abortion restrictions will likely be a major flashpoint in upcoming appropriations debates and on the campaign trail. (Bill Clark/CQ Roll Call file photo)

The partisan fight over whether the federal government will fund abortion coverage for Medicaid beneficiaries threatens to stall action on major appropriations bills, but the on-the-ground impact would be less dramatic than the debate suggests.

Democrats are prioritizing the removal of an annual appropriations rider known as the Hyde amendment, which bans federal funding of abortion except in cases of rape, incest or to protect the life of the woman. The policy, which prevents programs like Medicaid or the Children’s Health Insurance Program from using federal money to cover abortion outside of those three situations, has been in every spending law since 1976.

Additional legislative action outside of the fiscal 2022 Labor-HHS-Education funding bill would be needed to broaden abortion coverage for women who receive care through departments such as Defense or Veterans Affairs.

It would be challenging to remove a long-standing abortion policy that every lawmaker who voted for Labor-HHS-Education funding in previous years allowed to continue.

Even if changes to Hyde become law, the effects would be muted, based on state abortion policies, said Laurie Sobel, the Kaiser Family Foundation associate director for women’s health policy.


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Fate of Missouri Medicaid expansion in the hands of the state Supreme Court

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The Missouri Supreme Court has heard all arguments and is expected to announce a decision soon.


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.


After an eight-year fight over Medicaid expansion, the arguments are over. The question of whether 275,000 people will receive state-paid health care coverage is in the hands of the Missouri Supreme Court.

Oral arguments took place Tuesday in an expedited appeal. The seven judges must decide whether Medicaid eligibility will expand, as directed by the constitutional amendment approved by voters, or, as Cole County Judge Jon Beetem ruled, if it was fatally flawed because it did not include a new source of revenue to pay the anticipated costs.

The court’s only other option, suggested by Attorney General Eric Schmitt’s office in its final written brief, is to leave people eligible for coverage without actually providing it unless lawmakers explicitly fund it.

While there is no deadline for the decision, the expedited schedule indicates the court will rule soon, because coverage was supposed to start July 1.

“What is at stake here is life-saving health care,” Joel Ferber, director of advocacy for Legal Services of Eastern Missouri said to reporters after oral arguments concluded. “Our lead plaintiffs and our clients are desperate for the health care they need.”

In the days and hours leading up to the oral arguments, the judges received plenty of advice on how they should rule. The final written arguments from Schmitt’s office, which wants the court to uphold Beetem, were filed Friday. Friend-of-the-court briefs, along with the final filings from the plaintiffs seeking an order in favor of expansion, were being filed as late as Monday afternoon.

The court, however, heard only from John Sauer, representing the state, and Chuck Hatfield, representing three women who sued when Gov. Mike Parson announced the state would not open enrollment for the expansion group.

Amendment 2, passed last August opened Medicaid eligibility to adults ages 19 to 64 who earn less than 138 percent of the federal poverty guideline. Sauer told the court that while that group is eligible, lawmakers control state spending and did not make room for them in the budget.

“Their intent was not to fund the expansion population and only fund the pre-expansion population,” Sauer said.

Reading the same appropriation bills, Hatfield found a different interpretation. While the spending bills didn’t include the estimated $1.9 billion to cover the expansion population, he said there is money for every service available under Medicaid and there are options to control spending that would provide coverage for everyone eligible.

“The legislature must, of course, follow the priorities the people put in the constitution,” Hatfield said.

The path from passage of the Affordable Care Act in 2010, with a requirement that states expand Medicaid coverage, to Tuesday’s arguments, has been dominated by politics, with Democrats and their supporters pushing the state to go along and Republicans just as strongly resisting.

Then-Gov. Jay Nixon first asked lawmakers to expand coverage in 2013, but here was never a realistic chance the Republican-dominated General Assembly would go along.

Passage of Amendment changed some minds, but not enough. Parson, who opposed Amendment 2, put money for the anticipated costs in his January budget proposal. When the final vote on funding came in May in the Missouri Senate, only four Republicans joined 10 Democrats in support of Parson’s request.

