Vaccination is one of the most highly effective public health interventions, responsible for saving millions of lives each year. Despite the care taken in the development and deployment of vaccines and their clear and compelling benefit of saving individual lives and improving population health outcomes, an increasing number of people in the US are now declining vaccination for a variety of reasons, ranging from safety concerns to religious beliefs. The situation has now deteriorated to the point that population immunity against some vaccine-preventable infectious diseases is at risk, and thousands of excess deaths are likely to occur this season due to illnesses amenable to prevention or reduction in severity of illness with vaccines. Read more in this Feb. 15 JAMA article.

Thanks to a 2022 law, consumers across the commonwealth have a new option if a healthcare claim is denied. Consumers can now file an online appeal of insurer denials of healthcare coverage to the Pennsylvania Insurance Department (PID) using PID’s new appeal website. Pennsylvania took over the independent external review process from the federal government under Act 46 of 2022, which took effect January 1, 2024. According to PID, only a small number of individuals challenged claim denials in the past three years and a significant number of those appeals resulted in decision reversals. PID encourages individuals who believe that they were inappropriately denied coverage for a service to utilize the new process and appeal the decision.

The Health Resources and Services Administration (HRSA) has approved a request from drug maker Eli Lilly to audit a rural, multi-site community health center regarding how it prevents duplicate discounts on 340B drugs reimbursed under Medicaid managed care. This approval is notable as it is the first time that either a HRSA or manufacturer 340B audit will look at Medicaid managed care drugs. (Previous audits around Medicaid have been limited to fee for service drugs.) The rationale behind HRSA’s change in policy is unclear.

Nationally, over 15 million people have been disenrolled from Medicaid since April 1, 2023 and over 28 million have had their coverage renewed. Kaiser Family Foundation (KFF) has published a Medicaid Unwinding Brief that summarizes information gathered from stakeholder interviews to highlight key observations and themes from the field, including perspectives from Pennsylvania. With the growing concern over such large disenrollment numbers, the federal government issued additional guidance with strategies to help states protect coverage and prevent additional procedural terminations.  Pennsylvania has disenrolled more than 575,000 recipients from coverage since April 1, renewed coverage for 1.3 million, and terminated 44% for procedural issues.

Join Administrator Chiquita Brooks-LaSure of the Centers for Medicare & Medicaid Services (CMS) as she highlights CMS’ key 2023 accomplishments and reviews the 2024 priorities to advance CMS’ Strategic Plan. CMS’s focus for the coming year includes advancing health equity, expanding coverage, and improving health outcomes while engaging communities for input and feedback during the process.  RSVP for the January 23, 1:00 – 2:00 pm call here.

The PA Departments of Human Services (DHS) and Education will operate the Summer Electronic Benefits Transfer (Summer-EBT) program in the summer 2024, allowing children to access nutritious meals during the summer months when school is not in session.  An increase in the state’s budget will provide universal free breakfast to Pennsylvania’s public school students. Every public school student regardless of income will be eligible to receive free breakfast. The funding also provides free lunch to all 22,000 Pennsylvania students who are eligible for reduced-price lunches through the National School Lunch Program.

Congressmen David Trone (D-MD), Jamie Raskin (D-MD), and Brian Fitzpatrick (R-PA) reintroduced the Continuity in Necessary Evaluative Crisis Treatment (CONNECT) Act to connect individuals experiencing a behavioral or mental health crisis with follow-up services. The bill authorizes $30 million to create a new grant program through the Substance Abuse and Mental Health Services Administration (SAMHSA) to support these activities.

Advocates and dentists are hopeful a state House bill will restore dental services for adults with Medicaid coverage in Pennsylvania. The legislation passed the Democratic-controlled state House last month in a bipartisan 153-50 vote. Coverage for many adult dental services was cut in 2011 under the administration of former Gov. Tom Corbett as part of a cost-saving move; the change was estimated to save about $18 million in state funds at the time. Since that time, adults in the state’s Medicaid program have had a very limited set of dental benefits that don’t cover much beyond routine exams, cleanings, and basic fillings. The bill is now in the state Senate before the Human Services Committee. There is also a similar Senate bill, sponsored by Minority Leader Sen. Jay Costa, a Democrat.

