In March 2020, the Centers for Medicare & Medicaid Services (CMS) temporarily waived certain Medicaid and Children’s Health Insurance Program (CHIP) requirements and conditions as a result of the COVID-19 pandemic. The easing of these requirements was referred to as the ‘Medicaid Continuous Enrollment Condition,’ and it helped prevent people with Medicaid and CHIP from losing their health coverage during the pandemic.

The Medicaid Continuous Enrollment Condition ended on March 31, 2023, and states are now returning to regular operations, including restarting full Medicaid and CHIP eligibility renewals and terminations of coverage for individuals who are no longer eligible. Some states began terminating Medicaid enrollment for individuals no longer eligible as of April 1, 2023. On February 24, 2023, CMS posted the anticipated state timelines for initiating unwinding-related renewals on the Unwinding and Returning to Regular Operations after COVID-19 webpage.

NEW MEDICAID AND CHIP RESOURCES FOR PARTNERS

CMS has developed a variety of tools and materials for partners to help ensure that people enrolled in Medicaid and CHIP know what steps to complete regardless of where they are in the Medicaid and CHIP renewal process. All of these resources can be found on the recently updated Medicaid.gov/Unwinding webpage. These resources will help CMS partners educate Medicaid and CHIP enrollees on steps they need to take and when.

• Medicaid and CHIP Eligibility Renewals Communications Toolkit: The Unwinding Communications Toolkit has been updated with new materials for Phase II, including social media posts and graphics, a drop-in article, a Partner Tip Sheet, and factsheets on different coverage options.
• Unwinding Toolkit Supporting Materials: This zip folder contains downloadable versions of the materials featured in the Toolkit, including social media graphics, flyers, postcards, the Tip Sheet, and more.
• Medicaid and CHIP Renewals Webpage: A webpage designed for people enrolled in Medicaid and CHIP to help them prepare to renew their coverage. The page includes an interactive map with each state Medicaid office’s website and other contact information.
• Unwinding Speaking Request Form: Submit a request to have someone from HHS or CMS speak about Medicaid Unwinding at an upcoming event.

The complete Medicaid and CHIP Eligibility Renewals Communications Toolkit is available in Spanish, and select materials are available in five additional languages, which include:

• Chinese
• Hindi
• Korean
• Tagalog
• Vietnamese

All flyers, cards, and other handouts in the Medicaid Unwinding Toolkit Supporting Materials zip folder are available in Spanish. Select materials have also been translated to Chinese, Hindi, Korean, Tagalog, and Vietnamese. These materials include:

• Phase I Medicaid Unwinding Non-fillable Flyer
• Phase II Medicaid Unwinding Factsheet
• Phase II Post Card

The information on the Medicaid and CHIP Renewals page is also now available in Spanish.

UPDATES TO HEALTHCARE.GOV (MARKETPLACE INSURANCE)

The HealthCare.gov homepage was recently updated to highlight information for those who may be losing Medicaid or CHIP. Consumers can find information about health insurance coverage options and see if they qualify for a Special Enrollment Period (SEP).

Information has also been added to CuidadoDeSalud.gov.

UPCOMING PARTNER WEBINARS

HHS and CMS continue to host a series of monthly webinars on Medicaid and CHIP Continuous Enrollment Unwinding to educate partners. Topics covered during the webinar vary each month. Webinars take place the fourth Wednesday of each month from 12:00pm – 1:00pm ET. Register for upcoming webinars here.

Recordings, transcripts, and slides from past webinars can be found on the CMS National Stakeholder Calls webpage

During May, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) recognizes National Asian American, Native Hawaiian, and Pacific Islander (AANHPI) Heritage Month.

Throughout this month, and the entire year, CMS OMH is working to highlight disparities for Asian Americans, Native Hawaiian, and Pacific Islanders who account for more than 7% of the U.S. population, with Asian Americans being the fastest-growing race group in the United States. Between 2017 and 2019, the population of Asian Americans enrolled in Medicare grew by 11%, which was the highest percentage increase in enrollment compared to White, Black, and Hispanic enrollees.

However, nearly one-third of Asian Americans have limited English proficiency. CMS OMH’s Coverage to Care (C2C) initiative is working to close health literacy gaps and eliminate barriers to health care by helping AANHPI enrollees understand their health coverage and connect to primary care and preventive services. C2C resources are available in multiple languages—including Chinese, Korean, and Vietnamese— to help individuals make informed decisions and become active partners in their health care and the health care of their families.