Since 1945, the Missouri Constitution has prohibited initiatives that require appropriations if the same ballot measure does not generate the needed revenue. That is why Beetem ruled Amendment 2 is invalid, writing that because it requires the state to spend money, it is unconstitutional.

“How is it you can look back on an election that is past and decide it is invalid?” Judge W. Brent Powell asked Sauer. “How long can you continue to do that?”

“That is not our argument,” Sauer replied.

In his brief for the state, Sauer of the attorney general’s office argued that the judges have only two choices – find that Amendment 2 is valid but subject to appropriation, or that it was not validly enacted.

“This conflict is real, and it stubbornly resists plaintiffs’ belated attempts to explain it away,” Sauer wrote.

Last year, the court decided lawmakers could not use appropriation bills to make Planned Parenthood ineligible to provide Medicaid-paid family planning services. Sauer asked the court to overturn that decision and allow lawmakers to determine which legally eligible people will and will not receive Medicaid coverage.

The judges don’t have to stretch logic that far, Hatfield argued. The three women who initiated the lawsuit are eligible, the legislature appropriated money for every service provided by Medicaid and therefore they cannot be denied, the attorneys wrote.

“This court has consistently held that every doubt, and every ambiguity, should be resolved in favor of upholding the will of the people,” Hatfield said.

The governor has various methods to control spending and though some may be painful, the options are real, Hatfield said Tuesday.

In the brief filed Monday, Hatfield and his co-counsels in the case wrote that the program’s cost, whether for traditional Medicaid or the expansion population, is uncertain every year, they wrote.

First, no one has any idea whether the amount of money the General Assembly appropriated is too much, not enough, or just right, they wrote. “The number of enrollees in the MO HealthNet program fluctuates from year to year, as do the quantity and types of services used.”

The amicus curiae, or friend of the court, briefs have come in from conservative groups, health care providers, backers of Amendment 2 and lawmakers. There’s even a secondary dispute, with Missouri House Democratic Leader Crystal Quade of Springfield and Assistant Democratic Leader Richard Brown of Kansas City asking the court to reject, or at least ignore, the brief filed in the name of the full House.

The stakes are enormous, both for those who would receive coverage and for the state’s treasury.

In the brief for the state’s 12 Federally Qualified Health Care Centers, which serve 600,000 patients, Jim Layton, formerly the state’s top appellate attorney, wrote that it is essential that the clinics serve paying patients to support their work for those without insurance.

Of the people using them, he wrote, 46 percent are on Medicaid already and another 25 percent are without insurance. Many of the uninsured would receive coverage, he wrote, and lawmakers funded all services provided by Medicaid.

“But the General Assembly cannot, merely by changing a dollar figure in a line of an appropriation bill, change a parameter of the program that was constitutionally defined by the people by initiative, any more than it can, by changing a dollar figure or including a proviso in an appropriations bill, change eligibility for any other program,” he wrote.

Before passage of Amendment 2, Missouri was one of 14 states that had not yet expanded Medicaid under the 2010 Affordable Care Act. The law originally made expansion mandatory but the U.S. Supreme Court ruled in 2012 that penalty provisions that made Medicaid an all-or-nothing program were unenforceable.

Under the terms of the ACA, states pay 10 percent of the cost of expansion and the federal government covers 90 percent. In the traditional Medicaid program, Missouri pays about 35 percent of the cost.

Amendment 2 extended coverage to people aged 19 to 65 with household incomes less than 138 percent of the federal poverty guideline, or $17,774 a year for a single person and $36,570 for a household of four.

Under the current Medicaid program, adults without children are not eligible unless they are blind, have another qualifying disability or are pregnant.

The traditional Medicaid program is expected to cost about $12 billion in the current fiscal year.

In his January budget proposal, Parson estimated the total cost of expansion at $1.9 billion, with $130 million from general revenue, $1.65 billion from the federal treasury and the remainder from taxes on medical providers.

If Missouri does expand Medicaid coverage, it will become eligible for additional support for the traditional program estimated to save the state $1.2 billion over two years.


