Tag: Medicaid

Can Baby Bonds Fight the Wealth Gap and Racial Inequality? Connecticut Aims to Find Out.

Mary Pat Campbell

Link: https://www.ineteconomics.org/perspectives/blog/can-baby-bonds-fight-the-wealth-gap-and-propel-racial-equality-connecticut-aims-to-find-out

Excerpt:

Connecticut has made history as the first state to implement a baby bonds program — fully funded for 12 years of babies.

The state will invest $3,200 for each baby covered by HUSKY, the state’s Medicaid program – that’s about 15,000 babies a year and a whopping 36% of the state’s children. Kids are automatically enrolled; no action is required. Upon reaching adulthood (18-30), participants can claim funds for specific wealth-and-opportunity-building purposes like higher education, a home purchase, or starting a business in the state. To receive the funds, they have to be Connecticut residents and need to complete a financial literacy course (hopefully not one funded by self-serving Wall Street firms). The initial $3,200 investment is anticipated to grow to $11,000 – $24,000, depending on when claims are filed.

Turning the idea of baby bonds into reality was a rocky road: the Democratic-led Connecticut General Assembly passed the bill in 2021, championed by former Democratic Treasurer Shawn Wooden. However, Governor Lamont and his team initially opposed the program’s funding, citing concerns over borrowing more than $50 million annually. Internal conflict heated up, as revealed in a January 2023 investigation by the Connecticut Mirror, exposing tensions between Wooden and the governor’s staff. Yet, following the publication, the situation took an unexpected turn. The program became a reality.

The sticking point of funding was solved by a plan to use a $393 million reserve fund established in 2019 during the restructuring of the state’s cash-strapped pension fund for municipal teachers. Originally designed to cover shortfalls in pension fund contributions, this reserve could be repurposed. To safeguard the pension system and meet ratings agencies’ requirements, a $12 million insurance policy was necessary, leaving approximately $381 million available for investment in the baby bonds program.

Author(s): Lynn Parramore

Publication Date: 27 Feb 2024

Publication Site: Institute for New Economic Thinking

Few Nursing Facility Residents and Staff Have Received the Latest COVID-19 Vaccine

Mary Pat Campbell

Link: https://www.kff.org/medicaid/issue-brief/few-nursing-facility-residents-and-staff-have-received-the-latest-covid-19-vaccine/

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Excerpt:

Uptake of the current COVID-19 vaccine is higher in non-profit facilities than in for-profit or government facilities (Figure 2). The percentage of nursing facility residents who received the updated vaccine is 46% in non-profit facilities compared with 35% in for-profit facilities and 43% in government facilities. Uptake of the fall 2022 vaccine was also highest in non-profit facilities and lowest in for-profit facilities. Rates of vaccine uptake for nursing facility staff were low in all types of facilities with minimal variation across facility types (data not shown).

Author(s): Priya Chidambaram and Alice Burns

Publication Date: 13 Feb 2024

Publication Site: KFF, Medicaid

Lessons Learned During the Pandemic Can Help Improve Care in Nursing Homes

Mary Pat Campbell

Link: https://oig.hhs.gov/documents/evaluation/9808/OEI-02-20-00492.pdf

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Excerpt:

OIG recommends that the Centers for Medicare & Medicaid Services (CMS):

1. Implement and expand upon its policies and programs to strengthen the nursing home workforce.

2. Reassess nurse aide training and certification requirements.

3. Update the nursing home requirements for infection control to incorporate lessons learned from the pandemic.

4. Provide effective guidance and assistance to nursing homes on how to comply with updated infection control requirements.

5. Facilitate sharing of strategies and information to help nursing homes overcome challenges and improve care.

CMS did not explicitly state its concurrence or nonconcurrence for the five recommendations.

