- Child Care Workers Caught in Middle of Michigan's Broken Child Care System
- Few Options Available for Substance Abuse Treatment in the Big Bend
- Ways and Means Members Put Forth Solutions to Strengthen Telehealth Access and Improve Health Care for Rural Communities
- In Rural Texas, ERs Are Facing a Growing Mental Health Crisis
- Sage Memorial Hospital in Navajo Nation Constructs New Facility to Improve Health Care
- How the State, Tribes and Federal Government Are Working to Curb SD's Syphilis Epidemic
- Rural Children Struggle to Access Hospital Services, Say Researchers
- USDA Rural Development Seeks Input to Improve Access to Grants and Help More Communities Thrive
- Outlining the Intersection between Health Care and Missing and Murdered Indigenous People
- Biden-Harris Administration Announces Critical More Than $1.5 Billion State and Tribal Opioid Response Funding Opportunities
- A Pilot Program in Rural Vermont Hopes to Build a Blueprint for Substance Abuse Recovery
- RPHARM Program Fulfills Need for Rural Pharmacists
- Farmers Don't Do Mental Health
- Rural Telehealth Extension Reintroduced in Congress
- Students From Across the State Emphasized the Need for Mental Health Resources in Rural Alaska During a Conference
You Can Read About the School-Based Services Medicaid Announcement Here!
The Centers for Medicare and Medicaid Services (CMS) has released a comprehensive guide on Medicaid School-Based Services. The guide offers new flexibilities and consolidates existing guidance, making it easier for all schools, no matter their size or the resources available to them, to deliver Medicaid-covered services. The CMCS informational bulletin provides an overview of the new flexibilities that are immediately available regarding school-based Medicaid billing, documentation, and claiming.
State-Based Marketplaces Are Play a Significant Role in Medicaid Unwinding
Nationwide, state-based marketplaces have been partnering with Medicaid agencies to prevent gaps in coverage if consumers no longer qualify for Medicaid. Developing effective communication strategies is key for Medicaid recipients, health center patients, and other vulnerable communities. The PA Department of Human Services (DHS) has worked with Pennie, Pennsylvania’s state-based marketplace, to ensure messaging and outreach strategies align during the Medicaid continuous coverage unwinding period which began April 1. This includes co-branded mailers for those not replying to their renewal packet. Pennie also meets with DHS on a weekly basis to share data, coordinate press tours and update partner toolkits. Other states have created a year-round Special Enrollment Period for individuals with income up to 250% of the Federal Poverty Level. Covered California has implemented a program that automatically enrolls individuals in a marketplace plan when they lose Medicaid coverage, while Pennie has an automated eligibility system that provides individuals losing Medicaid who are account-transferred with an eligibility determination and automatic special enrollment period. However, consumers must claim their account and select a plan to enroll. Since April 1, Pennie’s key focus has been operational activities associated with the unwinding. Thousands of applications have been received for consumers who exceed the income qualifications for Medicaid. Individuals in the initial unwinding group with Medicaid coverage ending at the end of April are now in their 60-day window where they can select a plan and have continuous coverage through retroactive coverage dates to May 1, 2023. The Pennie Community Workgroup meets the second Friday of each month to provide updates, enrollment activity, processes, and procedures specific to the transition of consumers from Medicaid to marketplace coverage.
Pennsylvania Department of Human Services (DHS) Publishes Unwinding Numbers
The DHS Unwinding Renewal Tracker records 1,322,553 individuals listed as the Total Maintained Population during the COVID-19 Public Health Emergency continuous coverage period. This is the total number of individuals who would have been ineligible or did not return a renewal and had their Medicaid coverage maintained between March 2020 and March 2023. The Tracker also breaks down information by zip code, age group, and county. As of April, for the Maintained Population, 77,129 completed renewal packets with 1,245,424 yet to have a renewal completed. Of the 77,129 renewals, 7,908 were closed and 69,221 remained eligible for Medical Assistance. Closures were due to consumers being determined ineligible based on information provided, failure to return documentation, and enrolling in Pennie. For the entire Medicaid population, 3,708,405 recipients were enrolled in Medicaid, 28,366 were newly enrolled and 15,560 were closed, indicating enrollment increased despite closures. The number of individuals who were eligible for Medicaid in the previous month and maintained coverage in the current month was 3,680,039.
Federal Legislators Move Language Requiring 340B Reporting
The House Energy & Commerce Committee also acted on 340B, approving HR 3290, a bill that would impose 340B reporting requirements on disproportionate share hospitals. The bill permits but does not require, the Department of Health and Human Services (HHS) to extend these requirements to other covered entities (CEs), such as FQHCs. The committee also added and approved language requiring CEs who retain 340B savings on Medicaid MCO drugs to report the amount of these savings to HHS. This marks the first time that a Congressional committee has voted to impose 340B reporting requirements on any covered entities. The committee also approved Medicaid-related language that allows states to decide whether CEs can retain 340B savings on drugs reimbursed under Medicaid managed care – at least for in-house pharmacies.