As the number of AANHPI Medicare enrollees grows, we are working to ensure these populations can effectively access the health care they need through policy and equity initiatives. Throughout the month of May, CMS OMH encourages you to share the below resources with the Asian American, Native Hawaiian, and Pacific Islander populations you serve.

Resources:

• Review the Understanding the Health Needs of Diverse Groups of Asian and Native Hawaiian or Other Pacific Islander Medicare Beneficiaries data highlight, which includes data on self-rated general health status, days with activity limitations, prevalence of depression and obesity, and sleep health in AANHPI populations.
• Download the C2C Roadmap to Better Care, which explains what health coverage is and how to use it to get primary care and preventive services. The Roadmap to Behavioral Health, which highlights mental health and substance use services is also available for download. Both resources are available in 9 languages, including Chinese, Korean, and Vietnamese.
• Share the C2C Enrollment Toolkit designed to support community partners, assisters, and others who help consumers enroll in health insurance coverage or change their health plan.
• View the Asian American, Native Hawaiians, & Pacific Islanders Fact Sheet, which includes population data and trends in this population’s health insurance coverage.
• Read the Medicare & You handbook in Chinese, Korean, and Vietnamese.

Visit the Substance Abuse and Mental Health Services Administration’s Asian American, Native Hawaiian, and Pacific Islander webpage to find behavioral health resources specific to these populations.

Sandra Lane said she has been to the emergency room about eight times this year. The 62-year-old has had multiple falls, struggled with balance and tremors, and experienced severe swelling in her legs free.

A paramedic recently arrived at her doorstep again, but this time it wasn’t for an emergency. Jason Frye was there for a home visit as part of a new community paramedicine program.

Frye showed up in an SUV, not an ambulance. He carried a large black medical bag into Lane’s mobile home, which is on the eastern edge of the city, across from open fields and train tracks that snake between the region’s massive open-pit coal mines. Lane sat in an armchair as Frye took her blood pressure, measured her pulse, and hooked her up to a heart-monitoring machine.

“What matters to you in terms of health, goals?” Frye said.

Lane said she wants to become healthy enough to work, garden, and ride her motorcycle again.

Frye, a 44-year-old Navy veteran and former oil field worker, promised to help Lane sign up for physical therapy and offered to find an anti-slip grab bar for her shower.

Community paramedicine allows paramedics to use their skills outside of emergency settings. The goal is to help patients access care, maintain or improve their health, and reduce their dependence on costly ambulance rides and ER visits.

Read more.

Newly proposed standards and requirements would better ensure access to care, accountability, and transparency for Medicaid or CHIP services, including home and community-based services. 

The Centers for Medicare & Medicaid Services (CMS) unveiled two notices of proposed rulemaking (NPRMs), Ensuring Access to Medicaid Services (Access NPRM) and Managed Care Access, Finance, and Quality (Managed Care NPRM), that together would further strengthen access to and quality of care across Medicaid and the Children’s Health Insurance Program (CHIP), the nation’s largest health coverage programs. These rules build on Medicaid’s already strong foundation as an essential program for millions of families and individuals, especially children, pregnant people, older adults, and people with disabilities.

If adopted as proposed, the rules would establish historic national standards for access to care regardless of whether that care is provided through managed care plans or directly by states through fee-for-service (FFS). Specifically, they would establish access standards through Medicaid or CHIP managed care plans, as well as transparency for Medicaid payment rates to providers, including hourly rates and compensation for certain home care and other direct care workers. The rules would also establish other access standards for transparency and accountability, and empower beneficiary choice.

“The Biden-Harris Administration has made clear where we stand: we believe all Americans deserve the peace of mind that having health care coverage brings,” said HHS Secretary Xavier Becerra. “We are proposing important actions to remove barriers to care, engage consumers, and improve access to services for all children and families enrolled in these critical programs. One in four Americans and over half of all children in the country are enrolled in Medicaid or CHIP – and the Biden-Harris Administration is committed to protecting and strengthening these programs for future generations.”

“Having health care coverage is fundamental to reducing health disparities, but it must go hand-in-hand with timely access to services. Connecting those priorities lies at the heart of these proposed rules,” said CMS Administrator Chiquita Brooks-LaSure. “With the provisions we’ve outlined, we’re poised to bring Medicaid or CHIP coverage and access together in unprecedented ways – a key priority that’s long overdue for eligible program participants who still face barriers connecting to care.”