Author: Christi A. Grimm

Publication Date: February 2024

Publication Site: Office of the Inspector General, HHS

Americans’ Challenges with Health Care Costs

Mary Pat Campbell

Link: https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/

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Excerpt:

  • About half of U.S. adults say it is difficult to afford health care costs, and one in four say they or a family member in their household had problems paying for health care in the past 12 months. Younger adults, those with lower incomes, adults in fair or poor health, and the uninsured are particularly likely to report problems affording health care in the past year.
  • The cost of health care can lead some to put off needed care. One in four adults say that in the past 12 months they have skipped or postponed getting health care they needed because of the cost. Notably six in ten uninsured adults (61%) say they went without needed care because of the cost.
  • The cost of prescription drugs prevents some people from filling prescriptions. About one in five adults (21%) say they have not filled a prescription because of the cost while a similar share say they have instead opted for over-the-counter alternatives. About one in ten adults say they have cut pills in half or skipped doses of medicine in the last year because of the cost.
  • Those who are covered by health insurance are not immune to the burden of health care costs. About four in ten insured adults worry about affording their monthly health insurance premium, and 48% worry about affording their deductible before health insurance kicks in. Indeed, large shares of adults with employer-sponsored insurance (ESI) and those with Marketplace coverage rate their insurance as “fair” or “poor” when it comes to their monthly premium and to out-of-pocket costs to see a doctor.
  • Health care debt is a burden for a large share of Americans. About four in ten adults (41%) report having debt due to medical or dental bills including debts owed to credit cards, collections agencies, family and friends, banks, and other lenders to pay for their health care costs, with disproportionate shares of Black and Hispanic adults, women, parents, those with low incomes, and uninsured adults saying they have health care debt.
  • Notable shares of adults still say they are worried about affording medical costs such as unexpected bills, deductibles, and long-term care services for themselves or a family member. Additionally, about half of adults would be unable to pay an unexpected medical bill of $500 in full without going into debt.

Author(s): Lunna Lopes, Marley Presiado, and Liz Hamel

Publication Date: 21 Dec 2023

Publication Site: Kaiser Family Foundation

‘Worse Than People Can Imagine’: Medicaid ‘Unwinding’ Breeds Chaos in States

Mary Pat Campbell

Link: https://kffhealthnews.org/news/article/medicaid-unwinding-disenrollment-redetermination-state-delays/

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Excerpt:

Seven months into what was predicted to be the biggest upheaval in the 58-year history of the government health insurance program for people with low incomes and disabilities, states have reviewed the eligibility of more than 28 million people and terminated coverage for over 10 million of them. Millions more are expected to lose Medicaid in the coming months.

The unprecedented enrollment drop comes after federal protections ended this spring that had prohibited states from removing people from Medicaid during the three pandemic years. Since March 2020, enrollment in Medicaid and the related Children’s Health Insurance Program had surged by more than 22 million to reach 94 million people.

The process of reviewing all recipients’ eligibility has been anything but smooth for many Medicaid enrollees. Some are losing coverage without understanding why. Some are struggling to prove they’re still eligible. Recipients and patient advocates say Medicaid officials sent mandatory renewal forms to outdated addresses, miscalculated income levels, and offered clumsy translations of the documents. Attempting to process the cases of tens of millions of people at the same time also has exacerbated long-standing weaknesses in the bureaucratic system. Some suspect particular states have used the confusing system to discourage enrollment.

Author(s): Phil Galewitz and Katheryn Houghton and Brett Kelman and Samantha Liss

Publication Date: 2 Nov 2023

Publication Site: Kaiser Health News

Medicaid Enrollment and Unwinding Tracker – 11 Oct 2023

Mary Pat Campbell

Link: https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-and-unwinding-tracker/

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Excerpt:

There is wide variation in disenrollment rates across reporting states, ranging from 66% in Texas to 11% in Illinois. Differences in who states are targeting with early renewals as well as differences in renewal policies and system capacity likely explain some of the variation in disenrollment rates. Some states (such as Texas and South Carolina) are initially targeting people early in the unwinding period that they think are no longer eligible or who did not respond to renewal requests during the pandemic, but other states are conducting renewals based on an individual’s renewal date. Additionally, some states have adopted several policies that promote continued coverage among those who remain eligible and have automated eligibility systems that can more easily and accurately process renewals while other states have adopted fewer of these policies and have more manually-driven systems.

