Issue #137

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Debt Ceiling Deal

• House Republicans and the White House reached a compromise on the debt ceiling package where the Biden administration was successful in keeping out Medicaid work requirements from the deal. However, the deal would recover $28 billion in unallocated COVID-19 funding and make agencies offset the cost of discretionary rules that cost more than $1 billion over ten years. The deal would also provide an additional $604 million in funding for HHS’s Health Care Fraud and Abuse Control (Inside Health Policy, May 29).

FDA Approves Paxlovid

• After almost two years of emergency use, Pfizer’s COVID-19 treatment, Paxlovid, has been given full approval by the Food and Drug Administration (FDA). Approximately 11 million prescriptions for Paxlovid have been dispensed since late 2021, and the FDA’s decision now allows the drug to remain available permanently. Full FDA approval was only given for adults with COVID-19 who are older or are at high risks of severe disease, like diabetes, asthma, and obesity that may lead to hospitalization or death. For children ages 12-17, Paxlovid remains available under a separate emergency authorization. Paxlovid is the fourth COVID-19 drug that received approval, and the first that is in pill form (AP News, May 25).

News

• The Substance Abuse and Mental Health Services Administration (SAMHSA) has identified crisis hotlines, mobile crisis units, and crisis stabilization services as the three core crisis services that should be available to those in need of behavioral health support. However, a recent analysis conducted by the Kaiser Family Foundation (KFF) with survey data from 44 states and DC, found that 33 states do not cover all three core crisis services in their Medicaid programs. KFF found that 41 states (including DC) cover at least one core crisis service; 12 states (including DC) cover all three core crisis services; 18 states cover two; and, 11 states cover one. With 33 states covering it, mobile crisis units is the most commonly covered service (MedCity News, May 26).

Federal Studies and Reports

• According to a new KFF survey published May 24, approximately 65% of surveyed individuals were not aware that states could start removing individuals from their Medicaid rolls this year. KFF surveyed more than 3,600 insured adults in February and March 2023, including more than 1,200 adults with Medicaid coverage. Additional highlights of the survey include the following:
  • About 50% of adults currently enrolled in Medicaid have never participated in a renewal process.
  • One-third of Medicaid enrollees had not provided contact information to the state Medicaid agency in the past year, meaning they might be procedurally disenrolled because of the state’s inability to reach them.
  • Should their Medicaid coverage be terminated, 27% of Medicaid enrollees said they would not know where to look to obtain other health insurance coverage, 15% said they would go without insurance coverage, and only 33% said they would look for coverage on the Affordable Care Act marketplaces (MSN, May 25).
• On May 24, the Congressional Budget Office (CBO) published an estimate of the insurance rates for most adults in the country. According to their estimate, the country’s uninsurance rate is expected to hit a record low of 8.3% but is expected to climb to 10.1% by 2033. Additionally, CBO projects 6.2 million people will become uninsured due to the restart of Medicaid redeterminations along with 1.6 million people expected to enroll in individual coverage and the rest expected to have employer sponsored benefits. The agency is predicting that 61.1 million people will remain covered by Medicaid at the completion of the Medicaid redetermination process. The CBO also expects enrollment in the ACA marketplace to increase through 2025 and then drop in 2026 after the Inflation Reduction Act’s increased tax credits expire. (Inside Health Policy, May 24).

Waivers

• 1915(c) Appendix K
  • California
    • Uses funds from section 9817 of the American Rescue Plan (ARP) Act for one-time payments to help alleviate financial strain and hardships suffered by California’s HCBS direct care workforce during the COVID-19 PHE and expands access to providers and incentivize retention of current California’s existing HCBS direct care workforce. These one-time payments will be given to providers delivering services under the Home and Community-Based Alternatives (HCBA), Assisted Living, Medi-Cal Waiver Program (MCWP), and the Multipurpose Senior Services Program (MSSP) waivers. Payments will begin processing on September 1, 2023.
  • New Hampshire
    • Seeks to improve the Home- and Community-Based Services (HCBS) system strained from the pandemic by providing for directed payments to providers delivering services under the Choices for Independence Waiver for Elderly and Chronically Ill to fund recruitment, retention and training payments to new and existing HCBS Direct Services Workers (DSWs) and their immediate supervisors beginning May 10, 2023.
  • Pennsylvania
    • Extends previously approved Appendix K flexibilities for the Consolidated, Community Living, Person/Family Directed Support (P/FDS), and Adult Autism waivers until six months after the end of the public health emergency (PHE).