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MetroPlusHealth ranks #1 in 2020 Medicaid Quality Incentive Program

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MetroPlus Health Plan in NY was rated first out of 15 Medicaid plans for 2020 quality results.


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.


In a year that saw unprecedented challenges within the entire health care community, MetroPlusHealth, New York City’s Health Plan, was ranked number one among all 15 New York State Medicaid plans in overall quality, according to the New York State Department of Health’s 2020 Quality Incentive results. “While we have consistently scored high in quality, having achieved the #1 spot during a global pandemic speaks volumes about the dedicated people at our company who rose to the occasion,” said Dr. Talya Schwartz, President & CEO of MetroPlusHealth.

As New York City shut down in March of 2020, the staff of MetroPlusHealth pivoted to remote work as entire departments were redeployed. As part of Covid-19 operations, while family, friends and co-workers were dealing with personal challenges as a result of the spreading virus, new protocols were put into place and support and communications to members were intensified. “Navigating through unchartered territories was key during this time,” said Dr. Schwartz. “We were there for our members assisting with needed care, Covid-19 testing, and day-to-day essentials. It was during this time that our membership surged by 15% to over 600,000 and then continued growing to over 620,000 members this year,” she added.

Key factors contributing to the top ranking, where MetroPlusHealth scored above 90% of State benchmarks, included care related to diabetes, hypertension, substance abuse disorders and mental illness. The plan cites its streamlined process of working with NYC Health + Hospitals and its community providers in exchanging data, education, member support, and working to bring members in for care, especially those with the highest and most immediate needs.

The New York State Quality Incentive program is based on reporting and measurement from medical care in the prior calendar year. A plan’s score and ranking in the program indicates the quality of care provided to the plan’s members relative to all plans in the Medicaid Managed Care market. The data evaluated considers national standards of care, State specific measures and consumer input and assessment.

Rates of performance in Medicaid managed care have increased steadily over the last decade. New York State Medicaid plans have demonstrated a high level of care compared to national averages, and for many domains of care the gap in performance between commercial coverage and Medicaid managed care has been decreasing and, in some cases, has been completely closed since the Quality Incentive Program was implemented.

“Just a few months ago,” Dr. Schwartz said, “we and other Medicaid Managed Care plans were concerned about the viability of this program given some of the State cuts. Fortunately, some of those cuts were partially restored and allowed us and others to continue to focus on quality and adherence to standards of care for our members.” Partial restoration of State funding also allowed MetroPlusHealth to support the provider community, through monetary means, as well as operationally, to create and sustain the infrastructure and the personnel needed to focus on this aspect of care delivery. “We could not be prouder of our team and our provider partners,” Dr. Schwartz stated. “We are grateful to the MetroPlusHealth staff who once again demonstrated the enormous value of MetroPlusHealth and the Health + Hospitals’ system to all New Yorkers.”


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Senators seek Medicaid-like plan to cover holdout states

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US Congressmen are introducing a bill to sell Medicaid on the exchanges for free in holdout states.


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. Raphael Warnock, D-Ga., speaks at Alfred E. Beach High School in Savannah, Ga., Thursday, July 8, 2021. Warnock joined fellow Democratic senators Jon Ossoff of Georgia and Tammy Baldwin of Wisconsin in introducing a bill on Monday, July 12, 2021, to require the federal government to set up a Medicaid-like health plan in states that have not expanded Medicaid plans to cover more low-income adults. (Jim Watson/Pool via AP)

Jim Watsdon

ATLANTA (AP) — Three Democratic U.S. senators from states that have refused to expand Medicaid want the federal government to set up a mirror plan to provide health insurance coverage to people in those states.

Sens. Raphael Warnock and Jon Ossoff of Georgia and Tammy Baldwin of Wisconsin are introducing the bill Monday, they told The Associated Press. Congressional Democrats are pushing for a coverage expansion in upcoming legislation.

“The single most effective solution to closing our state’s coverage gap is to expand Medicaid,” Warnock said after a June 29 meeting with health care executives. “What we ought to be doing is expanding Medicaid rather than playing games with the health care of Georgia citizens.”

