Colorado legislators questioned Gov. Jared Polis about what he has described as his "belt-tightening" budget proposal.

The post States’ Share of Medicaid Costs Remains Low but Is Set to Increase was curated by information for practice.

Chiquita Brooks-LaSure, administrator of the Centers for Medicare & Medicaid Services, leads some of the Biden administration's efforts to expand Medicaid access.; Credit: Caroline Brehman/CQ-Roll Call, Inc via Getty Imag

The Biden administration is quietly engineering a series of expansions to Medicaid that may bolster protections for millions of low-income Americans and bring more people into the program.

Biden's efforts — which have been largely overshadowed by other economic and health initiatives — represent an abrupt reversal of the Trump administration's moves to scale back the safety-net program.

The changes could further boost Medicaid enrollment — which the pandemic has already pushed to a record 80.5 million. Some of the expansion is funded by the COVID-19 relief bill that passed in March, including coverage for new mothers.

Others who could also gain coverage under Biden are inmates and undocumented immigrants. At the same time, the administration is opening the door to new Medicaid-funded services such as food and housing that the government insurance plan hasn't traditionally offered.

"There is a paradigm change underway," said Jennifer Langer Jacobs, Medicaid director in New Jersey, one of a growing number of states trying to expand home-based Medicaid services to keep enrollees out of nursing homes and other institutions.

"We've had discussions at the federal level in the last 90 days that are completely different from where we've ever been before," Langer Jacobs said.

Taken together, the Medicaid moves represent some of the most substantive shifts in federal health policy undertaken by the new administration.

"They are taking very bold action," said Rutgers University political scientist Frank Thompson, an expert on Medicaid history, noting in particular the administration's swift reversal of Trump policies. "There really isn't a precedent."

The Biden administration seems unlikely to achieve what remains the holy grail for Medicaid advocates: getting 12 holdout states, including Texas and Florida, to expand Medicaid coverage to low-income working-age adults through the Affordable Care Act.

And while some of the recent expansions – including for new mothers -- were funded by close to $20 billion in new Medicaid funding in the COVID relief bill Biden signed in March, much of that new money will stop in a few years unless Congress appropriates additional money.

The White House strategy has risks. Medicaid, which swelled after enactment of the 2010 health law, has expanded further during the economic downturn caused by the pandemic, pushing enrollment to a record 80.5 million, including those served by the related Children's Health Insurance Program. That's up from 70 million before the COVID crisis began.

The programs now cost taxpayers more than $600 billion a year. And although the federal government will cover most of the cost of the Biden-backed expansions, surging Medicaid spending is a growing burden on state budgets.

The costs of expansion are a frequent target of conservative critics, including Trump officials like Seema Verma, the former administrator of the Centers for Medicare & Medicaid Services, who frequently argued for enrollment restrictions and derided Medicaid as low-quality coverage.

But even less partisan experts warn that Medicaid, which was created to provide medical care to low-income Americans, can't make up for all the inadequacies in government housing, food and education programs.

"Focusing on the social drivers of health ... is critically important in improving the health and well-being of Medicaid beneficiaries. But that doesn't mean that Medicaid can or should be responsible for paying for all of those services," said Matt Salo, head of the National Association of Medicaid Directors, noting that the program's financing "is simply not capable of sustaining those investments."

Restoring federal support

However, after four years of Trump administration efforts to scale back coverage, Biden and his appointees appear intent on not only restoring federal support for Medicaid, but also boosting the program's reach.

"I think what we learned during the repeal-and-replace debate is just how much people in this country care about the Medicaid program and how it's a lifeline to millions," Biden's new Medicare and Medicaid administrator, Chiquita Brooks-LaSure, told KHN, calling the program a "backbone to our country."

The Biden administration has already withdrawn permission the Trump administration had granted Arkansas and New Hampshire to place work requirements on some Medicaid enrollees.

