Medicaid/Medicare

States consider options for end to extra federal Medicaid payments

 

State officials are asking the federal government for more information to help them prepare for an eventual end to increased federal funding from the first COVID-19 relief law this year (Source: “States grapple with plans for end to coronavirus public health emergency,” Roll Call, Dec. 3). 

The health emergency is set to expire Jan. 20 but will almost certainly be extended by the next administration. The question is how states will transition to normal operations.

“The issue and the challenge is that CMS, I am sure, doesn’t want to send states a signal that the public health emergency is ending, given where we are. But on the other hand, states feel like they need some indications of what to do and when to do it,” said Allison Orris, counsel with Manatt Health and a former federal health policy official.

A CMS spokesperson pointed to existing guidance to states saying that the enhanced federal funding for Medicaid — a 6.2 percentage point increase being added to states' Federal Medical Assistance Percentage rates — will stop at the end of the quarter when the public health emergency ends. The spokesperson said it’s too early to speculate on potential status changes for the health emergency, and CMS remains in constant contact with states.


Deadline for Ohio Medicaid managed care bids is today

 

Bids are due today for insurance companies that want to be a part of Ohio Medicaid’s overhaul  (Source: “Insurance company bids due today for Ohio Medicaid overhaul,” Dayton Daily News, Nov. 20).

The state is overhauling how the health insurance program for people who are disabled or have low incomes operates and picking new insurance companies as contractors to manage those insurance claims. By rebidding the contracts, the state can update the conditions for getting and spending Medicaid dollars and can re-select which insurers it trusts to meet its goals.

In 2019, Ohio paid about $17 billion to Medicaid HMOs and about 90% of the 3 million Ohioans who are covered by Medicaid get an insurance plan managed by an insurance company. These insurers get a payment per member per month and use that money to pay for their member’s health care.


Ohio Medicaid facing budget gap

As Medicaid enrollment increases amid the pandemic and recession, declining state revenue and a projected budget shortfall will challenge the $23 billion budget of the federal-state program, Medicaid Director Maureen Corcoran said during a virtual post-election conference (Source: “Ohio Medicaid caseload soars due to COVID-19, but now program faces budget gap of billions,” The Columbus Dispatch, Nov. 6).

Medicaid caseloads have surged during the coronavirus pandemic, topping 3 million this year, up 9%, from last year.

During a discussion on health care and Medicaid during Impact Ohio's post-election conference, Corcoran and representatives of the healthcare industry said the coronavirus has strained the system, but also spurred improvements, such as expanded telehealth services.


Ohio Medicaid enrollment spikes amid pandemic

The number of Ohioans enrolled for Medicaid coverage has increased more than 250,000 since the start of the pandemic, according to new state data (Source: “Ohio Medicaid rolls increase during pandemic,” Dayton Daily News, Oct. 29).

The state- and federally funded insurance program as of September covered 3.05 million Ohioans, with the increase primarily from covered families and children, according to the latest data reported by Ohio Department of Medicaid.

The Medicaid rolls have steadily shrunk for years as the economy improved in Ohio. But amid the disruption of the pandemic and related restrictions, many people have lost income and Ohio’s unemployment rate rose to 8.4% in September.


DeWine announces plan for Medicaid managed care rebidding

Gov. Mike DeWine’s administration has unveiled plans for a long-awaited overhaul of the $28 billion Medicaid health-care program covering more than 3 million Ohioans (Source: “Wellness, quality of health care for poor Ohioans centerpiece of new Medicaid approach,” Columbus Dispatch, Oct. 1).

The Ohio Department of Medicaid seeks to update its managed-care setup with a focus on population health, meeting the needs of children with complex needs and reducing administrative hurdles for patients and health-care providers.

The state invited privately operated managed-care organizations to submit applications for new managed care contracts by Nov. 20. Contracts will be awarded early next year with a new system in place in 2022. About 90% of Medicaid beneficiaries are enrolled in managed care.

Medicaid Director Maureen Corcoran said the plan is largely based on input solicited by the department from beneficiaries, physicians, hospitals and other health care providers, along with managed-care plans over the last 18 months.

The director referred to concerns with the current system which has forced some families with children in need of intensive and costly services, either in their home or residential settings, to relinquish custody so they qualify for Medicaid because they can’t afford the cost on their own.

