After the Supreme Court declined to hear Red State arguments defending Medicaid’s work requirements originally scheduled for March 29, state health departments can once again focus on increasing health justice by making the scope of Medicaid non-existent expand traditional way.
Even before Biden took office, the Covid pandemic forced states to use Medicaid in many ways never imagined before. If one in five Americans say they cannot afford health care, what government legislation can we expect to improve equitable access to care?
Key solutions Improving health equity At the state level, among other things, the expansion of Medicaid is addressed. extending access to Medicaid from 60 days to one year after birth; Establishment of a nationwide quality strategy in accordance with CMS, expansion of telehealth, enabling family members to be paid as carers for their relatives, value-based contract design and consideration of social determinants of health through Medicaid programs.
“These concepts are no stranger to us, we just have to take care of the woodwork,” said Michael Cook, partner and co-leader of the Health Practice Group at Liles Parker, in a telephone interview. “How do we get the maximum bang for our money? Aiming and coordinating is the hard part; We use the resources we have and we know that we do not have unlimited resources and that we can rely on us having used them wisely. “
Expansion of access to Medicaid
Since declaring the Covid emergency, states have seen a dramatic increase in their Medicaid roles and an even more dramatic increase in the number of people who need insurance but cannot afford to buy it in the private market. One tool that states must use to support low-income families who are struggling to obtain health care coverage is the “Medicaid Expansion” provision of the Affordable Care Act.
Twelve Republican-led states requested CMS exemptions for the expansion, but under the American Rescue Plan Act, Biden sweetened the deal. In addition to the 90% of the federal matching funds offered under the ACA for the expanding population, the states will receive a 5 percentage point increase in their regular federal matching rate for 24 months after the expansion of Medicaid access.
Joe Biden’s administration faces the Texas Attorney General’s challenge Provisions in the American Rescue Plan Act that makes it more expensive for states not to extend access to Medicaid to people with household incomes nominally above the 100% poverty line, but States that accepted the deal found it invaluable during Covid.
“We saw tremendous need for the program,” said Karen Kimsey, service director for the Virginia Department of Medical Assistance, in a presentation to the American Bar Association in March.
Kimsey told the audience that the Virginia Medicaid program has gained over 300,000 new members since the declaration of a state of emergency, approximately half of whom were covered by the Medicaid expansion. The Virginia governor and legislature signed the Medicaid expansion in May 2018 and put the program into effect in 2019. As a result, the uninsured rate decreased by a full percentage point.
“This decline in the number of uninsured people in Virginia is a direct result of the decision to expand Medicaid and reject proposals for strict job requirements,” said Ashley C. Kenneth, senior vice president of policy and legislation for the Commonwealth Institute.
Expansion of the postpartum access
Biden’s American Rescue Plan Act also allows states to extend postpartum access to Medicaid from 60 days to a full year.
Washington State took the initiative to make this extension permanent, and last month passed law requiring the State Health Care Authority (HCA) to grant all residents whose incomes are at or below 193% of the population Income is federal poverty line insured by Apple Health one year after birth.
According to the Organization for Economic Cooperation and Development (OECD), the United States has a poor record of maternal care with one of the world’s highest maternal mortality rates among industrialized countries. For every 100,000 live births, 20 mothers died in 2019, more than twice as many as two decades ago. Over half of these women – 52 percent – died in the year after giving birth.
Washington law sponsor Emily Randall expressed the urgency of the law, saying, “We know that there are disproportionate health consequences for particularly black mothers. We also know that two months is hardly enough time to look after yourself after giving birth to a new baby and trying to do all of its many visits. And we also know that due to the expansion of the FMAP increase as part of federal policy, we have expanded coverage and made sure that newborn parents are insured for longer. And what I don’t want to do at the end of the emergency is create a huge cliff and all of a sudden everyone get started. “
Open the doors to immigrants
Virginia recognized the profound barriers to caring for immigrants last month by repealing what is known as the “40 Quarter Rule” that immigrants must have worked in the US for 10 years to be eligible for Medicaid coverage. This move immediately covered an additional 4,000 Virginians and the office expects data shortly on how many additional Virginians will be eligible each year and the exact budget impact.
