CMS Requires 30 States to Pause Medicaid Disenrollments After Systems Error

HEALTHCAREDIVE / By Emily Olsen

Nearly 500,000 people will regain Medicaid or Children’s Health Insurance Program coverage after being improperly removed from the rolls during redeterminations, according to the HHS.

More than seven million Medicaid beneficiaries have been disenrolled from the program geared toward low-income people since the redeterminations process began this spring, according to health policy research firm KFF.

States are required to figure out which enrollees are still eligible for the safety-net program after a long period of continuous enrollment during the COVID-19 pandemic, where beneficiaries were kept enrolled in Medicaid to avoid coverage losses during a public health emergency. 

But patient advocates have raised concerns about the large number of procedural disenrollments, or cuts due to administrative reasons like not completing paperwork. 

Among states with available data, 73% were removed from coverage due to procedural reasons, according to KFF. 

In 16 states reporting age breakouts, children accounted for 42% of Medicaid disenrollments. 

The federal government has taken steps to cut down on the number of inappropriate disenrollments including offering states more flexibility and pausing coverage terminations in states that weren’t compliant with renewal requirements.

“I think unwinding has revealed that there have always been more procedural terminations than we realized. And that’s contributed to the historic patterns of churn on and off of Medicaid that have impacted people’s ability to keep their coverage,” said Allison Orris, senior fellow at the Center on Budget and Policy Priorities, during a meeting of the Medicaid and CHIP Payment and Access Commission Thursday. 

Automatic renewals, or ex parte renewals, use existing data to determine whether beneficiaries are still eligible for coverage, and are key tools to keep people enrolled with lower documentation burden, regulators said. 

But some states were enacting renewals of whole households at once, even though some members may have different eligibility requirements, the CMS said in a letter last month.

Alaska, Colorado, Connecticut, Delaware, Washington, D.C., Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Nebraska, Nevada, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Vermont, Virginia, West Virginia, Wisconsin and Wyoming were not auto-renewing at the individual level, according to preliminary data released Thursday.

Pennsylvania and Nevada estimated the error affected more than 100,000 people in their states. Other states reported lower numbers or were still assessing the impact.

Dan Tsai, deputy administrator and director of the Center for Medicaid and CHIP Services, said Thursday there’s “no doubt” the Medicaid program will come out of the redeterminations process stronger due to the increased focus on eligibility and outreach.

“I hope this will lead to a renaissance over the next multi-year period of how we in the country collectively think about eligibility and the ease of maintaining and getting access to coverage through Medicaid and other programs,” he said during the MACPAC meeting. 

Lawmakers Back Home Health Providers, Condemn Payment Cuts In Symbolic Subcommittee Hearing

Home Health Care News / By Andrew Donlan
 
The Senate Finance Committee’s Subcommittee on Health Care held a hearing Thursday regarding aging in place and access to home health care in the U.S.

While current struggles were highlighted throughout, the hearing was ultimately a symbolic win for home health providers across the country.

Lawmakers came across as more educated on home health care – and the issues the sector faces – than ever. They also, generally, seemed to be unsure why more investment wasn’t being put toward home-based care.

“Because of the lack of a coordinated policy, seniors often end up in a more costly environment, in a less desirable environment, and – I would suggest – a more dangerous environment for their long-term health,” Sen. Ben Cardin (D-MA), the chair of the subcommittee, said.

Cardin also began the hearing by mentioning there’s a “great deal of interest” from both Democrats and Republicans on the topic of home health care.

The hearing was “very well attended,” according to Partnership for Quality Home Healthcare CEO Joanne Cunningham. 

The chair of the Senate Finance Committee, Ron Wyden, was also there, for instance.

Witnesses for the hearing included: William A. Dombi, the president of the National Association for Home Care & Hospice; Carrie Edwards, the director of home care services at Mary Lanning Healthcare; Judith Stein, the executive director of the Center for Medicare Advocacy; and David Grabowski, a professor and researcher at Harvard Medical School.

“I think the big message was very clearly that the Senate Finance Committee, on a bipartisan basis, cares a lot about the Medicare home health program, and is concerned about reimbursement cuts and the impact that workforce shortages are having on access to care,” Cunningham told Home Health Care News.

The overarching theme was, of course, the Centers for Medicare & Medicaid Services’ (CMS) home health payment cuts.

