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.

The USDA Rural Development program provides funding to agricultural producers and rural small businesses for renewable energy systems or to make energy efficiency improvements. More flexible Inflation Reduction Act Changes. Contact your State Energy Coordinator.

Application Deadline: 6 quarterly Cycles

By: January Contreras, Assistant Secretary, Administration for Children and Families and CMS Administrator Chiquita Brooks-LaSure

The Medicaid “continuous enrollment” period is ending.  As trusted community voices, you can help millions of children and families stay connected to affordable, comprehensive care through Medicaid and the Children’s Health Insurance Program (CHIP), Medicare, the Health Insurance Marketplaces, or employer-sponsored coverage.

With your partnership, we can maximize our outreach and ensure people experience smooth coverage transitions.  This blog explains where we are now and what you can do to help.

Where We Are Now

During the COVID-19 pandemic, Medicaid served its core purpose of providing reliable health coverage to millions of individuals and families during unprecedented circumstances. Individuals could count on having stable health coverage during the pandemic, regardless of changes in income or other circumstances, because of a “continuous enrollment” provision. This continuous enrollment provision is now coming to an end, and states must return to normal eligibility and enrollment operations.

This means that states will redetermine eligibility for each person currently covered by Medicaid or CHIP – a total of 91 million people – between April 1, 2023 and July 31, 2024. You can find the anticipated timeline for each state at Medicaid.gov/unwinding.

The Biden-Harris Administration is committed to engaging with states and community partners throughout this process to support individuals’ and families’ access to coverage and care. States are working to simplify and streamline processes, connect people to the Health Insurance Marketplaces, and adopt other innovative approaches. But we need your help to reach every person who may be affected by this process and help them maintain their health coverage or enroll in a new plan.

What You Can Do

The Administration for Children and Families (ACF), the Centers for Medicare & Medicaid Services (CMS), and other federal agencies are working together to recruit partners like you to help people stay connected to health care coverage.  There are several ways to help.

First, it’s critical that state Medicaid programs have accurate contact information for the children, individuals, and families enrolled in Medicaid and CHIP.  We need your assistance to share key messages to help people stay covered. Families and individuals should:

• Update their contact information with their state Medicaid or CHIP office. You can find state-specific contact information at Medicaid.gov/renewals.
• Check their mail.  The state will mail a letter about coverage, which will let them know if they need to complete a renewal form to see if they still qualify for Medicaid or CHIP.
• Complete their renewal form (if they get one). Fill out the form and return it to their state right away to help avoid a gap in coverage.

You can find these messages available in English, Spanish, Chinese, Hindi, Korean, Tagalog, and  Vietnamese, at Medicaid.gov/unwinding.

Second, you can amplify our message and help people learn the actions they need to take to keep health care coverage.  Below are several strategies to consider:

• Ensure front-line staff are knowledgeable on steps families can take to renew their health care coverage.  For example, they can help patients understand the 90-day reconsideration period.
• Promote Medicaid and CHIP renewal awareness on your websites, social media channels, and in your physical offices.  You can use our Medicaid Unwinding Toolkit graphics (English and Spanish).
• Share key information on Medicaid and CHIP renewal as part of your application intake or renewal process for other programs.  You can also tell people about their other health care coverage options, like HealthCare.gov and Medicare.gov.

Your work will help people enrolled in Medicaid and CHIP take the necessary actions to stay connected to health care coverage.  We are counting on ACF and CMS partners to be a part of our nationwide effort to ensure no one is left behind when it comes to health care.

Thank you for your continued collaboration to promote the well-being of children, youth, families, and communities.

Other helpful resources:

• Unwinding Homepage: Where states and stakeholders can learn more about Unwinding and access resources to help plan and prepare.
• Unwinding Communications Toolkit: Provides key messages and materials for states and stakeholders to help families get ready to renew, including flyers, postcards, tear pads, conference cards, and rack cards.
• Renew Your Medicaid or CHIP Coverage: Includes contact information for each state and territory’s Medicaid enrollment office.
• 50-State Unwinding Tracker.
• Child Uninsured Rate Could Rise Sharply if States Don’t Proceed with Caution – Center For Children and Families (georgetown.edu).

Beyond the Basics released two sets of frequently asked questions (FAQ) on unwinding Medicaid continuous coverage. The first set explains how unwinding the Medicaid continuous coverage requirement will work, the challenges Medicaid beneficiaries may face during the process, and what enrollment assisters such as health centers can do to help. The second set offers outreach and enrollment tips to assist people to retain coverage.

In recognition of National Minority Health Month, CMS OMH released a report outlining the quality of care received by people enrolled in Medicare Advantage to further understand and address health disparities. The Disparities in Health Care by Race, Ethnicity, and Sex report details the racial, ethnic, and sex differences in health care experiences and clinical care received by Medicare Advantage enrollees based on data reported in 2022.

This report explores national-level race, ethnicity, and sex disparities in health care quality received by Medicare Advantage enrollees in 2022. The report found Black, Hispanic, and particularly American Indian and Alaskan Native enrollees experienced lower than average quality for clinical care across many measures examined in the report. In particular, significant disparities in flu vaccination rates, as compared to the national average, with Black, Hispanic, and Multiracial enrollees vaccinated for the flu at lower than average rates.