In April, Biden blocked a multibillion-dollar Trump administration initiative to prop up Texas hospitals that care for uninsured patients, a policy that many critics said effectively discouraged Texas from expanding Medicaid coverage through the Affordable Care Act, often called Obamacare. Texas has the highest uninsured rate in the nation.

The moves have drawn criticism from Republicans, some of whom accuse the new administration of trampling states' rights to run their Medicaid programs as they choose.

"Biden is reasserting a larger federal role and not deferring to states," said Josh Archambault, a senior fellow at the conservative Foundation for Government Accountability.

But Biden's early initiatives have been widely hailed by patient advocates, public health experts and state officials in many blue states.

"It's a breath of fresh air," said Kim Bimestefer, head of Colorado's Department of Health Care Policy and Financing.

Chuck Ingoglia, head of the National Council for Mental Wellbeing, said: "To be in an environment where people are talking about expanding health care access has made an enormous difference."

Mounting evidence shows that expanded Medicaid coverage improves enrollees' health, as surveys and mortality data in recent years have identified greater health improvements in states that expanded Medicaid through the 2010 health law versus states that did not.

Broadening eligibility

In addition to removing Medicaid restrictions imposed by Trump administration officials, the Biden administration has backed a series of expansions to broaden eligibility and add services enrollees can receive.

Biden supported a provision in the COVID relief bill that gives states the option to extend Medicaid to new mothers for up to a year after they give birth. Many experts say such coverage could help reduce the U.S. maternal mortality rate, which is far higher than rates in other wealthy nations.

Several states, including Illinois and New Jersey, had sought permission from the Trump administration for such expanded coverage, but their requests languished.

The COVID relief bill — which passed without Republican support — also provides additional Medicaid money to states to set up mobile crisis services for people facing mental health or substance use emergencies, further broadening Medicaid's reach.

And states will get billions more to expand so-called home and community-based services such as help with cooking, bathing and other basic activities that can prevent Medicaid enrollees from having to be admitted to expensive nursing homes or other institutions.

Perhaps the most far-reaching Medicaid expansions being considered by the Biden administration would push the government health plan into covering services not traditionally considered health care, such as housing.

This reflects an emerging consensus among health policy experts that investments in some non-medical services can ultimately save Medicaid money by keeping patients out of the hospital.

In recent years, Medicaid officials in red and blue states — including Arizona, California, Illinois, Maryland and Washington — have begun exploring ways to provide rental assistance to select Medicaid enrollees to prevent medical complications linked to homelessness.

The Trump administration took steps to support similar efforts, clearing Medicare Advantage health plans to offer some enrollees non-medical benefits such as food, housing aid and assistance with utilities.

But state officials across the country said the new administration has signaled more support for both expanding current home-based services and adding new ones.

That has made a big difference, said Kate McEvoy, who directs Connecticut's Medicaid program. "There was a lot of discussion in the Trump administration," she said, "but not the capital to do it."

Other states are looking to the new administration to back efforts to expand Medicaid to inmates with mental health conditions and drug addiction so they can connect more easily to treatment once released.

Kentucky health secretary Eric Friedlander said he is hopeful federal officials will sign off on his state's initiative.

Still other states, such as California, say they are getting a more receptive audience in Washington for proposals to expand coverage to immigrants who are in the country without authorization, a step public health experts say can help improve community health and slow the spread of communicable diseases.

"Covering all Californians is critical to our mission," said Jacey Cooper, director of California's Medicaid program, known as Medi-Cal. "We really feel like the new administration is helping us ensure that everyone has access."

The Trump administration moved to restrict even authorized immigrants' access to the health care safety net, including the "public charge" rule that allowed immigration authorities to deny green cards to applicants if they used public programs such as Medicaid. In March, Biden abandoned that rule.

KHN correspondent Julie Rovner contributed to this report.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

This content is from Southern California Public Radio. View the original story at SCPR.org.

