Issue #138

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Medicaid Eligibility Redetermination

• According to an analysis completed by KFF, more than 600,000 people have lost Medicaid coverage since April 1. Of these individuals, four out of every five were removed from Medicaid rolls for procedural reasons, such as not completing paperwork. Of the 14 states that provided detailed disenrollment numbers, five states listed removal of coverage for procedural reasons for 40% of beneficiaries or more. Legislators, stakeholders, and advocates are concerned about the number of people losing coverage and are asking for some states to pause or alter their process. Over the next year, approximately 15 million people are expected to lose Medicaid coverage. Many of those will be able to get coverage on the ACA exchanges or through employer-sponsored coverage, but millions of others, including children, are expected to become uninsured and lose access to prescriptions and/or preventative care (KFF Health News, June 1).

CMS Reorganization

• CMS is establishing a new group titled the Managed Care Group (MCG) to provide accountability and oversight for Medicaid managed care access; oversee managed care 1115 waivers; and address various responsibilities related to policy and development, technical assistance, and oversight of managed care programs. The development of the CMS MCG follows the Notice of Proposed Rulemaking (NPRM) that was announced this spring which aims to improve access and accountability within managed care. The MCG will lead reviews of state contracts and amendments with managed care organizations and other associated groups to ensure compliance with statutory and regulatory requirements. The MCG will also handle Medicaid access and accountability policy for all managed care programs and will include all populations under managed care including dual eligibles and beneficiaries needing long-term services and supports (LTSS) (Inside Health Policy, June 2).

Debt Ceiling Deal

• The Debt Ceiling deal between House Republicans and the White House suspends the federal government’s borrowing limit until after the next presidential election until January 1, 2025, as well as caps non-defense federal funding at $704 billion for the next two years. The deal spared most health programs from deep cuts. The main health-related concession in the deal is the recission of approximately $27 billion in funding appropriated for covid-related programs with the biggest claw back being the $10 billion from the Public Health and Social Services Emergency Fund. The deal would also limit FDA funding by providing the agency with $6.6 billion even though the Biden administration originally asked for $7.2 billion (KFF Health News, June 1; Inside Health Policy, June 2).

News

• A group of conservative physicians are challenging the sex nondiscrimination rules for providers receiving federal funding arguing that the Affordable Care Act (ACA) does not prohibit discrimination against LGBT patients in all circumstances. The group is asking the U.S. Circuit Court of Appeals of the Fifth Circuit to determine whether the ACA protections against sex discrimination also provide protections based on sexual orientation and gender identity. The group is concerned about providing gender-affirming care which goes against their ethical beliefs (Inside Health Policy, May 31).
• The Biden administration plans to pick Dr. Mandy Cohen, the former health secretary for North Carolina, to lead the Centers for Disease Control and Prevention (CDC). Cohen would succeed Dr. Rochelle Walensky who is stepping down at the end of June (Wall Street Journal, June 1).
• Calls to create a “National Patient Safety Board” modeled after the National Transportation Safety Board (NTSB) are being made to improve patient safety in healthcare. Two measures are currently being considered to establish a safety council: a bill filed in the House in December 2022 expected to be refiled in the current House session; and, a presidential advisory council proposal to create a safety council by executive order. Current efforts to create a safety council stem from ongoing reviews of medical records which indicate patients continue to experience harm due to preventable errors. Information about safety concerns at specific facilities remains difficult to obtain, highlighting the need for improved accountability. While patient safety advocates support the creation of a board, opposition from the hospital industry and financial limitations pose challenges to implementation (KFF Health News, June 5).

Federal Studies and Reports

• According to the May 2023 National Hospital Flash Report released by Kaufman, Hall and Associates, LLC., hospital finances broke even in April even with increases in charity care, high expenses, and the unwinding of the Medicaid continuous coverage requirement. However, the impacts of the unwinding could soon be appearing in hospital data. According to the report, hospitals’ median operating margins were 0% in April, which slightly increased from -0.3% in March. Inpatient and outpatient visits decreased, and emergency department visits were the least impacted overall. As redeterminations continue over the next year, hospitals might be required to adjust to the post-COVID “new normal”, operating with lower patient volumes and higher expenses (Inside Health Policy, June 2).