From Becker’s

More than 15 million people have been disenrolled from Medicaid since April 2023, surpassing HHS’ original estimates with several months left in the redeterminations process.

According to KFF, as of Jan. 16, 15,015,000 people have been disenrolled from Medicaid during the continuous coverage unwinding process. HHS estimated around 15 million people would lose coverage during the process.

States began the process of redetermining the eligibility of Medicaid recipients for the first time since 2020 in April, after continuous eligibility requirements in place during the COVID-19 pandemic expired.

Here are five things to know about where the unwinding process stands:

1. Around one-third of people who had their coverage up for renewal were disenrolled from Medicaid, while two-thirds were reenrolled in the program, according to KFF.
2. The majority of those disenrolled had their coverage terminated for procedural reasons, rather than being determined ineligible on the basis of income. According to KFF, as of Jan. 16, 71% of disenrollments were due to procedural reasons.
3. Disenrollment rates vary widely by state. In Texas, 61% of those whose coverage was up for renewal were disenrolled, while in Oregon and Maine, 13% of those up for renewal were disenrolled.
4. Children account for around 4 in 10 of those disenrolled from Medicaid, according to KFF. In December, HHS asked nine states with the highest child disenrollment rates to implement more flexibility to keep eligible kids enrolled.
5. States were given 12 months to complete the unwinding process, though in December, HHS said it would extend flexibilities offered to states through the end of 2024. At least two states, Arkansas and Idaho, have already completed the redetermination process.

From Axios

Sixty percent of kids who have lost Medicaid coverage this year came from just nine states, all of which are Republican-led, according to new data from the Biden administration.

Driving the news: And the 10 states refusing the Affordable Care Act’s expansion of Medicaid to low-income adults have disenrolled more kids than all of the expansion states combined, the administration also reported.

Why it matters: The data hints at a partisan divide in reviews of Medicaid eligibility after those checks — which were put on hold during the pandemic — resumed this spring.

• The administration on Monday sent warnings to the nine states with large losses in kids coverage, but federal health officials said they have limited power to require those states to make changes.

Context: At least 2.2 million kids have been removed from Medicaid and its sister program, the Children’s Health Insurance Program, during the so-called “unwinding” of pandemic-era coverage protections as of September, according to data from the Centers for Medicare and Medicaid Services.

• More recent data tracked by outside sources suggest this number is closer to 3 million.
• Many may have been disenrolled because of a procedural issue and not necessarily because they were no longer eligible. States have been restoring coverage for over 500,000 people, many of them children, who were inappropriately booted from Medicaid because of an error in calculating income.

State of play: Health and Human Services Secretary Xavier Becerra sent letters to Arkansas, Florida, Georgia, Idaho, Montana, New Hampshire, Ohio, South Dakota and Texas on Monday urging them to better protect kids from losing Medicaid.

• The letters note that HHS “will not hesitate to take action to ensure states’ compliance with federal Medicaid requirements,” though they don’t specify what the department might do.
• CMS earlier this month warned it will fine states that don’t properly report data about who’s losing coverage, Modern Healthcare reported.

By the numbers: South Dakota and Idaho recorded the sharpest decreases in Medicaid enrollment among kids between March and September (27%), according to CMS data.

• Kids’ enrollment decreased by more than 10% in most other states receiving warning letters. Enrollment shrank by 9% in Georgia and 6% in Ohio, but those states are among those with the highest number of kids removed from the program.
• Enrollment also decreased by over 10% in New Mexico, Oklahoma and Utah, but those states did not receive warning letters.

States with the smallest decreases in kids’ enrollment were largely blue states. Enrollment actually increased slightly in New York, Oregon, Massachusetts, Rhode Island and Washington, D.C.

• As of June, more than 20% of children who lost coverage had been re-enrolled in Medicaid or CHIP, federal data shows. It’s unclear how many may have found coverage elsewhere, such as through the ACA insurance marketplaces or a parent’s employer.

The other side: States contacted by Axios defended the coverage losses and said they had followed federal requirements for the unwinding process.

Read more.