This report is based on an analysis of two sources of information, the Healthcare Effectiveness Data and Information Set (HEDIS) and the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. HEDIS collects information from medical records and administrative data on the quality of care that people enrolled in Medicare receive. The Medicare CAHPS survey is conducted annually by CMS and focuses on the health care experiences of people with Medicare across the nation.

Health care professionals, organizations, researchers, and hospital leaders can utilize this report along with other CMS tools and resources to help raise awareness of health disparities, develop health care interventions for racially and ethnically diverse populations, and implement quality improvement efforts that advance health equity.

CMS OMH welcomes your participation in promoting health observances such as National Minority Health Month, not only in April, but all year long to raise awareness about health issues affecting people across our nation.

Visit https://go.cms.gov/omh to learn more.

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is announcing a new opportunity for states to help increase care for individuals who are incarcerated in the period immediately prior to their release to help them succeed and thrive during reentry. The new Medicaid Reentry Section 1115 Demonstration Opportunity would allow state Medicaid programs to cover services that address various health concerns, including substance use disorders and other chronic health conditions.

“The Biden-Harris Administration has made expanding access to high-quality, affordable health care a top priority,” said HHS Secretary Xavier Becerra. “We are committed to ensuring all Americans have the peace of mind they deserve knowing they have access to life-saving health care, whether it is medication-assisted treatment for substance use disorders or prescription medication to treat other chronic health conditions. Through this historic new effort, we are working to ensure that people who were formerly incarcerated can transition successfully back into the community with the health care supports and services they need. This is an essential step for advancing health equity in our nation and we encourage all states to take advantage of this new opportunity.”

“Today, we reach a significant milestone in expanding access to health care in the Medicaid program,” said CMS Administrator Chiquita Brooks-LaSure. “This guidance outlines a pathway to implement historic changes for individuals who are incarcerated and eligible for Medicaid. By improving care and coordination prior to release from the justice system, we can help build a bridge back to the community and enhance individual and collective public health and public safety outcomes.”

The goal of this demonstration opportunity is to help Medicaid enrollees establish connections to community providers to better ensure their health care needs are met during their reentry process. In January, California became the first state to cover certain health care services for individuals transitioning back to the community. CMS’ action today builds on priorities established by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, and supports President Biden’s comprehensive, evidenced-based public safety strategy, the Safer America Plan, as well as the President’s Unity Agenda to address the mental health crisis and the opioid epidemic.

The Medicaid Reentry Section 1115 Demonstration Opportunity will allow states to cover a package of pre-release services for up to 90 days prior to the individual’s expected release date that could not otherwise be covered by Medicaid due to a longstanding statutory exclusion that prohibits Medicaid payment for most services provided to most people in the care of a state or county carceral facility.

According to the U.S. Department of Justice, from 2011 to 2012, approximately 37 percent of people in state/federal prisons and 44 percent of people who were incarcerated overall had a history of mental illness. The National Institute on Drug Abuse (NIDA) estimates that the rate of substance use disorders for people who are incarcerated may be as high as 65 percent. The NIDA report also says that, without treatment, individuals formerly incarcerated are at increased risk of overdose within the first few weeks of reentry.

The Medicaid Reentry Section 1115 Demonstration Opportunity focuses on covering high-quality services for individuals who are incarcerated, eligible for Medicaid, and returning home to their communities – a group of individuals who have been historically underserved and adversely affected by persistent poverty and inequality. Improving health care transitions and addressing social determinants of health – from case management to medication-assisted treatment – for individuals after they have been released from carceral settings increases the likelihood that they may continue to receive crucial substance-use disorder, mental health, and other health care treatment during this vital period. It also holds promise for reducing emergency department visits, inpatient hospital admissions, overdose, and overdose-related issues, including death, and improving health outcomes overall. Moreover, addressing people’s underlying health needs enhances their ability to succeed and thrive during reentry, thereby lowering the risk of recidivism, helping make our communities healthier and safer.

In addition to increased health and well-being and saving lives, the demonstration aims to accomplish several other essential goals, including improving coordination and communication between correctional systems, Medicaid systems, managed care plans, and community-based providers, as well as increasing investments in health care and related services.

To learn more, read the complete State Medicaid Direct Letter on Medicaid.gov.

The U.S. Department of Agriculture (USDA) today announced the availability of $20 million to deliver broadband technical assistance resources for rural communities, and to support the development and expansion of broadband cooperatives.

USDA is offering the funding under the new Broadband Technical Assistance Program. The program supports technical assistance projects such as conducting feasibility studies, completing network designs and developing broadband financial assistance applications. Funding is also available to help organizations access federal resources, and to conduct data collection and reporting.

“USDA is committed to making sure that people, no matter where they live, have access to high-speed internet. That’s how you grow the economy – not just in rural communities, but across the nation,” said USDA Under Secretary for Rural Development Xochitl Torres Small. “USDA is partnering with small towns, local utilities and cooperatives, and private companies to increase access to this critical service which in turn boosts opportunity and helps build bright futures.”

To learn more, read the full news release.