Tag: Medicaid Reform

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Adding SNAP Benefits for Older Adults in Medicare, Medicaid Can Reduce Hospital Visits, Healthcare Costs

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A new study suggests that SNAP benefits reduces hospitalizations, but the design is limited.

 
 

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.

 
 

A study published in Annals of Internal Medicine led by UNC School of Medicine’s Seth A. Berkowitz, MD, MPH, shows that participation in the Supplemental Nutrition Assistance Program (SNAP) by older adults dually enrolled in Medicare and Medicaid is associated with fewer hospital visits and lower healthcare costs. But millions of Americans do not take advantage of the program.

 
 

Seth Berkowitz, MD, MPH

CHAPEL HILL, NC – Food insecurity among older adults takes a toll on the nutrition and health of those affected. According to data from 2019, 5.2 million people age 60 and above in the U.S. were food insecure – equaling 7.1% of that population – and that number has likely grown during the COVID-19 pandemic.

Older adults facing food insecurity are more likely to have chronic health conditions like depression, asthma, diabetes, congestive heart failure and heart attack. Only 48% of older adults who qualify for the Supplemental Nutrition Assistance Program (SNAP), which provides benefits to supplement budgets to purchase healthy and nutritious foods, are enrolled in the program.

A study published in the Annals of Internal Medicine shows the importance of older adults taking advantage of this nutrition benefit, as it is associated with fewer hospital visits and lower healthcare costs.

“Providing income support for older adults is incredibly important for health,” said study lead author Seth A. Berkowitz, MD, MPH, assistant professor of general medicine and epidemiology at the UNC School of Medicine. “Along with affecting the foods they have access to, food insecurity can force people to choose between food and medications or other basic needs, and worsen mental health. All of this takes a toll on what is already a group at high risk for poor health outcomes.”

The study used a unique circumstance to better evaluate the association between SNAP participation and healthcare use and cost. In 2017, Benefits Data Trust – a national nonprofit dedicated to helping people access essential public benefits and services – was contracted by the North Carolina Department of Health and Human Services to help people age 65 and over who were dually eligible for Medicare and Medicaid enroll in SNAP. BDT provided outreach to these individuals by mail, a telephone-based screening, and – if the person chose to enroll in SNAP – the nonprofit would aid in filing an application. This circumstance allowed for previously unavailable linkages among data sets related to SNAP outreach, SNAP participation, and health care use and cost.

Researchers used data from BDT’s outreach to more than 115,000 people age 65 and older in North Carolina between 2016 and 2020 who were dually eligible for Medicare and Medicaid, and were eligible for SNAP but not enrolled. Almost 5,100 of those who received outreach about SNAP benefits enrolled in the program. SNAP enrollment was associated with a decrease in inpatient hospitalizations, emergency department visits, long-term care admissions, as well as fewer dollars in Medicaid payments per person per year.

“Billions of dollars in food and healthcare assistance go untapped every year, often because people aren’t aware they are eligible or they are not sure how to access them,” said Pauline Abernathy, chief strategy officer at BDT. “These research findings show that data-driven outreach and application assistance significantly increase SNAP participation, which in turn markedly improves health and lowers Medicaid costs. With millions of people 65 and older eligible but not participating in SNAP, this research underscores the urgent need to increase outreach and streamline enrollment.”

Study co-authors include Deepak Palakshappa, MD, MSHP, and Joseph Rigdon, PhD, of Wake Forest School of Medicine; Hilary K. Seligman, MD, MAS, of University of California San Francisco; and Sanjay Basu, MD, PhD, of the Center for Primary Care, Harvard Medical School.

This study was primarily funded by the National Institutes of Health.

 
 

Clipped from: https://news.unchealthcare.org/2021/10/adding-snap-benefits-for-older-adults-in-medicare-medicaid-can-reduce-hospital-visits-healthcare-costs/

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Missouri has enrolled 4,300 people in expanded Medicaid program

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The uptake and processing of applications is going very slow so far.

 
 

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.

  

Roughly 4,300 Missourians eligible for health care under Medicaid expansion have been enrolled, a top Missouri Medicaid official said Thursday….

 
 

Roughly 4,300 Missourians eligible for health care under Medicaid expansion have been enrolled, a top Missouri Medicaid official said Thursday.

That figure represents a little over a quarter of the more than 17,000 applications the state has received since it began accepting applications for Medicaid expansion coverage in August, the Centers for Medicare & Medicaid Services said in a news release Monday.

Kirk Mathews, the chief transformation officer within MO HealthNet, Missouri’s Medicaid program, told lawmakers during a Senate Interim Committee on Medicaid Accountability and Taxpayer Protection hearing Thursday that the 4,300 figure was as of two days before that, with pending applications still being evaluated.