Pennsylvania Governor’s Administration Strengthens Mental Health Parity Review for 2024 Health Plans
Pennsylvania Acting Insurance Commissioner Michael Humphreys announced the Pennsylvania Insurance Department (PID) has strengthened its review of mental health and substance use disorder coverage in 2024 health plans. Insurers under PID regulation must file their plans with the Department for approval. Now, for 2024 filings, PID is enhancing its compliance review of mental health and substance use disorder parity requirements to prevent potential violations before they have a chance to harm Pennsylvania consumers. PID pushed insurers to correct parity issues found during the large group and student health filing review process, resulting in insurers correcting 100% of the issues identified during the front-end product review. Some of the corrections included requiring insurers to remove session limits for rehabilitative and habilitative therapies when prescribed for mental health, and to provide clearer exclusions of cost-sharing or session limits for mental health services. For more information on the mental health and substance use disorder parity, or to file a complaint or ask a question, visit the department’s Bureau of Consumer Services at www.insurance.pa.gov/consumers or call 1-877-881-6388.
CMS: Advancing Health Equity During Pride Month
Throughout June, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) celebrates Pride Month. During this observance CMS OMH highlights the unique health care challenges and barriers faced by members of the Lesbian, Gay, Bisexual, Transgender, Queer and Questioning, Intersex, Asexual, and Two Spirit (LGBTQI+) community.
While members of the LGBTQI+ community share the burden of stigma surrounding their sexual orientation or gender identity and expression, their individual experiences related to health care outcomes vary by race, ethnicity, income, and other characteristics. For example, gay, bisexual, and other men who have sex with men are disproportionately affected by HIV. Compared to heterosexual women, lesbian women experience higher rates of many chronic diseases, including depression, obesity, hypertension, and diabetes. Transgender women have the highest rate of HIV in the US, with the highest prevalence among Black (44%) and Hispanic (26%) transgender women. Social determinants and drivers of health, including stigma and discrimination among other factors, can also influence health conditions.
In addition to these disparities in health outcomes, LGBTQI+ individuals continue to face barriers to accessing care, including an increased likelihood to be uninsured, delay care, not have a usual source of care, and be more concerned about medical bills than non-LGBTQI+ individuals. State and national surveys often lack questions on gender identity and sexual orientation, creating a lack of information and gap in addressing disparities.
Many LGBTQI+ individuals are reluctant to disclose their sexual orientation to health care providers because they fear rude and discriminatory reactions, or due to concern that their personal information could become public. Many patients have found in recent years that telehealth appointments have become a safe and convenient way to access health care, especially for those who live in rural areas or other locations without access to inclusive facilities, providers, and treatments.
During Pride Month, CMS OMH is highlighting how you can help address these barriers and disparities impacting the LGBTQI+ community. Below is a list of resources you can share during Pride Month and beyond to help individuals receive better health care coverage.
Resources
- Take the newly updated Medicare Learning Network training “Improving Health Care Quality for LGBTQ People” to learn how you can make a difference in the health care of LGBTQI+ individuals.
- View the LGBT Partners page to learn more about CMS’s partnerships with national and local organizations helping the LGBTQI+ community receive quality health insurance and health care information.
- Download the Office of the Assistant Secretary for Planning and Education’s Health Insurance Coverage and Access to Care for LGBTQ+ Individuals: Recent Trends and Key Challenges issue brief, which discusses demographic characteristics of the LGBTQI+ community, recent trends in insurance coverage for this population, and various challenges and barriers to care faced by the broader community.
- Review Telehealth.gov’s Telehealth for LGBTQ+ Patients resource for providers to learn how telehealth can support LGBTQI+ patients.
- Visit the Substance Abuse and Mental Health Service Administration’s Center of Excellence on LGBTQ+ Behavioral Health Equity, which provides behavioral health professionals with information on supporting LGBTQI+ populations.
- Download and share the HIV/AIDS Disparities in Medicare Fee-For-Service Beneficiaries data snapshot for an overview of HIV/AIDS prevalence among Medicare fee-for-service enrollees as well as various resources.
- Share the Coverage to Care (C2C) Enrollment Toolkit and Adult Preventive Services Flyer to help patients learn how to make the most of their health coverage. Use the C2C Roadmap to Behavioral Health to help LGBTQI+ individuals understand how to use their coverage to improve their physical and mental health.
- Check out the interactive Lesbian, Gay, Bisexual, and Transgender Health Workgroup website to track the progress of objectives related to LGBTQI+ health.
- Learn more about Healthy People 2030’s goal to increase the number of national surveys that collect data on lesbian, gay, and bisexual populations.
Explore the U.S. Department of Health and Human Services Office for Civil Rights Protecting the Rights of Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex (LGBTQI+) People webpage, which can help LGBTQIA2S+ individuals understand their rights and gather information about gender affirming care.
New Report Released on Dangers of Oral Health Home Remedies
The CareQuest Institute for Oral Health released a new visual report, “Dental Danger: Home Remedies to Avoid When Awaiting Care.” More than half of adults in the United States do not have consistent access to dental care and may resort to home remedies, which are not always safe. Unsafe home remedies include tobacco, pain medication prescribed for another purpose, illegal narcotics, a needle to lance a gum abscess, aspirin powder applied to the gums, and alcohol.
HRSA Comment Period: Make the Case for Oral Health
The Health Resources and Services Administration (HRSA) has proposed transitioning the oral health national performance measure (NPM) to a state performance measure (SPM). Oral health has been an NPM since 1997. If oral health is transitioned to an SPM, it will no longer be a national priority, and efforts to promote oral health care at the national, state, and local levels will suffer.
Send your comments by e-mail to paperwork@hrsa.gov or by mail to Health Resources and Services Administration, Information Collection Clearance Officer, 5600 Fishers Lane, Room 14N39, Rockville, MD 20857. In your communication, state that you are commenting on “Title V Maternal and Child Health Services Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report, OMB No. 0915–0172—Revision.”
The deadline to submit comments is July 5th.