SPAs

• Eligibility SPAs
  • Alabama (AL-23-0002, effective January 1, 2023): Authorizes changes to the eligibility rules for the Former Foster Care Children eligibility group, as enacted by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, Pub. L. No 115-217, section 1002.
  • Connecticut (CT-23-0009, effective January 1, 2023): Authorizes changes to the eligibility rules for the Former Foster Care Children eligibility group, as enacted by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, Pub. L. No 115-217, section 1002.
  • Massachusetts (MA-22-0026, effective January 1, 2023): Authorizes the state to adopt certain income disregards for eligibility determinations for the Medicare Savings Program (MSP) groups.
• Payment SPAs
  • Arizona (AZ-22-0014, effective October 1, 2022): Authorizes the Arizona disproportionate share hospital (DSH) pool 1, 2, 1A, 2A, and 4 payments, for the DSH state plan rate year ending 2023.
  • New Hampshire (NH-22-0044, effective July 1, 2022): Renews and updates the state’s critical access hospital inpatient supplemental payments for the state fiscal year ending June 30, 2023.
• Reimbursement SPAs
  • Oregon (OR-23-0008; effective March 7, 2023): Authorizes reimbursement for clotting factor payments for patients from specialty pharmacies within the state.
• Services SPAs
  • South Dakota (SD-23-0008, effective July 1, 2023): Provides for 12 months of extended postpartum coverage to individuals who were eligible and enrolled under the Medicaid state plan during their pregnancies (including during a period of retroactive eligibility).
  • Kansas (KS-23-0014, effective May 3, 2023): Removes the requirement for a motor vehicle screen from the provider qualifications for Consultative Clinical and Therapeutic Services and Intensive Individual Support.

News

• As Medicaid eligibility redeterminations continue, states have turned to technology vendors for assistance outreaching to and communicating with impacted beneficiaries. More than 600,000 people in 11 states have lost coverage already, many for procedural reasons. Arizona, Maryland, and Massachusetts are some of the states that have opted for technological solutions in their redeterminations processes. Arizona has implemented a web-based chatbot that is able to answer 30 frequently asked questions, with live agents supplementing the automated system this summer. Additionally, Socially Determined, a healthcare analytics firm, offers a tool for Medicaid insurers to create enrollee lists that help them identify who is most at risk for losing coverage. Gainwell Technologies is another option for states, offering a mobile digital platform for Medicaid agencies that helps beneficiaries. This platform features digital ID cards, ad hoc forms to complete and submit to the state agency, multilanguage options, electronic messages, and provider data. To date, Arkansas and Nevada use this app, with Delaware, New York, and California implementing it for dental coverage recipients. By utilizing technology, states and managed care organizations (MCOs) can ensure messaging is the same across all media and other platforms (Modern Healthcare, June 5).
• A health care worker minimum wage bill, SB 525, is on its way to the California Assembly after passing in the Senate. The proposal has gone through many rounds of modifications and has an $8 billion price tag that hospitals and lawmakers fear may cause some hospitals and other facilities to close. Last week, the bill was amended to postpone the pay bump and increase it more slowly, to $21 per-hour in June 2024 and $25 per-hour in June 2025. The changes also included lowering the minimums for salaried employees and decreasing yearly wage increases after 2025 (POLITICO Pro, May 31).
• New Mexico Department of Human Services (DHS), the state Medicaid agency, will extend the Medicaid managed care contracts with its three current MCOs for an additional six months- through June 2024. The contracts were set to expire at the end of the year. DHS has yet to issue a new RFP for MCOs to deliver Medicaid services to nearly 1 million of the state’s residents (Albuquerque Journal, June 5).
• Both chambers of the Texas Legislature in late May voted to extend Medicaid postpartum coverage to 12 months. The bill now heads to Governor Greg Abbott (R) for signature (MSN, May 28).
• Over the past year, North Carolina and South Dakota both voted to expand Medicaid under the ACA. As eligibility redeterminations are taking place, hundreds of thousands of states’ residents will lose their Medicaid coverage before the expansion takes place. This means that some individuals would have to wait months to receive coverage under the expansion (Health Payer Specialist, June 5).
• Arkansas has passed a law that will allow physician assistants (PAs) to enroll as a rendering provider through Medicaid. This law attempts to increase the number of PAs at primary care facilities, reducing the workload on supervising physicians and streamlining the employment process. Supporters of the law cited the rural healthcare workforce shortage and hope that this policy alleviates that burden (Becker’s ASC Review, June 1).
• Horizon Blue Cross Blue Shield of New Jersey has made a $600 million payment to the state as a part of its reorganization to a nonprofit mutual holding company. Governor Phil Murphy has proposed using the Horizon money to improve the affordability and accessibility of health insurance coverage among underserved individuals and communities in the state. An appellate court ruled in favor of keeping the reorganization in place despite legal challenges from New Jersey Citizen Action. However, Citizen Action has stated that it is “reviewing all possible legal actions” moving forward (POLITICO Pro, June 1).