Advocates for expanding Medicaid in Kansas staged a protest outside the entrance to the statehouse parking garage in Topeka in May 2019. Today, twelve states have still not expanded Medicaid. The biggest are Texas, Florida, and Georgia, but there are a few outside the South, including Wyoming and Kansas.; Credit: John Hanna/AP

There are more than 2 million people across the United States who have no option when it comes to health insurance. They're in what's known as the "coverage gap" — they don't qualify for Medicaid in their state, and make too little money to be eligible for subsidized health plans on the Affordable Care Act insurance exchanges.

Briana Wright is one of those people. She's 27, lives near Jackson, Miss., works at McDonalds, and doesn't have health insurance. So to figure out her options when she recently learned she needed to have surgery to remove her gallbladder, she called Health Help Mississippi, a nonprofit that helps people enroll in health insurances.

Because she lives in Mississippi, "I wasn't going to be eligible for Medicaid — because I don't have children [and] I'm not pregnant," she tells NPR. When she had her income checked for Healthcare.gov, it was just shy of the federal poverty line — the minimum to qualify for subsidies. "It was $74 [short]. I was like, oh wow," she says.

Wright's inability to get a subsidized policy on Healthcare.gov is related to how the Affordable Care Act was originally designed. People needing insurance who were above the poverty line were supposed to be funneled via the federal and state insurance exchanges to private policies — with federal subsidies to help make those policies affordable. People who were under the poverty line were to be funneled to a newly-expanded version of Medicaid — the public health insurance program that is jointly funded by states and the federal government. But the Supreme Court made Medicaid expansion essentially optional in 2012, and many Republican-led states declined to expand. Today, there are 12 holdout states that have not expanded Medicaid, and Mississippi is one of them.

So, Wright is still uninsured. Her gallbladder is causing her pain, but she can't afford the surgery without shuffling household bills, and risking leaving something else unpaid. "I'm stressed out about it. I don't know what I'm going to do," she says. "I'm going to just have to pay it out of pocket or get on some payment plan until it all gets paid for."

Hoping to finally find a fix for Wright and the millions like her who are in Medicaid limbo, several teams of Democratic lawmakers have recently been hashing out several options — hoping to build on the momentum of the latest Supreme Court confirmation that the ACA is here to stay.

OPTION 1: Sweet-talk the 12 holdout states

The COVID-19 relief bill passed in March included financial enticements for these 12 states to expand Medicaid. Essentially, the federal government will cover 90% of the costs of the newly eligible population, and an additional 5% of the costs of those already enrolled.

It's a good financial deal. An analysis by the nonprofit Kaiser Family Foundation estimates that the net benefit for these states would be $9.6 billion. But, so far — publicly, at least — no states have indicated they intend to take the federal government up on its offer.

"If that is not getting states to move, then that suggests that the deep root of their hesitation is not about financial constraint," says Jamila Michener, a professor of government at Cornell University and author of the book Fragmented Democracy: Medicaid Federalism And Unequal Politics.

Instead, Michener says, the reluctance among some Republican-led legislatures and governors to expand Medicaid may be a combination of partisan resistance to President Obama's signature health law, and not believing "this kind of government intervention for these groups of people is appropriate."

What's Next: When asked about progress on this front in an April press briefing, Biden's press secretary Jen Psaki said "the President is certainly supportive of — and an advocate for — states expanding Medicaid," but did not answer a follow up about whether the White House was directly reaching out to governors regarding this option.

OPTION 2: Create a federal public option to fill the gap

Some have advocated for circumventing these holdout states and creating a new, standalone federal Medicaid program that people who fall into this coverage gap could join. It would be kind of like a tailored public option just for this group.

This idea was included in Biden's 2022 budget, which says, in part: "In States that have not expanded Medicaid, the President has proposed extending coverage to millions of people by providing premium-free, Medicaid-like coverage through a Federal public option, paired with financial incentives to ensure States maintain their existing expansions."

But it wouldn't be simple. "That can be quite complex — to implement a federal program that's targeted to just these 2.2 million people across a handful of states," says Robin Rudowitz, co-director of the Medicaid program at the Kaiser Family Foundation, who wrote a recent analysis of the policy options.