Matthews said he did not know how quickly applications would be processed, noting the state has up to 45 days to determine eligibility on applications.

Advocates and attorneys for plaintiffs who sued the state to force it to implement Medicaid expansion have been keeping a close eye on whether applications would begin to be processed starting Oct. 1 as the state said it would.

Despite a Cole County judge’s August ruling that eligible residents must be permitted to enroll, the Department of Social Services said it would need two months to make necessary system updates and train staff.

Applications for coverage under Medicaid expansion that were submitted after July 1 — the date Medicaid expansion was initially slated to go into effect — were denied, kept in a queue and are “being reevaluated for their eligibility determination now,” Matthews said.

A Centers for Medicare & Medicaid Services spokeswoman confirmed Thursday that Missouri began processing applications Oct. 1 and is making eligibility determinations for Medicaid expansion applicants.

A DSS spokeswoman said Thursday that enrollment figures will start to be published in a monthly report that is expected to be released in November.

The state will also be eligible to draw down an estimated $968 million in federal funds for its Medicaid program over the next two years through the American Rescue Plan, according to the news release.

Approximately 275,000 Missourians are eligible for health care under Medicaid expansion. In the weeks leading up to Oct. 1, advocates have been working to help eligible residents sign up.

Under Medicaid expansion, adults aged 19 to 64 are eligible if their household incomes are 138% of the federal poverty guideline or less. That translates to $17,774 a year for a single person or $36,570 for a family of four.

When asked what comes next with Medicaid expansion enrollment, Matthews said the next few months will bring the unknown.

“We don’t know how rapid the take-up will be, where those numbers will settle in,” Matthews said. “But that’s where we are to date.”

 
 

https://www.joplinglobe.com/news/local_news/missouri-has-enrolled-4-300-people-in-expanded-medicaid-program/article_5017acb2-2841-11ec-9e49-3b2e1bd7e64f.html

 
 

 
 

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SD- Current, past S.D. officials say 60% requirement would apply to Medicaid-expansion measures

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A new ballot measure in SD would require a higher approval rate for future ballot measures.

 
 

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.

 
 

 
 

PIERRE, S.D. (KELO) — If South Dakota voters approve Amendment C in the June 7, 2022, primary elections, a 60% majority requirement would be in force for any measures on the ballot in the following November general election that propose to add or raise taxes or would cost state government $10 million or more per year.

So say the South Dakota Secretary of State’s office, which oversees elections, and Marty Jackley, the past state attorney general. The current attorney general, Jason Ravnsborg, hadn’t yet looked at the topic, according to chief of staff Tim Bormann, who referred the question to the secretary of state.

That means, barring some court order stopping it, the 60% requirement would apply to two possible ballot measures that seek to expand Medicaid eligibility in South Dakota.

Chief of staff says Ravnsborg didn’t miss deadline on explanation for ballot measure

The measures, one sponsored by Rick Weiland and Dakotans for Health, and the other from Laurie Jensen Wunder and a coalition of organizations in South Dakotans Decide, are currently circulating for signatures from registered voters. They need to be submitted by 5 p.m. CT November 8, 2021, to Secretary of State Steve Barnett for determination if one or both qualify for the 2022 ballot.

To make the ballot, a proposed constitutional amendment needs at least 33,921 valid signatures. The Legislature can’t change a constitutional amendment that voters pass. Lawmakers however can — and have — changed or repealed initiated measures that voters have passed that become state laws, such as IM 22 in 2016.

Regarding Amendment C, Jason Lutz, the deputy secretary of state, pointed to South Dakota law that says each constitutional amendment, initiated measure, or referred law that is approved by a majority of all votes cast is effective on the first day of July after the completion of the official canvass by the State Canvassing Board.

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“You’ll note that if Amendment C is approved by the voters in the June primary election, (the law) would set its effective date as July 1, 2022, thus being in effect for potential measures appearing on the November general election ballot,” Lutz said.

Jackley, who served 10 years as state attorney general after four years as U.S. attorney for South Dakota, reached a similar conclusion.

“Legally and practically it would apply to ballot measures on the 2022 general election ballot, at least until a judge would say otherwise in a likely challenge,” Jackley told KELOLAND News. 

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“If Amendment C wins approval by the South Dakota voters in the June 2022 primary election, the election results will be certified approximately 14 days later and become effective law 90 days after the certification sometime in September 2020,” Jackley continued. “Therefore, at the time of the November 2020 election Amendment C would be effective and in the South Dakota Constitution.”

Typically, ballot measures in South Dakota have been voted on in the November general elections or in special elections. It’s unusual to have a constitutional amendment on the June ballot, in part because sometimes there haven’t been statewide primary contests, and voter turnout has always been less than for a general election. A change to Marsy’s Law however was on the 2018 June ballot.

