CMS Requires States to Pause Disenrollments and Reinstate Coverage for Impacted Individuals

The U.S. Department of Health and Human Services (HHS) announced that it has helped half a million children and families regain their Medicaid and Children’s Health Insurance (CHIP) coverage. On August 30, the Centers for Medicare & Medicaid Services (CMS) issued a call to action to states about a potential state systems issue where systems were inappropriately disenrolling children and other enrollees, even when the state had information indicating the person remained eligible. Thanks to CMS’ swift action, nearly 500,000 children and other individuals who were improperly disenrolled from Medicaid or CHIP will regain their coverage, and many more are expected to be protected from improper disenrollments going forward.

CMS sent a letter on August 30 to all states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands requiring them to determine and report whether they have a systems issue that inappropriately disenrolls children and families, even when the state had information indicating that they remained eligible for Medicaid and CHIP coverage. Today’s summary indicates that to-date 30 states report having this systems issue. As a result, to avoid CMS taking further action, all 30 states were required to pause procedural disenrollments for impacted people unless they could ensure all eligible people are not improperly disenrolled due to this issue.

“Thanks to swift action by HHS, nearly half a million individuals, including children, will have their coverage reinstated, and many more will be protected going forward. HHS is committed to making sure people have access to affordable, quality health insurance – whether that’s through Medicare, Medicaid, the Marketplace, or their employer,” said HHS Secretary Xavier Becerra. “We will continue to work with states for as long as needed to help prevent anyone eligible for Medicaid or CHIP coverage from being disenrolled.”

“Medicaid and CHIP are essential for millions of people and families across the country,” said CMS Administrator Chiquita Brooks-LaSure. “Addressing this issue with auto-renewals is a critical step to help eligible people keep their Medicaid and CHIP coverage during the renewals process, especially children. CMS will keep doing everything in our power to help people have the health coverage they need and deserve.”

CMS’ letter on August 30 alerted states to a potential eligibility systems issue related to automatic renewals for Medicaid and CHIP coverage. Auto-renewals (also known as “ex parte” renewals) are one of the strongest tools that states have to keep eligible people enrolled in Medicaid or CHIP coverage during the renewals process. Federal rules require states to use information already available to them through existing reliable data sources (e.g., state wage data) to determine whether people are still eligible for Medicaid or CHIP. Auto-renewals make it easier for people to renew their Medicaid and CHIP coverage, helping to make sure eligible individuals are not disenrolled due to red tape. CMS continues to provide technical assistance to states as they address these system issues.

Throughout the renewals process, CMS has offered states many strategies to assist them in making it easier for people to renew their coverage. Nearly all states have adopted at least some of these strategies, and CMS continues to urge states to adopt these strategies. Additionally, to help make transitions from Medicaid to other health coverage options more accessible in every state, CMS has launched national marketing campaigns and made available Special Enrollment Periods through HealthCare.gov, State-based Marketplaces, and Medicare. CMS’ top priority remains making sure everyone has access to affordable, quality health coverage.

For a preliminary overview of state assessments regarding compliance with Medicaid and CHIP automatic renewal requirements at the individual level (as of September 21, 2023), visit: https://www.medicaid.gov/resources-for-states/downloads/state-asesment-compliance-auto-ren-req.pdf.

The Health Resources and Services Administration (HRSA) is pleased to share an update on our efforts related to the Organ Procurement and Transplantation Network (OPTN) Modernization Initiative.

HRSA is committed to continued dialogue with OPTN stakeholders to ensure that patient, family, and clinician voices are engaged in the OPTN modernization efforts.  In June 2023, HRSA, through its engagement with a program management support contractor, kicked off stakeholder interviews to better understand the pain points and perspectives of individuals and organizations that directly interact with the OPTN. Stakeholder engagement with patients also began this month.  In addition, a web-based contact form is now available on the OPTN Modernization website to provide another avenue to solicit feedback from patients, families, clinicians, and other interested parties.

HRSA is focused on fostering robust competition and innovation to procure best in class support for the OPTN through ongoing market research and industry engagement.  To advance this, HRSA hosted an Industry Day for interested parties and vendors to solicit feedback on the Fall 2023 solicitation.  Information shared during Industry Day is available on SAM.gov.

HRSA and the Centers for Medicare & Medicaid Services are engaged in a coordinated effort through the Organ Transplant Affinity Group’s (OTAG) newly released action plan to improve organ donation, procurement, and transplantation.  Both agencies are committed to drive improvements in donations, clinical outcomes, system improvement, quality measurement and transparency, and regulatory oversight.

HRSA will continue to provide updates on our modernization efforts toward achieving enhanced accountability, equity, and performance in the organ transplantation system.