It also may be a heavy lift, politically, says Michener. "Anything that expanded the footprint of the federal government and its role in subsidizing health care would be especially challenging," she says.

What's next: This idea was raised as a possible solution in a letter last month from Georgia's Democratic senators to Senate leaders, and Sen. Raphael Warnock said this week he plans to introduce legislation soon.

OPTION 3: Get around stubborn states by letting cities expand Medicaid

Instead of centralizing the approach, this next idea goes even more local. The COVER Now Act, introduced by Rep. Lloyd Doggett, D-Texas, would empower local jurisdictions to expand Medicaid. So, if you live in Austin, Texas, maybe you could get Medicaid, even if someone in Lubbock still couldn't.

The political and logistical challenges would be tough, policy analysts say. Logistically, such a plan would require counties and cities to create new infrastructure to run a Medicaid program, Rudowitz notes, and the federal government would have to oversee how well these new local programs complied with all of Medicaid's rules.

"It does not seem feasible politically," Michener says. "The legislators who would have to vote to make this possible would be ceding quite a bit of power to localities." It also might amplify geographic equity concerns, she says. People's access to health insurance would not just "be arbitrarily based on what state you live in — which is the current state of affairs — It's also going to be arbitrary based on what county you live in, based on what city you live in."

What's next: Doggett introduced the bill earlier this month. There's no guarantee it would get a vote on the House floor and — even if it did — it wouldn't survive a likely filibuster in the evenly divided Senate.

OPTION 4: Change the ACA to open up the exchanges

A fourth idea, Rudowitz says, is to change the law to remove the minimum cutoff for the private health insurance exchanges, since "right now, individuals who are below poverty are not eligible for subsidies in the marketplace." With this option, states wouldn't be paying any of the costs, since the federal government pays premium subsidies, Rudowitz says, but "there are issues around beneficiary protections, benefits, out-of-pocket costs."

What's next: This idea hasn't yet been included in any current congressional bills.

Will any of these ideas come to fruition?

Even with a variety of ideas on the table, "there's no slam dunk option, it's a tough policy issue," Rudowitz says. All of these would be complicated to pull off.

It's possible Democrats will include one of these ideas in a reconciliation bill that could pass without the threat of a Republican filibuster. But that bill has yet to be written, and what will be included is anyone's guess.

Even so, Michener says she's glad the discussion of the Medicaid coverage gap is happening, because it's sensitizing the public, as well as people in power, to the problem and potentially changing the political dynamic down the line. "Even in policy areas where you don't have any kind of guaranteed victory, it is often worth fighting the fight," she says. "Politics is a long game."

This content is from Southern California Public Radio. View the original story at SCPR.org.

Are you a self- directed, organized individual who would thrive multi-tasking in a fast paced office environment?  Do you desire to help others who cannot afford the cost of healthcare?   Catawba County Social Services is recruiting for several Eligibility Specialists II roles in Adult and Family Medicaid.  
 
ADDITIONAL INFORMATION:

• Salary is negotiable for applicants who are fully qualified.  (1 year or more of Income Maintenance experience in Medicaid or Food and Nutrition Services eligibility)
• Applicants must possess one year of experience in income maintenance eligibility in a Department of Social Services in order to be fully qualified. However, trainees may be accepted.   Trainee pay is $39,729.10 per year.  

The Corporate Whistleblower Center is urging a RN, LPN or CNA who is currently working at a long term care facility to call them at 866-714-6466 about rewards if their work place is constantly so short staffed there is no way to care for patients.

To Address the Escalating Need for Substance Use Disorder Treatment, Boulder Announces New Services Available to UnitedHealthcare Members under 18.

Misfit Addiction Counseling is Colorado's Leader in Teletherapy

Information regarding Medicaid expansion for cessation coverage and the number of adult smokers enrolled.

Find out how this Supreme Court Decision may impact your client's cases. Plaintiff attorneys need to know and understand how this decision could impact clients' settlement dollars. Defense attorneys need…

Medicaid can now pay for medical and mental health care delivered on the sidewalk. This will transform how care for unhoused people can be given in the states that take advantage of the policy change.