Amendment C found its way to the ballot through Republicans in the Legislature. Representative Jon Hansen brought the original version that called for it to be on the November 2022 ballot. Senator Lee Schoenbeck amended it to put it on the June 2022 ballot.

South Dakota voters rejected an attempt in 2018 to raise the requirement to 55% for passage of any constitutional amendment or revision. That result was 140,730 yes and 167,362 no.

Weiland’s group is campaigning against Amendment C, calling it “A ‘Crackdown’ on Democracy.” Americans For Prosperity recently sent a “Protect Your Money” postcard to households supporting Amendment C Nathan Sanderson from the South Dakota Retailers Association also supported it at a Senate committee hearing. The coalition in South Dakotans Decide so far hasn’t publicly taken a position.

 
 

Clipped from: https://www.keloland.com/news/capitol-news-bureau/current-past-s-d-officials-say-60-requirement-would-apply-to-medicaid-expansion-measures/

 
 

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Democrats Eye Time Limit on Medicaid Expansion in Quest for Cuts

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The proposed fallback plan to force expansion on non-expansion states is starting to be trimmed back in cost negotiations.

 
 

 
 

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.

 
 

Congressional Democrats from Republican strongholds say they expect legislation to create a federal Medicaid program for many of their states to be limited to as few as three years.

The battle now, they say, is getting funding for the program for as many years as possible.

“Right now it’s pretty clear it won’t be made permanent,” Sen. Tammy Baldwin (D-Wis.) said in a hallway interview.

Democrats Hold Tight to Obamacare, Medicaid in Funding Wish List

 
 

Photo: Kevin Dietsch/Getty Images

House Majority Whip Jim Clyburn (D-S.C.) speaks on Medicaid expansion and the reconciliation package during a press conference at the U.S. Capitol on Sept. 23, 2021. He was joined by Democratic Sens. Tammy Baldwin (Wis.), Raphael Warnock (Ga.), Jon Ossoff (Ga.), Elizabeth Warren (Mass.), and Rep. Carolyn Bourdeaux (Ga.).

Democrats are debating how to shrink a once-$3.5 trillion domestic spending agenda that has so far included creating a permanent federally run Medicaid program to cover Americans in states that haven’t grown their public health insurance programs under the Affordable Care Act.

A House committee approved a bill earlier this month that would immediately give no-cost insurance through the ACA marketplace to people in non-Medicaid expansion states under a certain income level, then transition them starting in 2025 to a new, federal Medicaid-like program.

Democrats’ Expansion of Medicaid in Hold-Out States Clears Panel

That plan, coupled with provisions to lower ACA premiums overall, could cost as much as $300 billion, House leaders have said. With moderates in both the House and Senate pushing to lower the price tag of the domestic spending bill, supporters of the so-called “Medicaid gap” fix say party leaders have signaled they’ll have to accept cuts.

Two senior Democratic aides, one of from the House and another from the Senate, said to cut costs the new Medicaid program could be shortened to as few as three years. However, both cautioned that Democratic leaders haven’t settled on the overall size of the package so it’s unclear what changes, if any, will be needed.

‘Big Deal’

Democrats from states such as Texas — where more than 1 million people could benefit from the proposed federal program for those who make too much money to qualify for Medicaid and too little to benefit from ACA subsidies — said they’re willing to compromise as long as their constituents get quality, no-cost health insurance coverage.

“It’s a really big deal for us and I know it’s a big number associated with it,” Rep. Colin Allred (D-Texas) said. “Any time the overall number gets adjusted you know it’s the big ticket items are going to get adjusted first.”

Baldwin said she’s working with her colleagues to get funding for as many years of Medicaid expansion as possible.

“We’re fighting for as long as we can,” Baldwin said

Others say the health care items in their domestic policy package don’t have to shrink if the party stays united.

“We have no shortage of potential revenue sources for Medicaid or any other policy we are seeking to enact in Build Back Better, only a question of the political will to move forward,” Rep. Lloyd Doggett (D-Texas) said.

House Backing

However, Doggett acknowledges that the policy has much more support in the House, where there are dozens of Democrats from non-expansion states, than the Senate, where there are only three: Baldwin and Sens. Jon Ossoff and Raphael Warnock of Georgia. Non-expansion states have little to gain from this policy.

“There’s much more stronger support here in the House for closing the Medicaid gap than there is in the Senate,” Doggett said.

That dynamic is partly why House Democrats have been pushing hard to make the issue about equity and helping the poorest Americans. Lawmakers say policies like expanding Medicare’s benefits are also pricey but aren’t focused on those most in need of government assistance.

“I’ve been pushing to target the resources to the needy,” said Rep. Jim Clyburn (D-S.C.), who also represents a state that hasn’t expanded its Medicaid program.