Under the plan, Ohio Rise, so-called multi-system youth would qualify for modified eligibility requirements, allowing them to receive assistance while remaining in their family’s custody.


Trump administration greenlights Medicare telehealth services in rural areas

The Trump administration is taking steps to give telehealth a broader role under Medicare, with an executive order that serves as a call for Congress to make doctor visits via personal technology a permanent fixture of the program (Source: “Trump wants broader role for telehealth services in Medicare,” Associated Press, Aug. 3).

The order President Donald Trump signed on Monday applies to one segment of Medicare recipients — people living in rural communities. But administration officials said it’s intended as a signal to Congress that Trump is ready to back significant legislation that would permanently open up telehealth as an option for all people with Medicare.

Monday’s executive order will also set in motion an experiment under which hospitals in rural communities could receive a more predictable stream of Medicare payments in exchange for delivering better performance on certain measures of quality.


Ohio Medicaid enrollment spikes due to pandemic, economic downturn

Ohio Medicaid rolls continue to increase, due to the pandemic and economic fallout associated with it (Source: “Ohio Medicaid rolls climbing toward 3 million again,” Cleveland.com, July 28, 2020).

In June, 2.98 million low-income Ohioans were enrolled in Medicaid, up from 2.92 million in May and 2.88 million in April, according to the Ohio Department of Medicaid’s caseload report.

The program tends to get more enrollees as the economy gets worse. Ohio’s strong economy over the past couple of years has resulted in lower numbers of beneficiaries. The last time Ohio Medicaid had 3 million enrollees was January 2018.


HHS to distribute $25b to Medicaid, safety-net providers

The federal Department of Health and Human Services has announced plans to distribute another $25 billion in funding to healthcare providers, with an emphasis on helping facilities that serve low-income patients (Source: “HHS to distribute $25B for Medicaid, safety-net providers,” MedCity News, June 9).

The agency will distribute $15 billion to providers that participate in Medicaid and CHIP programs, and another $10 billion to safety-net hospitals.

The funds are intended to help hundreds of thousands of Medicaid providers that did not receive funding through the general distribution that went out to providers in April and May. For example, community health centers, which provide healthcare services to low-income patients, and speech therapists and physical therapists that primarily serve children with disabilities were not included in the initial distributions of funding.

Safety-net hospitals, which provide a significant proportion of care to uninsured and low-income patients, will be able to receive between $5 million and $50 million. HHS said it plans to distribute the funds to hospitals this week.


Ohio Medicaid rolls increase amid pandemic

With increased joblessness accompanying the coronavirus pandemic, more Ohioans are turning to Medicaid for health coverage (Source: “Ohio Medicaid rolls now increasing, a reverse from the downward trend,” Cleveland.com, May 12, 2020).

About 3 million people are now on Medicaid, Ohio Medicaid Director Maureen Corcoran said Tuesday.

“We had an increase in the number of people by about 140,000 from the end of March until the end of April,” she said.

In July 2017, there were nearly 3.1 million people receiving health care through the joint state and federal program, which targets Ohioans with lower incomes and those with disabilities. Month-by-month since then, the number went down, hitting a low of just over 2.7 million in November 2019.

At the time of the decrease, state officials and social welfare experts had attributed the decrease to an improved economy providing more jobs, a decrease in advertising from the White House under President Donald Trump and problems with Ohio’s benefits system.


CMS relaxes rules, allows telemedicine practice across state lines

The Trump administration has relaxed rules to enable doctors to remotely care for patients across state lines at rural facilities and let nurse practitioners perform more duties as workforce capacity becomes a major concern (Source: “CMS relaxes rules to boost capacity of providers as facilities tackle COVID-19 outbreak,” Fierce Healthcare, April 9, 2020).

The Centers for Medicare & Medicaid Services (CMS) announced a series of rules that will be relaxed for the duration of the public health emergency. The agency is trying to remove regulatory burdens facing providers swamped with treating the COVID-19 outbreak.

“It’s all hands on deck during this crisis,” said CMS Administrator Seema Verma in a statement. “All frontline medical professionals need to be able to work at the highest level they were trained for.”