The effort is crucial for Warnock, who seeks reelection in 2022 facing several Republicans eager to defeat him.

People making more than 138% of the federal poverty level are eligible for federal health insurance subsidies through an online marketplace. But as many as 4 million people who make less don’t get assistance in a “coverage gap,” according to the Kaiser Family Foundation.

President Barack Obama’s Affordable Care Act envisioned states would expand Medicaid programs to cover those people, but many conservative states balked. There are 12 holdouts, while an expansion in Missouri mandated by referendum is in limbo after Republican lawmakers refused to pay for it.

Democrats increasingly say leaving people without coverage is unacceptable. They tried to lure remaining states with two years of extra money for expansion, but none budged. Baldwin said such a refusal is “just wrong.”

“Our legislation will open the door to those who have been shut out and expand access to affordable health care, including preventive care, that people want and need,” she said in a statement.

The bill would mandate a new health insurance plan that looks just like Medicaid offered to residents in holdout states. President Joe Biden proposed during his campaign to offer a public option through the federal healthcare marketplace. Democratic Rep. Lloyd Doggett of Texas and others introduced a bill June 17 to let local governments create local Medicaid expansions.

The Medicaid approach has key advantages, said Jesse Cross-Call, director of state Medicaid strategy with the liberal-leaning Center for Budget and Policy Priorities.

The plan would require no premiums and only small copayments, while those costs can be much higher for individuals on the marketplace. People can enroll in Medicaid year-round, while marketplace enrollment is typically only in the fall, or when someone’s circumstances change.

“The idea is for it to be as close to Medicaid coverage as possible,” Cross-Call said.

A new plan could take years to set up, though. Many states use managed care networks to provide Medicaid services, and it’s unclear if the federal government would be able to contract with the groups.

Sponsors say coverage is already paid for because the original Affordable Care Act included money for all 50 states. States normally shoulder 10% of the cost, but the bill would require no state contributions.

The plan also would boost incentives for holdout states to expand on their own. It would raise the federal share of state-federal Medicaid spending by 10 percentage points this coming decade. The current enticement, included in Biden’s coronavirus relief bill, is 5 percentage points for two years. Based on Kaiser Family Foundation estimates, that could be worth a cumulative $160 billion to holdout states and Oklahoma, which launched expansion July 1.

Republicans, Warnock said in June, are effectively “standing between Georgia voters and their tax dollars that are still being paid to cover Medicaid in other states.”

Republicans aren’t backing down. Georgia Gov. Brian Kemp is pursuing a limited expansion that would impose work or education requirements for benefits. It seeks to add 50,000 Georgia residents in its first two years and require everyone to shop for federally subsidized insurance through private agents. The Biden administration is reevaluating previous approval of the plan by the Trump administration, a reversal Kemp says isn’t allowed.

“The Biden administration has been, in my opinion, trying to throw up roadblocks to our waiver plan that was approved,” Kemp recently told AP. “Senator Warnock can hit me all he wants on Medicaid. What he never mentions is … working on lowering costs for private sector health care. A lot of people don’t want government health care.”

Financial incentives could be required to keep other states from dropping Medicaid expansion to avoid current costs. The bill doesn’t address that.

Warnock spokesperson Meredith Brasher reaffirmed that sponsors want the measure attached to any budget reconciliation measure Democrats use to advance educational and social welfare priorities through the Senate without Republican support.

“Recovery legislation presents a unique, historic opportunity to close the gaps in coverage for the millions of people in the Medicaid coverage gap,” wrote more than 60 members of the Congressional Black, Hispanic and Asian Pacific American caucuses on June 16.

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Oregon Will Use Medicaid Funding For Mental Health Emergency Response


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Oregon is improve $10M to provide mental health crisis response.


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.

Oregon Legislature recently approved a bill that will help fund mobile mental health crisis teams around the state.

The bill allocates $10 million dollars of federal funding to be distributed across the state for crisis intervention centers.

Jackson County Representative Pam Marsh co-sponsored the bill. She says these crisis teams would complement police presence in terms of public safety during emergencies.