To contact the reporter on this story: Alex Ruoff in Washington at aruoff@bgov.com

 
 

 
 

Clipped from: https://about.bgov.com/news/democrats-eye-time-limit-on-medicaid-expansion-in-quest-for-cuts/

 
 

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MS- Fact check: Medicaid chief disputes expansion study

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The Medicaid Director is not making any friends by pointing out that 2/3rds of potential expansion enrollees already have insurance coverage.

 
 

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.

 
 

Drew Snyder, the executive director of the Mississippi Division of Medicaid, said that based on a study conducted by University Research Center economists, most of the people who would gain health care coverage if Mississippi expands Medicaid already have coverage.

Referring to the study conducted by State Economist Corey Miller and Senior Economist Sondra Collins, Snyder recently said, “What really jumped out to me was that 65% (of the people who would be covered under Medicaid expansion) already had some form of insurance… What it looked to be was this was primarily not providing individuals with a new affordable coverage, but shifting insurance coverage for people already covered.”

The report, as Snyder correctly pointed out, does conclude that a significant majority of the people who would sign up for Medicaid expansion if the state provided it already have health care coverage. Gov. Tate Reeves and others have argued that enacting Medicaid expansion would allow people to drop private coverage they are at least partially paying for and enroll in a program — Medicaid expansion — paid by the federal and state governments. But the study pointed out nuances.

The study estimates that 233,489 people would be added to the Medicaid rolls if the state expands Medicaid as is allowed under federal law.

Of those 233,489:

  • 82,204 would be people who currently have no insurance.
  • 11,623 would be people with employer-based coverage.
  • 28,910 would be people with private insurance through the federal Healthcare Exchange where they currently receive federal subsides to help pay for the coverage.
  • 110,752 would be people currently covered by the state Medicaid program.

But Snyder did not mention the fact that if the state had Medicaid expansion like 38 other states and the District of Columbia, those 110,752 could be diverted from the current Medicaid program, where the state must pay a greater share of the match than the state would if the people were covered through Medicaid expansion.

Put simply, under Medicaid expansion, the state would be paying less for the health care for those 100,000-plus.

Mississippi has the best matching rate for its traditional Medicaid program with the federal government paying 84.5% of the costs during the COVID-19 pandemic. But the federal matching rate for those covered through Medicaid expansion is 90%.

READ MORE: State economist refutes politicians’ claim that Mississippi cannot afford Medicaid expansion

There are currently about 780,000 people covered by Medicaid in Mississippi. Those people include the disabled, poor pregnant women, poor children and a segment of the elderly population. Most healthy adults who are not pregnant cannot garner coverage through the current program except for in certain caregivers of those on the Medicaid program living in extreme poverty.

Under Medicaid expansion, coverage is provided to those making up to 138% of the federal poverty level or $17,774 annually for an individual.

The study estimated that the total state population that would be eligible to enroll in any potential Medicaid expansion is 330,000, though a significant number of that group would not enroll in the Medicaid expansion program.

Reeves, who opposes Medicaid expansion, and others have argued that more people would sign up for Medicaid expansion than projected in many studies. During his successful 2019 gubernatorial campaign, he also said that in neighboring Louisiana when that state began Medicaid expansion, many people with insurance through other means dropped that coverage and enrolled in Medicaid expansion.

The study by the Mississippi Institutions of Higher Learning University Research Center surmises that Medicaid expansion would produce an average of 11,000 jobs per year between 2022 and 2027 and provide an additional $44 million per year for the state general fund.

The positive results, the study concludes, are the result of several factors, including the economic boost from the infusion of the federal money into the state, the savings from moving certain groups from the traditional Medicaid program to the expansion program and from other incentives provided by the federal government to expand Medicaid.

Snyder questioned the validity of the study.

“We recognize these are big decisions,” Snyder recently told legislative leaders of the possibility of expanding Medicaid. “…This is not a free or add-on to the state. It will cost money. The question now comes is this the money we want to spend.”

After making his comments, Snyder conceded he is not an economist.

Snyder first was appointed as executive director of the Medicaid Division by former Gov. Phil Bryant and re-appointed by Reeves. Both Reeves and Bryant have been adamant opponents of Medicaid expansion.

 

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MO- 275K Missourians Eligible for Coverage Following Medicaid Expansion

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The expansion category is now active, but there still have been no state funds appropriated to cover the additional enrollment or the additional state staff work needed to implement.

 
 

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 more than a year of pushback and legal barriers, individuals in Missouri can now apply for coverage under the state’s Medicaid expansion amendment.

 
 

Source: Getty Images

 
 

By Victoria Bailey

October 05, 2021 – Following Missouri’s approval for Medicaid expansion, more than 275,000 individuals are eligible for healthcare coverage, CMS reported.

