Feds pitch plan to improve Medicaid transparency, quality of care

The Biden administration on Thursday rolled out proposals to set national standards for care in Medicaid and children’s health care plans, amid upheaval for millions of Americans’ coverage in both programs (Source: “Biden officials propose slate of Medicaid transparency changes,” Stat News, April 27).

A pair of draft rules released by federal health officials Thursday would require Medicaid plans to book enrollees for appointments within two weeks. The rules would also require states to track and report the quality of care patients receive, to share provider payment rates and to oversee these changes through “secret shopper” surveys.

However, while the agency proposed a slew of reporting requirements, the changes did not come with clear penalties or incentives for improving wait time and care.

The draft plans come as states reassess Medicaid and Children’s Health Insurance Program enrollment in the wake of the Covid-19 emergency. Congress allowed states to begin removing people from Medicaid rolls this month, ending a pandemic freeze that saw Medicaid coverage balloon with more than 20 million new enrollees. An estimated 18 million people could lose coverage in the next year, according to a KFF survey of state Medicaid programs.

Enrollment set to begin for new Ohio Medicaid managed care plans

Medicaid enrollees in Ohio can begin selecting from among a new slate of managed care plans beginning next week (Source: “Ohio Medicaid managed care plan enrollment begins Tuesday,” Associated Press, Feb. 28).

As part of the Ohio Medicaid Next Generation initiative, millions of enrollees in the program must choose from seven managed care plans or be assigned one.

The approved plans are: Buckeye Community Health Plan, CareSource, Molina Healthcare, UnitedHealthcare Community Plan, AmeriHealth Caritas, Humana and Anthem Blue Cross and Blue Shield.

Next Generation is scheduled to go live July 1.

States test adding ‘food as medicine’ programs to Medicaid

More states are testing Medicaid programs that’ll provide more people with healthy foods and, potentially, lower health care costs (Source: “Can food cure high medical bills? Pilot 'food as medicine' programs aim to prove just that.” USA Today, Feb. 15). 
Medicaid typically only covers medical expenses, but ArkansasOregon and Massachusetts received approval from the Centers for Medicare & Medicaid Services last year to use a portion of their Medicaid funds to pay for food programs, including medically tailored meals, groceries and produce prescriptions (fruit and vegetable prescriptions or vouchers provided by medical professionals for people with diet-related diseases or food insecurity). The aim is to see whether providing people with nutritious foods can effectively prevent, manage, and treat diet-related diseases.  
study published last fall estimated that if all patients in the U.S. with mobility challenges and diet-related diseases received medically tailored meals, 1.6 million hospitalizations would be avoided, with a net savings of $13.6 billion annually. Another study in 2019 found that over the course of about a year, the meals resulted in 49% fewer inpatient admissions and a 16% cut in health care costs compared with a control group of patients who did not receive the meals. 
This spring, the American Heart Association and the Rockefeller Foundation plan to launch a $250 million “Food is Medicine” Research Initiative to determine if such programs can be developed cost-efficiently enough to merit benefit coverage and reimbursement for patients.

March 31 set for end of Medicaid continuous enrollment, regardless of emergency status

Signing up for Medicaid correctly will once again become an important step for enrollees after a three-year break from paperwork hurdles (Source: “6.8 million expected to lose Medicaid when paperwork hurdles return,” NPR Shots, Jan. 24).

In 2020, the federal government recognized that a pandemic would be a bad time for people to lose access to medical care, so it required states to keep people on Medicaid as long as the country was in a public health emergency. The pandemic continues and so has the public health emergency, most recently renewed on Jan. 11.

But continuous enrollment will end on March 31, no matter what. It was part of the budget bill Congress passed in December 2022. Even if the public health emergency is renewed, states will begin to make people on Medicaid sign up again to renew their coverage. And that means between 5 million and 14 million Americans could lose their Medicaid coverage, according to the Kaiser Family Foundation.

The federal Department of Health and Human Services expects 6.8 million people to lose their coverage even though they are still eligible, based on historical trends looking at paperwork and other administrative hurdles.

In the three pandemic years, the number of Americans on Medicaid and CHIP – the Children's Health Insurance Program – swelled to 90.9 million, an increase of almost 20 million.

Study finds fewer post-partum hospitalizations in Medicaid expansion states

States that expanded Medicaid under the Affordable Care Act (ACA) saw a 17% drop in hospitalizations among women during the first 60 days postpartum, new research shows (Source: “Medicaid expansion linked with fewer postpartum hospitalizations: research,” The Hill, Jan. 11).

According to a study published in the journal Health Affairs, states with expanded Medicaid coverage for residents with lower incomes saw a 17% drop in post-partum hospitalization within the first 60 days.

Expansion states included in the study were Iowa, Maryland, New Mexico and Washington. Rates were compared with non-expansion states Florida, Georgia, Mississippi and Utah.

Currently, 40 states (including Ohio) and Washington D.C., have expanded Medicaid under the ACA. Much of the Southeast region of the country continues to hold out on adoption, along with Texas, Kansas, Wyoming and Wisconsin.

Medicare mulls adding limited dental benefits

Proposed changes in Medicare rules could soon pave the way for a significant expansion in Medicare-covered dental services, while falling short of the comprehensive benefits that many Democratic lawmakers have advocated (Source: “After Congress fails to add dental coverage, Medicare weighs limited benefit expansion,” Kaiser Health News via Ohio Capital Journal, Oct. 18, 2022).

Under current law, Medicare can pay for limited dental care only if it is medically necessary to safely treat another covered medical condition. In July, officials proposed adding conditions that qualify and sought public comment. Any changes could be announced in November and take effect as soon as January.

The review by the Centers for Medicare & Medicaid Services follows an unsuccessful effort by congressional Democrats to pass comprehensive Medicare dental coverage for all beneficiaries, a move that would require changes in federal law. Sen. Bernie Sanders (I-Vt.) sought in vain to add that to the Democrats’ last major piece of legislation, the Inflation Reduction Act, which passed in August. As defeat appeared imminent, consumer and seniors’ advocacy groups along with dozens of lawmakers urged CMS to take independent action.

Congress temporarily extends Medicare programs that boost pay to rural hospitals

Congress has cleared a short-term spending bill that includes extensions of two programs aimed at helping rural hospitals, punting the issue and others into December (Source: “Congress passes short-term spending bill that extends 2 key rural hospital programs,” Fierce Healthcare, Sept. 30). 

The House voted 230 to 201 to advance to President Biden’s desk a continuing resolution that funds the federal government through Dec. 16. Biden is expected to sign the legislation.
The legislation also extends through Dec. 16 the hospital payment adjustment for certain low-volume hospitals (LVH) and the Medicare-Dependent Hospital (MDH) program, which have helped shore up finances for rural hospitals that have been vulnerable to closures in recent years and strained further due to the COVID-19 pandemic. 
Both programs were set to expire after September. 

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.