“What we’re trying to do is explore the idea that different kinds of professionals can be involved in responding to those 9-1-1 calls where there’s not a danger of violence or a need for someone to intervene in the way that law enforcement can intervene,” said Marsh.

Some of these professionals would be social workers, nurse practitioners, and mental health workers. They would address issues such as mental health crises and suicide threats.

Groups in Southern Oregon have been advocating for this bill in recent years. Marsh believes recent cases of people in mental health crises being killed during police encounters have led more Americans to rethink public safety methods.

“I certainly know that the Rogue Valley has been interested in this, and has been for a very long time,” she said. “We know that communities across the country woke up and started looking at these questions last summer. How many communities will actually come forward to put together a proposal? We’ll find that out in the grant process.”

Communities can apply for grant money to be used to assess existing resources, provide behavioral healthcare training, or develop and implement crisis intervention services. State Medicaid offices will be responsible for coordinating the mental health units.


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Wisconsin Submits Plan to Enhance and Improve Medicaid Home and Community-Based Services

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Wisconsin is requesting additional federal money to improve HCBS services.


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.


Central to the plan are critical initiatives to strengthen the caregiving workforce left out of state budget passed by legislature

The Wisconsin Department of Health Services (DHS) has submitted a plan to the federal Centers for Medicare and Medicaid Services (CMS) to use American Rescue Plan Act (ARPA) funds to improve and enhance Wisconsin’s home and community-based services under Medicaid. DHS estimates it will receive approximately $350 million under this part of ARPA. Key components of the plan that support Wisconsin’s caregiving workforce include increasing rates for home and community-based services and expanding the professional advancement opportunities for the workers who provide these services.

“Strengthening our caregiver workforce and making investments in the services that many seniors and people with disabilities rely on across our state are critical steps we must take to support our economic recovery from the pandemic,” said Governor Tony Evers. “We are fortunate to have access to these federal funds to move these efforts forward since many of the proposals to support and strengthen our caregiving workforce included in my proposed state budget were removed by the legislature and not included in the budget that was recently passed.”

In consultation with key stakeholders and partners, DHS assembled a plan that will continue to advance Wisconsin’s successful record of implementing innovative programs that enable older adults and people with disabilities to live independently in their homes and communities. In Wisconsin, these efforts include the Family Care, Family Care Partnership, IRIS, PACE and the Children’s Long-Term Support programs, as well as personal care, private duty nursing, home health, and rehabilitative services provided to eligible Medicaid members.

“Wisconsin has long been a national leader in developing and implementing programs that allow the elderly and people with disabilities to live their best lives in their homes and communities. In 2021, we achieved a major milestone by fully eliminating the adult waiting list for home and community-based services,” said DHS Secretary-designee Karen Timberlake. “The ARPA funds designated by Congress and President Biden to support state home and community-based services will help us continue to build on that success and help stabilize and the services people depend upon as well as the workforce needed to provide them.”

Foundational to Wisconsin’s plan is a commitment to ensuring all eligible people in Wisconsin have access to home and community-based services by addressing health disparities and focusing on equity in program design and access. In addition to working with the Governor’s Health Equity Council to support implementation of the approved plan, DHS will work alongside community-based organizations that share our commitment to addressing disparities within the home and community based service system for Black, Indigenous, and people of color, people with varying abilities, people living in extremely rural areas, and other historically underserved and disadvantaged communities. Wisconsin is also engaging in individual conversations with each of the 11 federally recognized tribes to identify ways to enhance HCBS services for tribal members under the proposals in the submitted plan.

CMS is currently reviewing Wisconsin’s plan, along with those plans submitted by other states. Implementation efforts will begin once CMS approval is received.

Learn more by visiting the Proposed Funding for Home and Community-Based Services.


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A Medicaid boost gives Colorado a chance to re-do disability services

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Colorado is requesting additional federal money to improve HCBS services.


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.


Funding for in-home personal care for aging Coloradans and people with disabilities would jump for three years under American Rescue Plan spending.