Missouri will receive around $968 million from the American Rescue Plan over the next two years to fund the expansion. In order to encourage Medicaid expansion, the American Rescue Plan offers states a five percent increase to their original federal matching rate for services for two years.

States that enroll in Medicaid expansion also receive 90 percent matching funds for medical services through the Affordable Care Act.

“Hundreds of thousands of Missourians can now gain the peace of mind of having health coverage through Medicaid,” HHS Secretary Xavier Becerra stated in the press release. “This is a win for all Missourians who have fought long and hard to gain their rightful access to quality health insurance made possible through the Affordable Care Act.”

Missouri’s Medicaid program, MO HealthNet, started accepting applications for Medicaid expansion coverage in August 2021. Since then, more than 17,000 individuals have applied. The expansion offers coverage for primary and preventive care, substance use disorder treatment, prescription drugs, and emergency services, the press release noted.

Medicaid coverage is now available to even more low-income individuals in Missouri. An individual who makes up to around $17,000 per year or a four-person family that makes up to $36,750 per year may qualify for MO HealthNet following the expansion.

So far, 38 states—including Missouri and the District of Columbia—have passed Medicaid expansion, contributing to the more than 80 million individuals who receive healthcare coverage from Medicaid and the Children’s Health Insurance Program (CHIP).

Twelve states have yet to expand their Medicaid programs.

“As we celebrate Missouri’s Medicaid expansion, the Biden-Harris Administration will double down on our outreach efforts to urge the remaining twelve states to join the rest of the nation in ensuring access to health care during this critical time,” Becerra added.

States that have expanded their Medicaid programs have seen reduced uninsurance rates and lower state Medicaid spending, according to a report from the Menges Group.

Missouri first passed its Medicaid expansion amendment in August 2020, during the COVID-19 pandemic. The expansion guidelines offered coverage to individuals between ages 19 and 65 whose income is up to 138 percent of the federal poverty level.

Those who supported the amendment said that expansion would help Missourians who did not have employer-sponsored health plans and it would reduce high healthcare spending by offering better preventive care access to low-income residents.

Opponents, including Missouri’s state treasurer Scott Fitzpatrick, said the expansion was not financially feasible, especially with the financial strain of the pandemic.

Despite two lawsuits against it, the state passed the amendment. The expansion was set to go into effect on July 1, 2021, but another court ruling put enactment on hold in June 2021.

MO HealthNet withdrew the amendment, citing that the initiative petition was unconstitutional and could not require the General Assembly to provide funds for its operation.

The Medicaid program indicated that the state did not have the funds to pay for the expansion and the General Assembly did not budget for the funding, leading MO Healthnet to withdraw the plan. The circuit court sided with the state.

However, the Missouri Supreme Court overturned the ruling, sending the case back to the Cole County Circuit Court.

On August 10, 2021, the court ordered that the state could resume Medicaid expansion. Missouri’s governor Mike Parson included funding to cover the additional healthcare costs for newly eligible enrollees in his FY 22 budget proposal, but the funds were not included in the final budget.

MO HealthNet will have to leverage existing employees and funds to assist with applications, the governor’s press release noted.

 
 

Clipped from: https://healthpayerintelligence.com/news/275k-missourians-eligible-for-coverage-following-medicaid-expansion
 

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Agonizing choices as Dems debate shrinking health care pie

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Dems in the House and Senate have different priorities and they are in conflict as choices must be made about whether to focus on Medicaid or Medicare.

 
 

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.

 
 

 
 

FILE – In this image from video, Majority Whip Rep. Jim Clyburn, D-S.C., speaks from Charleston, S.C., during the first night of the Democratic National Convention on Monday, Aug. 17, 2020. Democrats are debating how to divide up what could be a smaller serving of health care spending in President Joe Biden’s domestic policy bill, pitting the needs of older adults who can’t afford their dentures against the plight of uninsured low-income people in the South. “There’s always a battle of where you place your priorities,” Clyburn, said Wednesday, Spet. 29, 2021. (Democratic National Convention via AP)

WASHINGTON (AP) — Democrats are debating how to divide up what could be a smaller serving of health care spending in President Joe Biden’s domestic policy bill, pitting the needs of older adults who can’t afford their dentures against the plight of uninsured low-income people in the South.

“There’s always a battle of where you place your priorities,” Rep. Jim Clyburn, the No. 3 House Democratic leader, said Wednesday. “We don’t means-test Medicare, which means that pretty wealthy people will be getting both dental care (and) vision care while poor people will be denied. … I don’t know that that’s a real good choice.”

Clyburn explained that more than 100,000 of his fellow South Carolinians remain uninsured because Republicans in charge of state government have refused to expand Medicaid to low-income working adults under the Affordable Care Act.