For more information and the latest OPTN Modernization updates, visit www.hrsa.gov/optn-modernization.

From Stateline

When someone with a medical emergency calls 911, they expect an ambulance to show up.  But sometimes, there simply isn’t one available.

Most states don’t declare emergency medical services (EMS) to be an “essential service,” meaning the state government isn’t required to provide or fund them.

Now, though, a growing number of states are taking interest in recognizing ambulance services as essential — a long-awaited move for EMS agencies and professionals in the field, who say they hope to see more states follow through. Experts say the momentum might be driven by the pandemic, a decline in volunteerism and the rural health care shortage.

EMS professionals have been advocating for essential designation and more sustainable funding “for longer than I’ve been around — longer than I’ve been a paramedic,” said Mark McCulloch, 42, who is deputy chief of emergency medical services for West Des Moines, Iowa, and who has been a paramedic for more than two decades.

Currently, 13 states and the District of Columbia have passed laws designating or allowing local governments to deem EMS as an essential service, according to the National Conference of State Legislatures, a think tank that has been tracking legislation around the issue.  Those include Connecticut, Hawaii, Indiana, Iowa, Louisiana, Maine, Nebraska, Nevada, Oregon, Pennsylvania, South Carolina, Virginia and West Virginia.  And at least two states — Massachusetts and New York — have pending legislation.  Idaho passed a resolution in March requiring the state’s health department to draft legislation for next year’s legislative session.  Meanwhile, lawmakers in Wyoming this summer rejected a bill that would have deemed EMS essential, according to local media.

“States have the authority to determine which services are essential, required to be provided to all citizens,” said Kelsie George, a policy specialist with the National Conference of State Legislatures’ health program.  Among those states deeming EMS as essential services, laws vary widely in how they provide funding. They might provide money to EMS services, establish minimum requirements for the agencies or offer guidance on organizing and paying for EMS services at the local level, George said.

The lack of EMS services is acute in rural America, where EMS agencies and rural hospitals continue to shutter at record rates, meaning longer distances to life-saving care.

“The fact that people expect it, but yet it’s not listed as an essential service in many states, and it’s not supported as such really, is where that dissonance occurs,” said longtime paramedic Brenden Hayden, chairperson of the National EMS Advisory Council, a governmental advisory group within the U.S. Department of Transportation.

More financial support

There isn’t a sole federal agency dedicated to overseeing or funding EMS, with multiple agencies handling different regulations, and some federal dollars in the form of grants and highway safety funds from the Department of Transportation. Medicaid and Medicare offer some reimbursements, but EMS advocates argue it isn’t nearly enough.

“It forces it as a state question, because the federal government has not taken on the authority to require it,” said Dia Gainor, executive director for the National Association of State EMS Officials and a former Idaho state EMS director. “It’s the prerogative of the state to make the choice” to mandate and fund EMS.

In states that don’t provide funding, EMS agencies often must rely on Medicaid and Medicare reimbursements and money they get from local governments.

Many of the latter don’t have the budgets to pay EMS workers, forcing poorer communities to turn to volunteers. But the firefighter and EMS volunteer pool is shrinking nationally as the volunteer force ages and fewer young people sign up.

Overhead for EMS agencies is expensive: A basic new ambulance can cost $200,000 to $300,000. Then there are the medicine and equipment costs, as well as staff wages and farther driving distances to medical centers in rural areas. The fact that people expect it, but yet it’s not listed as an essential service in many states, and it’s not supported as such really, is where that dissonance occurs.

By contrast, police departments are supported and receive funds from the U.S. Department of Justice along with local tax dollars, and fire departments are supported by the U.S. Fire Administration, although many underserved areas also rely on volunteer firefighters to fill gaps.  “We need more if we’re going to save this industry and [if] we’re going to be available to treat patients,” Hayden said. “EMS in general represents a rounding error in the federal budget.”  What’s more, reimbursements only occur if a patient is taken to an emergency room. Agencies may not receive compensation if they stabilize a patient without transporting them to a hospital.

Gary Wingrove, president of the Paramedic Foundation, an advocacy group, has co-authored studies on the lack of ambulance service and on ambulance costs in rural areas. The former Minnesota EMS state director argues that reimbursements should be adjusted on a cost-based basis, like critical-access medical centers that serve high rates of uninsured patients and underresourced communities.

A rural crisis

About 4.5 million people across the United States live in an “ambulance desert,” and more than half of those are residents of rural counties, according to a recent national study by the Maine Rural Health Research Center and the Rural Health Research & Policy Centers. The researchers define an ambulance desert as a community 25 minutes or more from an ambulance station.