Covering nearly one in four Americans and over half of all children in the country, Medicaid is the single largest health coverage program in the U.S. Medicaid and CHIP provide robust benefits with little to no out-of-pocket costs for over 92 million people. Many of those enrolled in Medicaid or CHIP come from underserved communities whose populations have disproportionately higher uninsured rates, and who often experience chronic health issues. Over 70 percent of people with Medicaid or CHIP coverage are enrolled in managed care plans. Ensuring families and individuals can find an in-network provider and access health care coverage in a timely way is a foundational principle of health equity, and a critical priority for the Biden-Harris Administration.

Together, the Access NPRM and Managed Care NPRM include new and updated proposed requirements for states and managed care plans that would establish tangible, consistent access standards, and a consistent way to transparently review and assess Medicaid payment rates across states. The rule also proposes standards to allow enrollees to easily compare plans based on quality and access to providers through the state’s website. Other highlights from the proposed rules include:

• Establishing national maximum standards for certain appointment wait times for Medicaid or CHIP managed care enrollees, and stronger state monitoring and reporting requirements related to access and network adequacy for Medicaid or CHIP managed care plans, which now cover the majority of Medicaid or CHIP beneficiaries.
• Requiring states to conduct independent secret shopper surveys of Medicaid or CHIP managed care plans to verify compliance with appointment wait time standards and to identify where provider directories are inaccurate.
• Creating new payment transparency requirements for states by requiring disclosure of provider payment rates in both fee-for-service and managed care, with the goal of greater insight into how Medicaid payment levels affect access to care.
• Establishing additional transparency and interested party engagement requirements for setting Medicaid payment rates for home and community-based services (HCBS), as well as a requirement that at least 80 percent of Medicaid payments for personal care, homemaker, and home health aide services be spent on compensation for direct care workers (as opposed to administrative overhead or profit).
• Creating timeliness-of-access measures for HCBS and strengthening necessary safeguards to ensure beneficiary health and welfare as well as promote health equity.
• Strengthening how states use state Medical Care Advisory Committees, through which stakeholders provide guidance to state Medicaid agencies about health and medical care services, to ensure all states are using these committees optimally to realize a more effective and efficient Medicaid program that is informed by the experiences of Medicaid beneficiaries, their caretakers, and other interested parties.
• Requiring states to conduct enrollee experience surveys in Medicaid managed care annually for each managed care plan to gather input directly from enrollees.
• Establishing a framework for states to implement a Medicaid or CHIP quality rating system, a “one-stop-shop” for enrollees to compare Medicaid or CHIP managed care plans based on quality of care, access to providers, covered benefits and drugs, cost, and other plan performance indicators.

For fact sheets about the Ensuring Access to Medicaid Services NPRM, please see:

Summary of CMS’s Access-Related Notices of Proposed  Rulemaking: https://www.cms.gov/newsroom/fact-sheets/summary-cmss-access-related-notices-proposed-rulemaking-ensuring-access-medicaid-services-cms-2442-p

Summary of Medicaid and CHIP Payment-Related Provisions: https://www.cms.gov/newsroom/fact-sheets/summary-medicaid-and-chip-payment-related-provisions-ensuring-access-medicaid-services-cms-2442-p

Summary of Key Home and Community-Based Services (HCBS) Provisions: https://www.cms.gov/newsroom/fact-sheets/ensuring-access-medicaid-services-cms-2442-p-notice-proposed-rulemaking

Summary of the Medical Care Advisory Committee and Beneficiary Advisory Group Provisions: https://www.cms.gov/newsroom/fact-sheets/ensuring-access-medicaid-services-cms-2442-p-notice-proposed-rulemaking

For a fact sheet about the Medicaid or Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality NPRM, please see:

https://www.cms.gov/newsroom/fact-sheets/notice-proposed-rulemaking-medicaid-and-childrens-health-insurance-program-chip-managed-care-access

Both NPRMs can be downloaded from the Federal Register at https://www.federalregister.gov/public-inspection.

CMS looks forward to receiving feedback on both during the public comment period, which ends July 3, 2023.

U.S. Department of Agriculture (USDA) Rural Development Under Secretary Xochitl Torres Small announced that USDA is inviting applications for grants to strengthen rural cooperatives and expand access to new and better markets for people in rural America.

USDA is making the $5.8 million in grants available under the Rural Cooperative Development Grant (RCDG) program to start, improve or expand rural cooperatives and other mutually owned businesses that will help
improve economic conditions in rural areas.

Nonprofit organizations and institutions of higher education are eligible to apply for grants to provide technical and cooperative development assistance to individuals and rural businesses.

