Medicaid/Medicare

Uninsured rate for children dropped during pandemic, federal data shows

The rate of children without health insurance declined during the COVID-19 pandemic, likely the result of a provision passed by Congress that barred states from dropping anyone from Medicaid during the public health emergency (Source: “More Children Have Gained Health Insurance During Pandemic,” Pew Stateline, Sept. 21).

According to an analysis of new U.S. Census Bureau data by Georgetown University’s Center for Children and Families, the child uninsurance rate in 2021 was 5.4%, compared with 5.7% in 2019, the year before the pandemic took hold.

The center described that change as a “small but significant decline,” equating to 200,000 more children with health insurance in 2021 than in 2019. Overall, about 4.2 million children were uninsured in 2021, according to the analysis.

The data comes from the Census Bureau’s American Community Survey, which provides annual estimates of income, education, employment, health insurance coverage and housing costs and conditions for U.S. residents. The Census Bureau did not release standard results in 2020 because of difficulties in data collection in the pandemic’s first year.

The Georgetown analysis speculated that the downward trend in child uninsurance was the result of Congress’s provision in the Families First Coronavirus Response Act, passed in March 2020, that prohibited states from involuntarily dropping anyone from Medicaid, the health plan covering lower-income Americans.


CMS proposes rule change to simplify Medicaid, CHIP enrollment

A proposed federal rule change was introduced last week that aims to make the Children’s Health Insurance Program (CHIP) and Medicaid enrollment easier (Source: “Proposed CMS rule would streamline Medicaid, CHIP enrollment,” Healthcare Dive, Sept. 1).

The Centers for Medicare and Medicaid Services on Aug. 31 issued a proposed rule with the goal of reducing coverage gaps by streamlining the application and renewal process for Medicaid enrollees and other programs such as CHIP by limiting renewals to once a year, establishing standardized statewide renewal processes and giving applicants 30 days to respond to information requests.

The proposed rule comes as states begin to notify Medicaid beneficiaries about potential losses of coverage due to the impending end of the COVID-19 public health emergency.

Earlier this year, HPIO released an Ohio Medicaid Basics update, Trends in Enrollment and Expenditures During the COVID-19 Pandemic, that provides information on enrollment and spending changes to the Ohio Medicaid program during the pandemic.


CMS approves Ohio Medicaid coverage extension for new moms

Federal officials have approved Ohio Medicaid’s plan to extend benefits for new mothers from 60 days to 12 months after the birth of their child (Source: “Ohio Medicaid extends postpartum coverage for new mothers,” Dayton Daily News, Aug. 17).

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare and Medicaid Services (CMS), on Tuesday approved the state’s request to extend the coverage.

“Maternal health is a strong predictor of a child’s health, so by extending health coverage for new moms, we are helping to provide the healthiest possible start in life for Ohio’s children,” said Gov. Mike DeWine.

The American Rescue Plan Act (ARPA) provided the option for states to expand this Medicaid coverage for new moms from 60 days to 12 months. The state of Ohio’s budget included this expanded coverage in its portion of Medicaid funding. DeWine said the state of Ohio began this extended coverage on April 1 and CMS’s final approval is the last step to continuing those services.


Report finds flawed Medicare data inhibits analysis of health disparities

Inaccuracies in Medicare's race and ethnicity data have hurt the program’s ability to assess health disparities, a new federal report found (Source: “Flawed Medicare data hampering analysis of health disparities, inspector general says,” Becker’s Payer Issues, June 15).

According to a report from the HHS Office of the Inspector General, Medicare's enrollment data is inconsistent with federal data collection standards, and the inconsistencies "inhibit the work of identifying and improving health disparities within the Medicare population,"

By comparing Medicare data to other federal sources, the report found that Medicare's race and ethnicity data is less accurate for certain groups, particularly for beneficiaries who identified as American Indian/Alaska Native, Asian/Pacific Islander or Hispanic. 

The report includes recommendations that CMS develop its own source of race and ethnicity data, use self-reported race and ethnicity information to improve data for current beneficiaries, develop a process to ensure that the data is as standardized as possible and educate beneficiaries about CMS efforts to improve the race and ethnicity information.


Ohio House approves Medicaid coverage of doulas in attempt to address racial disparities

A bill that is aiming to combat racial disparities in infant and maternal mortality rates passed the Ohio House during a session Wednesday (Source: “Doula services could soon be covered by Medicaid after racial equity bill passes Ohio House,” Ohio Capital Journal, June 9).

House Bill 142 would provide Medicaid coverage for licensed doula services.

Between 2008 and 2017, Black women died during birth about two and a half times more than white women, according to the Ohio Department of Health. Black women also have twice the amount of birth complications, which ODH data show cannot be attributed to factors such as the pregnant person’s income, education, marital status, tobacco/ alcohol use and insurance coverage.

Doulas “can save lives,” said Dorian Wingard, partner and COO of Restoring Our Own Through Transformation (ROOTT), an organization dedicated to addressing the needs of women of color. “They can prevent the death of mothers, they can prevent the death of children.”

Doula services can also result in lower rates of preterm births, as well as help save money for families, according to Wingard.

Republican state Rep. Tom Brinkman, one of the bill’s sponsors, said he convinced his fellow Republicans to vote for the bill by explaining that it could allow Ohio to save money, since doula services lead to fewer preterm births, which are expensive for the state.