Witnesses were able to openly discuss the impact that cuts have had up to this point, and the impact further cuts would have in the future.

They were also able to discuss the dangers of skyrocketing referral rejection rates, the impact of further Medicare Advantage (MA) penetration and the issues the provider community takes with Medicare Payment Advisory Commission’s (MedPAC) reports on home health care.

“It is overall financial margins that really measure financial stability, not the incomplete analysis presented by MedPAC,” Dombi said during the hearing. “Medicare margins – to the extent they exist – are subsidizing other payers like Medicaid and Medicare Advantage.”

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HCAOA Proud to Announce Jason Lee as NEW CEO

Home Care Association of America

HCAOA is proud to announce Jason R. Lee as the new Chief Executive Officer, effective October 2, 2023. Lee will succeed Vicki Hoak, HCAOA CEO for the past four years, who will continue to contribute her expertise as CEO Emeritus through the end of October.

​​Lee brings over 20 years of experience in advocacy and nonprofit management. His background includes a tenure as Chief of Staff and Senior Advisor to the President at the American Dental Education Association (ADEA), where he played a pivotal role in helping to guide the $30 million national organization representing academic dentistry and shape the association's strategic direction. Additionally, Lee served as Chief Advocacy and Strategy Officer at the Association of Fundraising Professionals (AFP) in Arlington, VA. While at AFP, he also held positions as Interim President and CEO, General Counsel, and Director of Government Relations. Before joining AFP, Jason was a lobbyist for Alcalde & Fay and held legislative positions with Sen. Barbara Boxer (D-CA) and Rep. Sheila Jackson Lee (D-TX).

Lee holds a Juris Doctor degree from The George Washington University Law School, a Master of Arts in English Literature from Binghamton University, and a Bachelor of Arts in English Honors and Plan II Honors from The University of Texas at Austin.

Please join the HCAOA in welcoming Jason Lee as the new HCAOA CEO!

Free Covid Tests Will Be Offered Again to All U.S. Households

StatNews / By Helen Branswell and Rachel Cohrs

The federal government is again offering free Covid-19 tests to Americans, providing a fifth round of free tests in part to meet current needs, in part to stimulate a domestic testing industry that has struggled with cratering demand for the rapid diagnostics.

The measure, announced Wednesday, will see rapid tests released from the Strategic National Stockpile. In addition, 12 domestic test manufacturers will receive investments totaling $600 million to help “warm-base” the U.S. capacity for rapid test production, both for Covid and future disease threats.

“We will make available some of those tests that we have in our stockpile,” Xavier Becerra, health and human services secretary, said in Washington, “so that Americans can … use those tests during this viral season.”

Earlier in the pandemic, demand for rapid tests was huge. But it has been up and down, based on levels of transmission — and on the intensity of public concern. For instance, some manufacturers scaled back production in 2021, as the national vaccination effort gained ground.

When the massive Omicron wave hit in late 2021 and early 2022, it took weeks to get significant supplies of tests available again, Dawn O’Connell, HHS assistant secretary for preparedness and response, told STAT in an interview. Since the end of the public health emergency in May, some health insurers have declined to pay for rapid tests, further depressing sales.

The country needs to have ongoing production capacity, based in the U.S., O’Connell said.

“What it does is keep the lines running, so we no longer have that boom and bust [cycle],” she said. “This capability is important now for Covid and we’re using it and exercising it now as we’re heading into the fall and winter season. But it’s going to be critically important for other outbreaks that we’re responding to in the future.”

Households will be entitled to receive four free rapid tests apiece, with ordering at COVIDtests.gov opening on Sept. 25. O’Connell said test shipments are expected to start on Oct. 2.

The money flowing to the 12 domestic producers will require them to keep their production bases warm. O’Connell said that after the winter, when public demand for tests may again shrink, the federal government will receive, as part of the deal, 200 million new Covid tests to replenish the national stockpile.

She encouraged people to order the tests and use them, especially when planning to spend time around people for whom Covid remains a significant health threat.

“We’ve seen each fall and winter season an increase in cases as people move indoors and are seeing their families again and interacting in smaller groups and closer quarters. We wanted to make sure as we head into that season … that we provide an avenue for people to be able to receive these tests for free,” O’Connell said.

“It’s just one of the arrows in our quiver for the fall and winter season and we’re pleased to provide these tools to protect Americans from Covid and keep their family members safe.”