Nancy Bach, 63, and her niece Elizabeth, 36, on Monday, July 19, 2021, in Northglenn. Nancy struggles to fill Elizabeth’s pill boxes because her hands tremble, and aids have mistakenly caused Elizabeth to overdose by providing inaccurate amounts. Elizabeth, who has a developmental disability along with bipolar disorder, has lived with her aunt for five years and gone through four different home aid agencies. (Olivia Sun, The Colorado Sun)

Nancy Bach, 63, can handle most of the daily tasks for her 36-year-old niece, Elizabeth, who has developmental disabilities.

But Bach’s hands shake with persistent tremors, making it impossible to fill the pillboxes that sort her niece’s complicated array of prescriptions. The two of them need help, and good help is hard to find. 

When others have sorted the pills wrong, Elizabeth Bach has ended up in the hospital for a week for overdoses. Other weeks she has missed crucial Trazodone because an aid counted wrong. Recently the home health agency just stopped sending anyone to do it. 

Colorado is about to get $500 million over the next three years that advocates for people with disabilities hope will help solve problems experienced by the Bachs and many others. A bigger Medicaid match from the American Rescue Plan will help Colorado pay for things including better training for home health and personal care aids, retention bonuses, and new systems allowing caretaking families to directly hire their own choice of personal aid. 

That’s extremely welcome news to Bach and her niece.

“I know exactly who I’d hire, and there’d be no issue,” Bach said. 

The funds are a “once-in-career opportunity,” a chance to make systematic change in an industry that has long struggled to maintain workers, said Bonnie Silva, director of the state Office of Community Living at the Department of Health Care Policy and Financing, which includes the Medicaid program. 


Elizabeth Bach takes over a dozen medications and supplements at specific times of the day. Nancy, her aunt, struggles to fill her pill boxes because her hands tremble, and aids have mistakenly caused Elizabeth to overdose by providing inaccurate amounts. (Olivia Sun, The Colorado Sun)

The Medicaid department serves about 60,000 people through community-based programs, meaning programs for those who live at home and receive community services instead of living in institutions. The division spends about $2.5 billion on those services each year. Still, the extra $500 million is “an extraordinary amount of money” that will allow Colorado to transform its in-home programs, Silva said.

“It would be a shame if in 2024 we find ourselves with the exact same problems that we have today,” she said.

Letting people like Bach hire help of their choosing, and providing a larger pool of home aids trained in what clients actually need, is exactly how the new $500 million in Medicaid money could make a difference for thousands of Colorado families if done thoughtfully, said Julie Reiskin, executive director of the Colorado Cross Disability Coalition. 

“One of the problems I think we’ve always had in Colorado was that when we need to do something we were always in the situation where we have to do it cheap,” said Reiskin, who has for years been a leader of advocacy for more patient-directed home and community-based services through Medicaid. “And then we don’t do it right. So I think there’s a lot of systems change we could do that’s really exciting. And we have the time to do it properly.” 


Nancy Bach, 63, and her niece Elizabeth, 36, on Monday, July 19, 2021, in Northglenn. Elizabeth, who has a developmental disability along with bipolar disorder, has lived with her aunt for five years and has gone through four different home aid agencies. (Olivia Sun, The Colorado Sun)

To come up with a plan to spend the $500 million, the state Medicaid department held seven meetings attended by more than 800 people, plus gathered online surveys from about 450 others. The No. 1 issue was easy to identify: the workforce shortage in the in-home care industry. 

The challenge with the cash is that it’s a one-time allotment. Instead of just using the funds to increase the rate Medicaid pays to service providers, a boost that would end in three years, Colorado is trying to spend the money to come up with long-term fixes to a broken system. 

State officials want to create a training pool where people who work in the industry could get help earning certification to care for people with more complex health needs. They plan to spend money to hire a contractor who would come up with new policies for compensation and benefits that would make in-home care a “viable industry,” in which people could make a living and expect to advance, Silva said.


Those new designs could include more avenues for clients like the Bachs to direct more of their care and payments, advocates noted. 