Health care is foundational to Biden’s $3.5 trillion domestic policy bill, which touches everything from taxes to climate change, child care to community college.

When budget screws get applied, entire proposals can disappear from legislative wish lists, or they can get authorized for a shortened time period, a fiscal tactic akin to wading in the water as opposed to swimming.

For now, nothing has been dropped from Democrats’ health care agenda, which includes new dental, vision and hearing coverage under Medicare, richer subsidies that reduce premiums for “Obamacare” plans, a federal work-around to expand Medicaid in a dozen states still refusing, improved post-partum Medicaid coverage for low-income women, and a permanent extension of the popular Children’s Health Insurance Program.

The health care upgrades amount to a major renovation of federal programs covering more than 145 million Americans and part of the Democratic political legacy.

“The health care elements are the tip of the spear, the most important, the most popular, and the most politically salient, and we simply have to get that done,” said Brad Woodhouse, executive director of Protect Our Care. The advocacy group, which is urging Democrats to go big, sponsored a teleconference with lawmakers Wednesday.

The plan has been to pay for health care improvements with savings reaped by authorizing Medicare to negotiate prices for the costliest prescription drugs. But there’s a dilemma. Just as with the overall price tag for the legislation, Democrats have disagreements over Medicare negotiations. A Senate bill still in the works may not go as far as the measure pending in the House.

And there’s another element to factor in: Biden is pushing for a major expansion of home-based long-term care services under Medicaid, an alternative to institutional placement in nursing homes.

Tensions are simmering between Senate Budget Chairman Bernie Sanders and some House Democrats. The Vermont independent is pushing hard to keep expanded Medicare benefits for dental, vision and hearing care at the front of the line, but Democratic veterans in the House who labored to pass and preserve the Obama-era health law see improving it as unfinished business that is their calling to complete.

Under the umbrella of the Obama law, closing the so-called Medicaid coverage gap has become a rallying cry for Black and Latino lawmakers, as well as for advocates for the poor. Some 2 million people in states refusing the health law’s Medicaid expansion make too much to qualify for Medicaid and too little to be eligible for HealthCare.gov plans. Three out of 5 are Black or Hispanic. Texas and Florida, states Democrats would like to flip, could see the biggest gains in coverage if the federal government steps in.

The intraparty political dynamics differ from the House to the Senate. While many House Democrats represent districts that would benefit from closing the Medicaid coverage gap, only three Democratic senators come from states that have not already expanded their programs. They are Sens. Tammy Baldwin of Wisconsin and Georgians Raphael Warnock and Jon Ossoff. They represent a sliver of the Democratic caucus in the Senate, but also the edge that gives Democrats control of the evenly divided chamber. Warnock, who faces reelection next year, has made closing the Medicaid gap his signature issue.

Advocates are worried that lawmakers will pare back the Medicaid fix to save money and apply it only for a brief period of several years, leaving it to a future Congress to make the change permanent.

“If the policy isn’t permanent, it’s important that it extend long enough to get the federal Medicaid program up and running,” said Judy Solomon of the Center on Budget and Policy Priorities, a nonprofit that advocates on behalf of low-income people. Medicaid is one of the most complex government programs and splicing in a new federal component for a limited number of states could be a time-consuming process.

For now, Democrats are hoping they don’t have to slice and dice their health care ambitions to fit new budget constraints.

“Obviously negotiations are ongoing,” said Rep. Lauren Underwood, D-Ill. “I’m sure that these critical health care topics have come up in discussion. I think that what we know for sure is that you can’t ‘build back better’ without protecting folks’ health care and lowering out-of-pocket costs, period.”

 
 

Clipped from: https://apnews.com/article/joe-biden-business-health-medicaid-medicare-1dda9033a7c4475ae82f679b7d964d72

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Oregon Health Authority Wants Millions From Feds For Equity Spending

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The state has submitted a waiver to address SDH, and is asking for a shared-savings component from CMS.

 
 

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 Health Authority officials plan to ask the federal government for millions in funding that will allow communities to determine their unique needs and priorities related to health equity, as part of their next Medicaid application. 

 Potential areas of investment include workforce needs, green spaces or programs to help people obtain housing, but could vary after community input.

The Medicaid application, called a waiver, reflects the authority’s overall goal to make health care equitable for all Oregonians by 2030. As part of that focus, the state wants to address social determinants that can influence a person’s overall health, such as their access to housing, food and social programs.

To accomplish those goals, Oregon hopes the federal government will recognize the state’s efforts to rein-in growth of its health care costs. Oregon officials will ask federal Centers for Medicare & Medicaid Services to calculate the federal government’s estimated savings due to Oregon’s 2019 law that caps the per capita growth of health care at 3.4% annually. 