(The Center Square) — Effective Jan. 1, through its Trans Health Equity Act, Maryland Medicaid coverage has expanded gender-affirming services and procedures.

New Jersey used an incorrect method to calculate Medicaid reimbursements for services provided to students with disabilities, according to a federal audit, but the state disputes that claim.

Attorney General Kathy Jennings announced Friday that Delaware’s Medicaid program would receive $7,666,379.00 following a settlement that would resolve federal False Claims Act (FCA) and Delaware False Claims and Reporting Act (DFCRA) allegations against Christiana Care Health System (CCHS). The case, which was initiated by a whistleblower, alleges that CHSS provided free or below-market value […]

NEW CASTLE (Julio 12, 2022) – El Departamento de Salud y Servicios Sociales (DHSS) anunció hoy que ha seleccionado tres compañias para operar su Programa de Atención Administrada de Medicaid. La División de Medicaid y Asistencia Médica (DMMA) del DHSS continuará su asociación de MCO con Highmark Health Options Blue Cross Blue Shield, que empezó […]

NEW CASTLE (July 12, 2022) – The Department of Health and Social Services (DHSS) announced today that it has selected three companies to operate its Medicaid Managed Care Program. DHSS’ Division of Medicaid and Medical Assistance (DMMA) will continue its MCO partnership with Highmark Health Options Blue Cross Blue Shield, which began in 2015, and […]

Congress sets April 1, 2023, as Medicaid renewal start date; Members should verify contact information with DHSS  The Delaware Department of Health and Social Services (DHSS) will resume the standard eligibility renewal process for Medicaid and CHIP recipients starting April 1, 2023, as required by federal law. Annual renewals have not been required since March […]

Medicaid renewals began April 1;   Members should verify contact information with DHSS, watch for renewal information  The Delaware Department of Health and Social Services (DHSS) has resumed the standard eligibility renewal process for Medicaid and CHIP recipients as of April 1, 2023, as required by federal law. Annual renewals were not required from March […]

NEW CASTLE (June 16, 2023) – The Delaware Department of Health and Social Services’ Division of Medicaid and Medical Assistance announces that it has extended Medicaid postpartum health care coverage from 60 days to 12 months after the end of a pregnancy. This expansion is made possible through a State Plan Amendment approved by the Centers […]

Attorney General Kathy Jennings announced on Monday that a Maryland resident was arrested for allegedly stealing the identity of a registered nurse (“RN”), and then trying to use those credentials to fraudulently obtain employment in Delaware nursing homes.  “The licensing system for healthcare professionals is crucial to patient safety,” Attorney General Jennings said.  “The Delaware Department of […]

Title: Michigan Senate OK's Medicaid Expansion
Category: Health News
Created: 8/30/2013 11:00:00 AM
Last Editorial Review: 8/30/2013 12:00:00 AM

PURPOSE

Despite being key to better health outcomes for patients from racial and ethnic minority groups, the proportion of underrepresented in medicine (URiM) physicians remains low in the US health care system. This study linked a nationally representative sample of family physicians (FPs) with Medicaid claims data to explore the relative contributions to care of Medicaid populations by FP race and ethnicity.

Whitney Haggerson — vice president of health equity and Medicaid at Providence — discussed the significance of her role, as well as how her health system is working to give all employees, regardless of title, the skills needed to help reduce health inequities.

The post Inside Providence’s Health Equity & Medicaid Strategy appeared first on MedCity News.

Between 1999 and 2014, opioid use disorder (OUD) among pregnant women more than quadrupled, risking the health of the women—before and after giving birth—and their infants. As states grapple with COVID-19’s exacerbation of the opioid crisis, several are taking innovative steps to address the needs of high-risk groups, including low-income, postpartum patients with OUD.