The spending plan, which still needs final approval from the federal Centers for Medicare and Medicaid, also includes money for respite care. Those funds would pay increased wages for workers willing to care for people while their relatives or regular caregivers get a break. 

Another part of the $500 million plan calls for hiring a contractor to study how best to transition large residential centers, such as nursing homes, into smaller settings. During the pandemic, smaller centers had more success keeping residents healthy, Silva said. 

Targeting the “invisible waitlist”

Colorado has struggled for decades to keep up with the need among those who, despite severe disabilities or aging, want to live in their own homes. 

The waitlist to get on a Medicaid program that provides round-the-clock, in-home services for adults with intellectual disabilities was about 15 years long seven years ago. State lawmakers have slowly invested in the program, and this year, the state plugged enough money into the program to enroll 667 on the waitlist, although there are still about 2,000 people waiting. 

But the waitlist is only part of the problem. Families say that even when they get a spot in the program, there is still an “invisible waitlist” to actually find service providers to come to their homes to cook, clean and care for loved ones. 

And while they are eligible for many of the services as they wait to get enrollment in the 24/7 program, it’s difficult to find workers who have openings in their schedule. 

At other times, regulations require clients and their caregivers to hire people with qualifications above what they truly need to be helpful in an at-home situation, Reiskin said. In the Bachs’ case, for example, what they need is someone reliable, who can read prescription information, and has some basic people skills. The state and the disability support community could use the Medicaid infusion to design new regulations and programs that make sense for thousands more clients, she said. 

Even before the coronavirus pandemic hit Colorado, the turnover rate among in-home service jobs was 82%, according to the Colorado Department of Health Care Policy and Financing. State officials suspect it’s only gotten worse in the last year. 


A pillow made by Elizabeth Bach (not pictured) is framed on the wall of the Bachs’ home in Northglenn. Elizabeth’s favorite hobbies are swimming, crafting and collecting keychains. (Olivia Sun, The Colorado Sun)

Among workers who care specifically for people with intellectual disabilities, the turnover rate pre-pandemic was 40%, said Ellen Jensby, senior director of public policy and operations for Alliance Colorado, which advocates for people with disabilities. As Coloradans isolated themselves during the pandemic, many workers left the in-home care industry, she said.

“What we’ve heard from the providers is that they are having a harder time than ever right now trying to recruit people to come back into the workforce,” Jensby said. “They are trying everything to get people through the door, including recruitment bonuses. Everybody has a ‘We’re Hiring’ sign on their door.” 

But unlike coffee shops and fast food restaurants, which can raise their prices in order to pay staff higher wages, the system for people with disabilities is dependent on reimbursement rates set by the government.

Providers who run day programs, such as adult daytime care or field trips to museums, are extremely low on staff, Jensby said, as are transportation providers and programs that provide job training and on-the-job support for people with disabilities. 

“The result is they are not able to reopen many of their services fully,” Jensby said. “They just don’t have enough staff to bring everyone back. Families are like, ‘We’re ready! We’re vaccinated!'”


Still, there were stories of dedication from these other “first-responders,” the folks who donned masks and continued going to work each day alongside nurses, grocery store workers and others whose jobs couldn’t stop because of coronavirus.

“We saw the dedication really shine,” Jensby said. “There were people who quarantined for days or a week with families, … stayed with people they cared for instead of going home to their families. Just amazing stuff.”

Rate increases, along with reform

Alliance is thrilled that Colorado plans to use the extra $500 million to boost pay, recruitment and training for in-home care workers, but those workers need help in the short term, too, Jensby said. The advocacy organization also is pushing for rate increases now so that agencies can afford to pay the salaries and signing bonuses needed to hire workers. 

In legislative and congressional hearings, people talk about how the workforce shortage in the in-home service industry has reached the level of a “crisis.” But Jensby said it’s been a crisis for decades — at this point, “it’s a systematic failure.”

The state legislature passed a bill, Senate Bill 286, that gives the health care department broad authority to spend the bolstered Medicaid matching funds once the state gets the go-ahead from federal officials. If all goes as planned, Colorado should get to start spending the $500 million by early September.


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