Some regions are more underserved than others: States in the South and the West have the most rural residents living in ambulance deserts, according to the researchers, who studied 41 states using data from 2021 and last year.  State Rep. Eric Emery, a Democrat, is a paramedic and EMS director of the tribe’s sole ambulance station, providing services to 11,400 residents.

Emery and his colleagues respond to a variety of critical calls, from heart attacks to overdoses. They also provide care that people living on the reservation would otherwise get in the doctor’s office — if it didn’t take the whole day to travel to one. Those services might include taking blood pressure measurements, checking vital signs or making sure that a diabetic patient is taking their medicine properly.  Nevertheless, South Dakota is one of 37 states that doesn’t designate emergency medical services as essential, so the state isn’t required to provide or fund them.

While he and his staff are paid, remote parts of the reservation are often served by their respective county volunteer EMS agencies. It would simply take Emery’s crew too long — up to an hour — to arrive to a call.  “Something I wanted to tackle this year is to really look into making EMS an essential service here in South Dakota,” Emery said. “Being from such a conservative state that’s very conservative when it comes to their pocketbook, I know that’s probably going to be a really hard hill to climb.” Ultimately, Wingrove said, officials need to value a profession that relies on volunteers to fill funding and staffing gaps.  “We’re looking for volunteers to make decisions about whether you live or die,” he said.  “Somehow, we have placed ourselves in a situation where the people that actually make those decisions are just not valued in the way they should be valued,” he said. “They’re not valued in the city budget, the county budget, the state budget, the federal budget system. They’re just not valued at all.”

The Pennsylvania Broadband Development Authority (PBDA) has drafted its Volume I of the Broadband Equity, Access, and Deployment (BEAD) Program, as required through the National Telecommunication and Information Administration’s BEAD Notice of Funding Opportunity and supplemental guidance. Volume I includes critical components of PBDA’s plans for implementing BEAD grant funding, to ensure that all Pennsylvanians have access to high-speed internet. To draft the document, PBDA complied with NTIA requirements and guidance on elements such as the application process, scoring criteria, labor standards, and other requirements, as well as Commonwealth policies.

Volume I will be available for public review and comment for the required 30 days, from September 11, 2023 through October 10, 2023. The draft document can be accessed here. Upon receipt and consideration of comments to this document, PBDA will seek approval from its Board of Directors and submit the Volume for consideration to NTIA. Public viewers are asked to share comments through this form by 11:59 PM on October 10, 2023. Please note that Volume II will be available to view and comment on later this fall and prior to the NTIA submission deadline of December 27, 2023.

Applications for Fiscal Year (FY) 2024 NIH Loan Repayment Program (LRP) awards will open on September 1, 2023. LRPs can repay up to $100,000 of qualified educational debt for those who are eligible and agree to perform NIH mission-relevant research. The deadline to submit an application is November 16, 2023.

The LRPs help recruit and retain highly qualified health professionals to careers in biomedical or behavioral research. Several different extramural LRP categories are available, so review each to see which may be the right fit for your research. Please also take a couple minutes to watch this brief video where Matthew Lockhart, M.B.A. Director of the OER Division of Loan Repayment (DLR) discusses eligibility criteria and the program categories.

Similar to when we expanded the Health Disparities Research LRP for the FY 2020 LRP program cycle, we are doing the same for the Clinical Research LRP for Individuals from Disadvantaged Backgrounds. The recently published funding opportunity explains who qualifies as an individual from a disadvantaged background and this post shares some other related information.

The process of applying for and managing an LRP award is also now simpler and more cybersafe. Along with moving the application to ASSIST to prepare and submit applications electronically a couple years ago, we also recently launched two new portals that can be accessed through eRA Commons. The enhanced cybersecurity features afforded by eRA means their financial and other personal information is more safe and secure.

• The LRP Participant Portal allows awardees to see their student loans as well as payment and verification history.

• Research supervisors can use their portal to verify an LRP awardee’s research service by answering a series of questions about LRP recipients under their supervision, including their research service hours and ensuring they are fulfilling other necessary requirements.

We hope all eligible candidates consider applying for the FY 2024 LRP cycle. Be sure to review each Institute or Center Mission and Research Priorities first, and consider discussing the process and your ideas with appropriate scientific LRP liaisons at NIH.  Research and funding priorities can change on a yearly basis, so it is essential that applicants contact a liaison – ideally in advance of the opening of the application cycle – to ensure an appropriate understanding of each NIH Institute and Center research priorities. DLR is also available to answer any questions you may have by phone, or email, Monday through Friday, 9.a.m. to 5 p.m. ET.