State, National Long Term Care Leaders to Warn of Growing Threat to Washington Seniors' Care in Wake of Legislative Sess

Individuals with disabilities were more likely to be employed in Medicaid expansion states compared to other states who have not expanded their Medicaid policy, finds a new study.

The rise of suicide cases has slowed slightly in states that have implemented Medicaid expansion. "Suicide is a public health problem, and our findings

Minorities and women enrolled in Medicaid program are less likely to receive regional anesthesia techniques. The study of more than 56,000 patients

Among young adults aged 18-39 newly diagnosed with cancer, the expanded Medicaid coverage under the Affordable Care Act (ACA) led to better survival outcomes,

In states that expanded Medicaid, a 17% reduction in hospitalizations during the first 60 days postpartum was observed. The study also revealed some

Medicaid-benefit eligibility being expanded to cover all people earning up to 138 percent of the federal poverty line decreased Black-white disparities

1 in 10 Medicaid patients receive long-acting birth control methods such as IUDs and implants from their primary care physicians, revealed study published in iJAMA Health Forum.

In United States among different cities, medical reimbursement for the same medlinkmental health/medlink treatment was found to vary dramatically.

Medicaid telemedicine coverage is linked to meaningful growth in medlinktelemedicine/medlink use and increased healthcare access, according to a study

medlinkMedicaid/medlink expansion provision of the Affordable Care Act to more people enhanced patient outcomes, prevention measures and screening access (!--ref1--).

Adults with medlinkDown syndrome/medlink exhibit more consistent enrollment in Medicaid, alongside higher expenses and utilization of services, when

The Affordable Care Act (ACA) seeks to enhance healthcare accessibility, yet its impact on maternal and newborn health in women with medlinkgestational

A survey of low-income adults in Arkansas, Kentucky, Louisiana, and Texas revealed that one in eight respondents who had enrolled in Medicaid at some

Millions of Americans who gained Medicaid coverage during the medlinkCOVID-19 pandemic/medlink have lost their benefits since March 2023 due to the

Medicaid's Accountable Care Organizations ACOs failed to significantly improve asthma care for children during their initial three-year period, revealed study published in iJAMA Pediatrics/i.

Medicaid expansion under the Affordable Care Act (ACA) is associated with better outcomes for patients with hormone receptor (HR)-negative, human epidermal

The Corporate Whistleblower Center is now urging a CNA, LPN or a RN at a nursing home or a skilled nursing facility that is constantly short staffed to call them-if the owner of the facility is billing Medicaid as if they are fully staffed.

The Corporate Whistleblower Center says, "We are urging a LPN, RN or CNA with proof a nursing home is billing Medicaid as if the facility is fully staffed with caregivers-when if fact the facility is short-staffed to call us about possible rewards."

The Corporate Whistleblower Center is inviting a RN, LPN or CNA anywhere in the nation to call them at 866-714-6466 if they work far a nursing home that is so short staffed their patients are dying prematurely. This is a nationwide problem.

The Corporate Whistleblower Center is urging a RN. LPN or CNA to call them anytime at 866-714-6466 if they work for a long term care facility that is short on staff. There can be significant rewards for information about Medicare-Medicaid fraud.

The Corporate Whistleblower Center says, "We are urging an employee at a drug rehab center that is supposed to be helping Medicaid patients with their drug addiction to call us if your employer is billing for services that didn't happen-get rewarded.

On the Young Turks, Cenk Uygur quotes passages from Bob Woodward's book, "The Price of Politics", quoting statements made by President Obama proving that he intends to cut entitlements like social security, medicare, and medicaid. Continue reading →

OBJECTIVE

To compare trends in Medicaid expenditures among adults with diabetes who were newly eligible due to the Affordable Care Act (ACA) Medicaid expansion to trends among those previously eligible.

The ADA said it believes a new policy from the Centers for Medicare and Medicaid could be “detrimental” to the millions of adults who rely on Medicaid for dental care.

Cancer patients on Medicaid or who don't have insurance benefit less from experimental treatments, even if they get into clinical trials, a study published Thursday by JAMA Network Open has found.