At this point, it’s unclear how much money that may generate for Oregon. State and federal officials would need to negotiate those terms. However, Oregon officials project $16 billion in state, federal and private savings during the next six years due to the state’s Sustainable Health Care Cost Growth Target Program, which started due to the passage of Senate Bill 889 in 2019.

“Oregon plans to ask the federal government to share those savings back with us so that the state can invest it into communities affected by health inequities,” the concept paper says, though the potential negotiated amount is unknown.

Lori Coyner, the authority’s senior Medicaid policy advisor, said: “We plan to ask for shared savings from the federal government to further invest in addressing health equity, but the exact amount has not been determined. We anticipate a significant ask, but it would not run into the billions of dollars.”

That’s a key piece of the concepts behind Oregon’s Medicaid waiver application, which is essentially a five-year plan. The waiver application process lets states seek flexibility from the federal government for how they tailor Medicaid. To succeed, Oregon’s waiver application must  win approval from the Centers for Medicare & Medicaid Services before its current waiver expires on June 30, 2022.

The waiver system establishes health care policy for the more than 30% of Oregonians who are covered by Medicaid, or about 1.4 million people. Oregon’s past Medicaid waiver applications have led to substantial changes. In 2012, Oregon’s waiver allowed the state to set up coordinated care organizations.

Oregon Health Authority officials plan to send the application to federal officials in early 2022. That’s a little later than the state’s earlier target of December. But it’s still enough time for state and federal officials to negotiate the details. 

In early November, the state will release its final concept papers and accept more public input. The authority released draft concepts earlier this year.

The state will release a more detailed draft application in December and accept feedback for a 30-day comment period before sending the document to the federal government.

“While this new timeline is slightly delayed from our original ambitious plan, it reflects the reality of incorporating the important feedback we’ve received so far, as well as our commitment to ensuring non-waiver feedback is routed to right programs for consideration,” Jeremy Vandehey, Health Policy and Analytics director, and Coyner, the senior Medicaid policy advisor, wrote in an email about the timeline. 

Coordinated care organizations, which contract with Oregon as Medicaid insurers, are part of the plan. Oregon officials want CCOs to have more flexibility to spend money on equity-related health measures that may not necessarily be direct health care a patient receives in a clinic or hospital. This means that CCOs would be able to spend 3% of their global budgets on equity-related items. Currently, CCOs have less flexibility and can only spend on those items out of administrative budgets.

“The goal is to give CCOs the ability to continue meeting members’ needs around social determinants of health,” Coyner said in an interview, adding that community voice and input would be key. 

That means there would be a lead entity from the community and a strong community input in the process, Coyner said.

 “Those could be things like building green space for folks to have access to outdoors,” Coyner said. “It could be developing clinics or some kind of social programs that happen right in the community.”

There are limits to the funding, however. While housing support programs could be one option, the health authority will not build new housing complexes. 

If more funding comes Oregon’s way through the waiver, it will be awhile before Oregon communities will see it. Most likely, that wouldn’t happen until at least 2023. 

It could also require changes to CCO contracts, a separate process that would spell out the funding process.

Other preliminary concepts in the waiver application include increasing the number of Oregonians with health insurance, which is currently about 94% and boosting access to care. 

You can reach Ben Botkin at ben@thelundreport.org or via Twitter @BenBotkin1.

Clipped from: https://www.thelundreport.org/content/oregon-health-authority-wants-millions-feds-equity-spending

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CMS Investing $15M in Medicaid Mobile Health Crisis Intervention

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CMS is seeding innovations in how first responders can deliver on-scene behavioral health crisis 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.

 
 

The rescue plan funds will be used by state Medicaid programs and community health groups to develop mobile health intervention services for people experiencing a behavioral health or opioid use disorder crisis.

 
 

Source: Getty Images

 
 

By Eric Wicklund

September 21, 2021 – Federal authorities are awarding $15 million in rescue plan funding to 20 states to help expand mobile health intervention services for Medicaid patients in crisis.

The planning grants, administered through the Centers for Medicare & Medicaid Services, will help state Medicaid agencies and community health organizations develop emergency intervention services for people experiencing a mental health or substance abuse disorder crisis. This may include the use of mHealth apps or telehealth services to connect those in crisis to a behavioral health specialist or other care provider.

“With these grants, CMS is taking strides to connect individuals in crisis with the high-quality, expert care they need. Providing behavioral health care experts as alternatives to police is an example of how we can better help communities deliver on the behavioral health needs of all its residents,” CMS Administrator Chiquita Brooks-LaSure said in a press release.

Programs like this are designed to connect people to healthcare providers during an emergency, rather than using police intervention or transports to a jail or hospital. In some instances police and EMS units are provided with tablets or apps to connect with care providers at the scene for a virtual consult, while other programs create multi-disciplinary teams capable of responding in person or via connected health channels.