SPAs

• COVID-19 SPAs
  • Guam (GU-23-0002, effective March 11, 2021): Adds mandatory coverage of COVID-19 vaccine and administration, testing, and treatment benefits as required by Section 9811 of the American Rescue Plan Act.
  • Massachusetts (MA-22-0025, effective March 11, 2021): Adds mandatory coverage of COVID-19 vaccine and administration, testing, and treatment benefits as required by Section 9811 of the American Rescue Plan Act.
  • Massachusetts (MA-23-0026, effective March 18, 2020): Disregards income that would have otherwise been counted for purposes of determining Medicaid eligibility. This time-limited COVID-19 SPA terminated at the end of the PHE.
  • Pennsylvania (PA-23-0011, effective May 12, 2023): Temporarily extends the Alternative Payment Methodology (APM) to pay Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) for COVID-19 vaccine administration.
  • Wyoming (WY-22-0005, effective March 11, 2021): Adds mandatory coverage of COVID-19 vaccine and administration, testing, and treatment benefits as required by Section 9811 of the American Rescue Plan Act.
• Eligibility SPAs
  • Puerto Rico (PR-23-0001, effective January 1, 2023): Verifies the state’s Aid to Families with Dependent Children (AFDC) income standards and local poverty level for the Medicaid program.
• Services SPAs
  • Colorado (CO-23-0001, effective July 1, 2023): Adds the populations served by the following 1915(c) HCBS waivers as target groups for Targeted Case Management: Brain Injury (BI), Children’s Home and Community Based Services (CHCBS), Children with Life Limiting Illness (CLLI) Complementary and Integrative Health (CIH), Community Mental Health Supports (CMHS), and Elderly, Blind, and Disabled (EBD).
  • Colorado (CO-23-0001-A, effective July 1, 2023): Adds a target group for children with developmental disabilities receiving services through the Early Intervention program for Targeted Case Management.
  • Massachusetts (MA-23-0003, effective January 1, 2023): Updates the coverage language for certain non-prescription drugs on the state’s pharmacy coverage pages.
  • Texas (TX-22-0023, effective September 1, 2022): Expands the settings an ambulance provider may transport a beneficiary to and from a nursing facility or hospital to any appropriate setting.

News

• Arkansas continues discussions with CMS about their unwinding efforts after having dropped over 72,800 Medicaid beneficiaries from coverage since April. Arkansas was one of the first states to begin redeterminations and announced in April that they had disenrolled over 54,300 people because they could not be located, did not submit timely renewal forms, or did not answer requests for more information. While states are responsible for determining Medicaid coverage for their residents, CMS continues to work closely with states to ensure that people remain covered (Inside Health Policy, May 30).
• Starting June 1, thousands of South Carolina residents may lose Medicaid coverage due to the post-pandemic unwinding process. The South Carolina Department of Health and Human Services anticipates close to 300,000 members being disenrolled by next year. Due to these large numbers, some lawmakers have revived the consideration of Medicaid expansion in the state. Without Medicaid expansion, many South Carolina residents will have to contend with limited eligibility criteria once the disenrollment process ends (Yahoo News, May 30).
• Since April 1, Arizona has decreased its Medicaid/CHIP enrollment by 56,000 beneficiaries. The state has the second highest number of disenrollments, after Arkansas, since the continuous coverage requirement ended on April 1. However, Medicaid advocates have noted that the state has a much better system for its redetermination process than other states as only one-third of the redeterminations have resulted in coverage termination. In comparison, Arkansas and Idaho have disenrollment rates of 52% and 60% respectively (Inside Health Policy, May 25).
• A study conducted by the Center for Budget and Policy Priorities from November 2019 found that the lack of Medicaid expansion in Mississippi has attributed to the premature deaths of 540 of the state’s residents between 55-64 years of age over a four-year period. The study further notes that over 19,000 lives have been saved in states that have expanded Medicaid. Today, Mississippi is one of ten states that has not expanded Medicaid (Mississippi Today, May 28).