The maximum award is $200,000. Grants are awarded on a competitive basis through a national competition.

To learn more, read full Stakeholder Announcement.

By Eric Scicchitano erics@cnhinews.com, The Daily Item, April 22, 2023

Changes to Medicaid coinciding with the end of the pandemic health emergency could exacerbate financial and operational stressors already burdening hospitals across Pennsylvania.

Medicaid enrollment grew by 30% in Pennsylvania during the pandemic, climbing to about 3.6 million members. Continuous enrollment stalled the Department of Human Services from performing its eligibility determination work during the pandemic and members benefited from temporary automatic enrollment.

Both policies ended April 1 and the redetermination process is now underway.

An estimated 617,000 members are at risk of losing health care coverage once eligibility is reassessed while another 598,000 hadn’t completed membership renewal as of January, Human Services officials told WESA 90.5.

The U.S. Department of Health and Human Services estimates that nationally, as many as 15 million Medicaid recipients and Children’s Health Insurance Program enrollees could lose coverage.

“Hospitals are facing this perfect storm. They’re in a precarious financial situation for a number of reasons. One of the most important is the workforce shortage and the impact on the financial viability of hospitals,” said Jeffrey Bechtel, senior vice president of health economics and policy, The Hospital and Healthsystem Association of Pennsylvania (HAP).

“The unwinding of Medicaid,” Bechtel said, “that’s just going to be another challenge hospitals will have to face during these difficult times.”

The Shapiro Administration has worked to contact enrollees about their potential risks and to ensure that they reapply to maintain benefits. Visit www.dhs.pa.gov/COMPASS, download the myCOMPASS PA mobile app, call 1-877-395-8930 or for CHIP, 1-800-986-KIDS (5437).

Steered to Pennie

Those losing coverage will be steered to the state’s health care marketplace, Pennie, or other programs. The administration pledges that no one will lose coverage without the opportunity to renew coverage.

Private health plans like Geisinger and Highmark are efforting such contacts among their own members in jeopardy.

The anticipated surge in uninsured Pennsylvanians is expected to tax hospital resources and safety net providers like free clinics and federally qualified health centers.

Hospitals and health care providers have already been beset by staffing shortages causing labor costs to swiftly balloon. And, they’re hardly immune to supply chain disruptions, high-interest rates and inflated costs.

Vacancy rates in Pennsylvania hospitals for registered nurses, nursing support staff, respiratory therapists, nurse practitioners and medical assistants hovered above 30% as recently as November, according to the latest data available from HAP.

“What we fear is that people will not know what they have to do, and that a significant number of people are going to lose their coverage as a result,” said Robert Dewar, chief revenue officer at Geisinger.

Dewar supports Medicaid expansion, not contraction.

“I feel like everybody loses in this. Patients lose; a significant number of patients. Hospitals lose. I don’t think it’s gong to help our taxes. It’s not going to lead to less cost for individual taxpayers. It’s just not good policy. I just don’t see any winners in this,” Dewar said.

A report by the Pennsylvania Health Care Cost Containment Council released last year found that in Pennsylvania, rising expenses and lost revenue due to the pandemic totaled $678.3 million through the first half of 2022 and nearly $7.9 billion to that point since the pandemic’s start.

The healthcare management consulting firm Kaufman Hall found that more than half of all U.S. hospitals ended 2022 at a fiscal loss, marking it as the worst financial year since the pandemic’s start.

Hospital losses

UPMC reported a net loss of $916 million last year. Geisinger’s reported loss totaled $842 million.

That year’s first half proved especially bad though steady improvement into the late winter months signaled a potential turnaround in 2023. While operating margins were up 16% in February year over year, profits fell 6% month over month compared to January, Kaufman Hall stated in a report released last month.

All told, hospital profits were down 32% nationally year-to-date in February compared to February 2020, the March report states.

Bechtel estimates Medicaid enrollees account for about 15% of hospital revenues. Combined with Medicare, the share leaps to 50%. Reimbursement falls below cost, he said.

Those revenues, even below cost, disappear for those members who become uninsured. The anticipation is that some will trend toward seeking costlier care at emergency departments for ailments best treated by primary care physicians or avoided altogether through preventative care afforded by health insurance.

“Having health insurance does not automatically equal access to care but it sure helps,” said Lisa Davis, director of the Pennsylvania Office of Rural Health and outreach associate professor with Penn State, a reference to rural health care deserts across the commonwealth.