The interventions are designed to not only take pressure off of police to deal with mental health emergencies, but to improve access to care and speed up treatment for people in crisis.

The funding will be used to develop and launch Medicaid-based 24-hour community-based mobile crisis intervention services, offering training and technical assistance.

States receiving the grants are Alabama, California, Colorado, Delaware, Kentucky, Massachusetts, Maryland, Maine, Missouri, Montana, North Carolina, New Mexico, Nevada, Oklahoma, Oregon, Pennsylvania, Utah, Vermont, Wisconsin and West Virginia.

Officials say all states should be eligible for a temporarily enhanced matching rate for implementing a qualified community-based mobile crisis intervention option in the Medicaid programs by April 2022.

Clipped from: https://mhealthintelligence.com/news/cms-investing-15m-in-medicaid-mobile-health-crisis-intervention

 
 

 
 

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OIG: Most states not doing enough to monitor Medicaid telehealth fraud for behavioral health services

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The report implies that states have very little idea about what is going on with their telehealth programs.

 
 

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.

 
 

 
 

A new survey of 37 states found that three didn’t know which Medicaid behavioral health services are offered via telehealth compared to in person, an Office of Inspector General report found.

Many states don’t monitor for telehealth fraud and fail to evaluate how telehealth has impacted patient access and care, a Department of Health and Human Services watchdog found.

The agency’s Office of Inspector General (OIG) released a report Tuesday that explored how states are evaluating the use of telehealth to treat behavioral health in Medicaid. While states have increasingly turned to telehealth during the COVID-19 pandemic, OIG found that a few don’t even know what services are offered virtually.

“As the nation confronts the psychological and emotional impact of COVID-19, the use of telehealth will be important in addressing behavioral health needs for Medicaid enrollees,” the report said.

Telehealth can be used to cover several behavioral health services such as mental health assessments and therapy. This reliance has increased since the pandemic that caused patients to stay home for fear of contracting the virus.

But the report finds states still have a way to go if telehealth flexibilities offered by the Centers for Medicare & Medicaid Services become permanent.

OIG spoke with Medicaid directors for 37 states that provide telehealth behavioral services.

RELATED: New House, Senate bills aim to make telehealth expansion permanent in Medicare, Medicaid

The agency found only two states have evaluated the effectiveness of telehealth on access to services for Medicaid enrollees.

One of the states found that 70% of enrollees who used telehealth for behavioral services resided in a rural area and would have to be transported a long distance to get care without it. Another found telehealth increased the types of providers beneficiaries could access such as psychiatrists, psychologists and nurse practitioners that specialize in mental health.

Only one of the 37 states evaluated the impact of telehealth on cost. It found that prior to the pandemic, telehealth generated $8,600 in savings for emergency room care avoidance in one managed care plan and $484,000 in reduced transportation costs for another plan.

OIG also found that three of the 37 states couldn’t say which services are provided to Medicaid beneficiaries via telehealth compared to in person.

“These states cannot do any analysis on the effects of telehealth, nor do they have the ability to perform basic monitoring and oversight specific to telehealth services, which are essential to ensuring the fiscal integrity of the Medicaid program and to protecting Medicaid enrollees,” the report said.

States are already providing a small amount of monitoring and oversight on telehealth. OIG found that 11 out of the 37 states perform monitoring and other actions to combat any fraud or waste in telehealth. But 23 out of the 37 states report fraud is a major concern surrounding telehealth use.

Even though Medicaid is a federal-state joint program, states are responsible for monitoring.

A few states told OIG it is difficult to verify that telehealth services are being provided appropriately.

States need to step up their efforts to evaluate and examine the impact of telehealth on their Medicaid programs, especially as flexibilities that emerged during the pandemic could be made permanent, OIG said.

“Evaluating the effects of telehealth on access, cost and quality of behavioral health services is particularly important in helping states make decisions about how best to use telehealth and about which populations benefit most from these services,” OIG said.

RELATED: Telehealth use drops for 3rd straight month as patients return to in-person appointments

An accompanying data brief from OIG (PDF) also found that states have had major challenges with implementing behavioral telehealth services. The brief looked at state challenges from January through February 2020 before the onset of the pandemic.

“Most states reported multiple challenges with using telehealth, including a lack of training for providers and enrollees, limited internet connectivity for providers and enrollees, difficulties with providers protecting the privacy and security of enrollees’ personal information, and the cost of telehealth infrastructure and interoperability issues for providers,” the brief said.

The findings act as a clarion call to states to prepare for potential permanent expansion of telehealth after the pandemic subsides. States can decide how to apply telehealth in their Medicaid programs.

 
 

Clipped from: https://www.fiercehealthcare.com/payer/oig-most-states-not-doing-enough-to-monitor-medicaid-telehealth-fraud-for-behavioral-health