“The hardest thing was to talk to my colleagues and say, ‘look, we are going to expand Medicaid, which we don’t necessarily want to do because we’re trying to restrain costs, but what it’s going to do is result in overall savings because we won’t be paying for [as many complications],” Brinkman said.


Graphic of the week

MedicaidBasicsUpdate2022_Fig5_Standalone

HPIO analysis of Ohio Medicaid data has found that the state share of spending on the Medicaid program has risen at a slower rate than the federal share over the past decade (see graphic above).

Since SFY 2011, total Medicaid spending in Ohio (including state and federal funding) has increased about 80% from $17.6 billion in SFY 2011 to $31.7 billion in SFY 2021. During that time, the federal share of Ohio Medicaid spending grew by 87%, while the state share grew by 63%.
 
The graphic is included in HPIO's fact sheet that was released in April, “Ohio Medicaid Basics Update: Trends in Enrollment and Expenditures During the COVID-19 Pandemic.”


Policy experts call for better Medicaid data collection to address health inequity

A team of healthcare policy experts is calling for an overhaul of the ways in which Medicaid data is collected and analyzed to address health equity issues (Source: “Health Policy Experts: Medicaid Data Processes Must Be Improved to Achieve Equity,” Heathcare Innovation, May 25).

Writing in Health Affairs, the researchers say that “the COVID-19 pandemic has highlighted and exacerbated health care inequities in the United States. Calls to address health care disparities have intensified, and the Biden Administration has made equity a central component of its policy agenda. The confluence of these social and political forces has reinvigorated discussion about how to address health care inequities in public insurance programs, and refocused attention on Medicaid — which now covers more than 86 million Americans — as a lever for advancing health equity.”

The authors point to the 2021 decision by the Center for Medicare and Medicaid Innovation (CMMI) to explicitly add health care equity as one of its five core objectives. CMMI also specifically prioritized initiatives to improve care and outcomes for vulnerable and underserved populations in Medicaid.

“These efforts depend, however, on the ability to measure disparities in access to care, quality of care, and health outcomes by race and ethnicity,” the authors wrote. “Due to lack of high-quality data, it remains impossible to fully evaluate the state of health equity in the Medicaid program.”


Graphic of the week

MedicaidBasics_COVIDUpdate_Fig2_StandAlone
HPIO analysis of Ohio Medicaid data has found that Medicaid enrollment increased by more than 580,000 enrollees between March 2020 (the beginning of the COVID-19 pandemic) and March 2022, an increase of about 20.5%.

As indicated in the graphic above, Medicaid enrollment grew most significantly between April 2020 and August 2020. This is likely because unemployment was highest during the early months of the pandemic, when an economic recession occurred. Since August 2020, growth in Ohio Medicaid enrollment has stabilized, averaging 0.6% growth per month.

The graphic is included in HPIO's fact sheet that was released last month, “Ohio Medicaid Basics Update: Trends in Enrollment and Expenditures During the COVID-19 Pandemic.”


400k Ohioans may lose Medicaid benefits this summer, report estimates

Hundreds of thousands of Ohioans may lose Medicaid coverage this summer when the federal government's COVID-19 emergency declaration ends, according to a new national report (Source: “More than 400,000 Ohioans at risk of losing Medicaid coverage this summer as COVID emergency ends,” Cincinnati Enquirer, April 19).

Around 3.3 million Ohioans were enrolled in Medicaid this fiscal year as of February, an increase from around 2.8 million from 2020. Under the declaration, Ohio and other states were unable to take people off Medicaid, even if they become ineligible. A new Commonwealth Fund report estimates that as many as 400,000 Ohioans could lose their coverage at the conclusion of the public health emergency.

Last week, HPIO released a new fact sheet, “Ohio Medicaid Basics Update: Trends in Enrollment and Expenditures During the COVID-19 Pandemic,” which details enrollment and spending trends in Ohio Medicaid due to the COVID-19 pandemic.

HPIO is also hosting a free online forum May 3, titled “What’s on the Horizon for Ohio’s Medicaid Program? Innovation, Equity and Unwinding the Public Health Emergency.”


New HPIO fact sheet explores Medicaid enrollment, spending trends during pandemic

The Health Policy Institute of Ohio has released a new fact sheet, “Ohio Medicaid Basics Update: Trends in Enrollment and Expenditures During the COVID-19 Pandemic.”
 
Since the COVID-19 pandemic began in March 2020, enrollment in, spending on and federal funding for Ohio Medicaid have increased significantly. Drawing from the foundational information provided in HPIO’s Ohio Medicaid Basics 2021 policy brief, this fact sheet provides information on:

  • Changes to the Medicaid program due to the COVID-19 pandemic
  • Enrollment changes during the COVID-19 pandemic
  • Ohio Medicaid spending during the COVID-19 pandemic

“Ohio policymakers must be agile in their response to new challenges facing Medicaid enrollees as the COVID-19 pandemic continues, including the end of the (public health emergency) and potential loss of Medicaid eligibility for tens of thousands of Ohioans,” the fact sheet concludes. “State policymakers and other stakeholders must also balance the benefits of the Medicaid program with budgetary and administrative challenges to improve health, achieve equity and promote sustainable healthcare spending in Ohio.”