According to Davis, rural hospitals are especially at risk of accumulating bad debt through uncompensated care. Comparatively, she said urban hospitals tend to have higher rates of commercially insured patients.

Patients losing health insurance risk putting off preventative care and may end up more sickly, Davis said. She said it likely will result in the safety net system taking on more clients.

“I think that’s probably the biggest impact, the increase of uncompensated care,” Davis said. “It really does put the hospital at financial risk.”

Expected surge

Staff at Community Health Centers including Federally Qualified Health Centers anticipate a surge of people seeking medical care once their insurance is lost as well as assistance in finding Medicaid alternatives, according to Tia N. Whitaker, statewide director of outreach and enrollment, Pennsylvania Association of Community Health Centers.

The network of health centers treats one million patients across three million visits annually, Whitaker said. It has 132 employees tasked with helping find insurance through Pennie.

“We fully anticipate in the next few months that requests for assistance will be flowing in because folks will be terminated,” Whitaker said.

Whitaker expressed concern that the Pennsylvania Department of Human Services staffing complement may not be enough to meet the demand to process applications and determine eligibility for Medicaid.

To seek help through the Pennsylvania Association of Community Health Centers, contact 717-761-6443, 1-866-944-2273 or pachc@pachc.org.

DACA recipients would have access to health care through Affordable Care Act Marketplaces, Medicaid, and the Children’s Health Insurance Program

The Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), released a notice of proposed rulemaking (NPRM) that, if finalized, would expand access to health care by reducing barriers for Deferred Action for Childhood Arrivals (DACA) recipients. Earlier this month, HHS announced its intention to release this rule by the end of April, and today’s announcement marks the fulfillment of that promise. The proposed change applies to the Health Insurance Marketplaces, the Basic Health Program, and some Medicaid and Children’s Health Insurance Programs (CHIP).

“DACA recipients, like all Dreamers, are Americans, plain and simple. The United States is their home, and they should enjoy the same access to health care as their fellow Americans,” said HHS Secretary Xavier Becerra. “Every day, nearly 580,000 DACA recipients wake up and serve their communities, often working in essential roles and making tremendous contributions to our country. They deserve access to health care, which will provide them with peace of mind and security.”

“Young people who come to this country—in many cases, the only country they have ever known as home—work hard to build their lives here, and they should be able to keep themselves healthy,” said CMS Administrator Chiquita Brooks-LaSure. “The Biden-Harris Administration is committed to ensuring affordable, quality health care for all, and to providing DACA recipients the opportunities and support they need to succeed.”

The proposed rule, if finalized, would remove the current exclusion that treats DACA recipients differently from other individuals with deferred action who would otherwise be eligible for coverage under select CMS programs. If the rule is finalized as proposed, it could lead to 129,000 previously uninsured DACA recipients receiving health care coverage. Over the last decade, DACA has provided peace of mind and work authorization to more than 800,000 Dreamers.

The proposed rule would amend the definition of “lawfully present” to include DACA recipients for the purposes of Medicaid and CHIP. In effect, this would extend Medicaid and CHIP coverage to children and pregnant women in states that have elected the “CHIPRA 214” option for children and/or pregnant individuals, the Basic Health Program, and Affordable Care Act Marketplace coverage. DACA recipients would need to meet all other eligibility requirements to qualify for coverage. Additionally, DACA recipients would be eligible for financial assistance through the Marketplace, such as advance payments of the premium tax credit and cost-sharing reductions if they meet all other eligibility requirements.

If the rule is finalized as proposed, DACA recipients would qualify for a special enrollment period to select a qualified health plan through a Marketplace during the 60 days following the effective date of the final rule.

This NPRM has a proposed effective date for all provisions of November 1, 2023. CMS is requesting comment from the public on proposed regulations, and specifically on the feasibility of this date and whether to consider a different effective date.

Children in every community in Pennsylvania rely on Medicaid and the Children’s Health Insurance Program for their comprehensive health insurance, including more than 1.3 million children enrolled in Medicaid and more than 130,000 children enrolled in CHIP.

Medicaid and CHIP helped improve the state’s child uninsured rate during the COVID-19 pandemic. The three fact sheets in this series show enrollment by Congressional, state House, and state Senate districts:

• Enrollment by Congressional District
• Enrollment by State House District
• Enrollment by State Senate District

Our last two newsletters covered the Medicaid unwinding and significant operational changes to CHIP. We encourage you to share Katie Meyer’s in-depth coverage about reenrolling in Medicaid and ensuring that CHIP or other health care options cover kids.