“This historic change in policy is long overdue,” said Kimsey. “I am so grateful that we were able to overcome this unjust barrier and give these people access to doctor visits, prescriptions, hospital care and all the health services they need to be safe and successful in these uncertain times.”
Addressing social determinants of health
States are also finding creative ways to meet the social needs of people who make health impacts through their Medicaid programs.
North Carolina Minister of Health and Welfare Mandy Cohen recently shared the story of the “a-ha” moment when she recognized that social determinants of health such as access to food, housing, education and employment are integral to health Are medicine.
As a third year resident, she had spent weeks trying to diagnose why a woman was losing weight and hair in her twenties. It was only when a technician gently nudged her that she should ask if the young woman had eaten that she thought of asking.
“What a huge failure on my part as a doctor,” she told the audience at a recent AMA conference. “Oh my god,” Cohen said, “she hasn’t eaten in six to eight weeks while I did all these stupid blood tests.”
That moment prompted her to survey all patients about social determinants and create health systems protocols while serving as chief operating officer and chief of staff for Centers for Medicare and Medicaid Services (CMS). between 2015-2017. Now their state is the first to invest in a comprehensive, all-round health and personal care program called NCCare360, run by Unite Us, a technology service that enables health and personal care providers to send, receive and send electronic transfers Communicate, support real-time, exchange customer information and track results.
The system also draws on community-based organizations, social services, health systems, independent providers and community members, and creates a nationwide coordinated supply network.
Finally, technologies from Expound Decision Systems will be used to analyze the success of interventions that address social determinants of health.
Cohen was shortlisted to lead CMS, a role recently given to Manatt, Phelps & Phillips, LLP partner and longtime ally of Biden, Chiquita Brooks-LaSure.
The state health department in Georgia has embarked on the path of incorporating value-based shopping into its Medicaid-funded care. She tried this approach as part of her Georgia Families 360 program for foster children in assistance or in juvenile justice.
“How this program works, we withhold 5% of the contractor’s principal payment until certain metrics and goals are met,” said Lynnette Rhodes, Medical Assistance Plans Department, in a March presentation to the ABA. “And then we do a valuation at the end of the fiscal year. Depending on where you landed, we’ll either refund all 5% or the part you hit.”
Rhodes reported that the program has been a success so far, as Amerigroup Community Care has achieved 95% of its goals since 2014.
“There has been a delay in implementing this program in the regular managed care population and that has to do with funding and funding,” said Rhodes, “but we hope to do so in the near future.”
Paying and protecting caregivers
Since the Covid pandemic began, Georgia has partnered with New York to provide consumer-focused personal assistance and aftercare that enables people with disabilities and seniors receiving Medicaid to pay family members for their care.
The American bailout plan also increases the amount states can receive in federal funding for Medicaid Home and Community Services (HCBS) through March 30, 2022 if those programs are implemented or expanded. HCBS helps seniors and people with disabilities live independently in the community by assisting with daily self-care and household activities.
While the bill does not yet describe specific activities, examples of initiatives states could fund include: helping direct caregivers, family carers, and HCBS providers affected by the pandemic; Providing services to combat the effects of the pandemic on the elderly and people with disabilities; and increasing the number of people receiving HCBS, according to the Kaiser Family Foundation.
A number of states have also started extending paid sick time for people with Covid symptoms and their caregivers. Many of these Americans received protection under the Families First Coronavirus Response Act (FFCRA) until it expired in December.
In countries that had access to paid sick leave as part of the FFCRA, around 400 fewer cases of COVID-19 occurred per day, according to studies by Cornell University and the Swiss Economic Institute.
A report by the National Partnership for Children and Families showed that eight out of ten voters in the 2020 elections support a permanent paid family and sick leave program for workers and carers.
Overall, state health officials have stayed creative and committed to addressing the state-level differences, Cook said.
“Medicaid directors in the red and blue states all have the same goal,” Cook said in a telephone interview, “they could get there in different ways, but these people are absolute professionals regardless of their governors’ positions.”
Photo: Märzmeena29, Getty Images