Publication Date: last updated 11 Oct 2023

Publication Site: Kaiser Family Foundation

Small Town and Rural Hospitals Are at Risk of Closing due to Funding

Mary Pat Campbell

Link: https://angrybearblog.com/2023/06/107367

pdf report: https://chqpr.org/downloads/Rural_Hospitals_at_Risk_of_Closing.pdf

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Excerpt:

Things are changing more rapidly. Smaller hospitals are under an attack of high costs and less revenue. As a result, many are closing leaving the small town and rural residents without medical care or having to drive long distances in emergencies. As reported by Healthcare Quality and Payment Reform:

Many people across the country could not receive hospital care in their community when the pandemic began. Over 150 rural hospitals closed between 2005 and 2019. An additional 19 rural hospitals closed in 2020, more than any year in the previous decade. The closures are not resulting from the pandemic, but by financial losses in previous years. Ten more rural hospitals closed in 2021 and 2022. The closures decreased in 2019 due to the special financial assistance hospitals received during the pandemic. The pandemic aid has ended and closures are likely to increase.

Hundreds of Hospitals are at Risk of Closing

Six hundred rural hospitals or ~ 30% of all rural hospitals in the country are at risk of closing. At risk because of the serious financial problems, they are experiencing:

Author(s): Center for Healthcare Quality and Payment Reform

Publication Date: 7 Jun 2023 on blog, accessed 14 Jun 2023

Publication Site: Angry Bear Blog

Biden Admin Implores States to Slow Medicaid Cuts After More Than 1M Enrollees Dropped

Mary Pat Campbell

Link: https://kffhealthnews.org/news/article/biden-administration-states-medicaid-cuts-million-dropped/

Excerpt:

Too many Americans are losing Medicaid coverage because of red tape, and states should do more to make sure eligible people keep their health insurance, the Biden administration said Monday.

More than a million Americans have lost coverage through the program for low-income and disabled Americans in the past several weeks, following the end of pandemic protections on April 1, according to the latest Medicaid renewal data from more than 20 states.

After a three-year pause, most states have now resumed checking which Medicaid recipients remain eligible and dropping those who no longer qualify or don’t complete required paperwork. About 4 in 5 people dropped so far either never returned the paperwork or omitted required documents, federal and state data show.

….

The Biden administration outlined several optional steps states can take to ensure everyone who still qualifies for the safety-net health insurance program stays covered. For instance, states can pause the cancellations to allow more time to reach people who haven’t responded. Health insurance companies that manage Medicaid plans can help their enrollees fill out the paperwork.

Author(s): Hannah Recht

Publication Date: 13 Jun 2023

Publication Site: Kaiser Health News

To Attract In-Home Caregivers, California Offers Paid Training — And Self-Care

Mary Pat Campbell

Link: https://khn.org/news/article/california-paid-training-self-care-in-home-caregivers/

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Excerpt:

The class is a little touchy-feely. But it’s one of many offerings from the California Department of Social Services that the agency says is necessary for attracting and retaining caregivers in a state-funded assistance program that helps 650,000 low-income people who are older or disabled age in place, usually at home. As part of the $295 million initiative, officials said, thousands of classes, both online and in-person, will begin rolling out in January, focused on dozens of topics, including dementia care, first-aid training, medication management, fall prevention, and self-care. Caregivers will be paid for the time they spend developing skills.

Whether it will help the program’s labor shortage remains to be seen. According to a 2021 state audit of the In-Home Supportive Services program, 32 out of 51 counties that responded to a survey reported a shortage of caregivers. Separately, auditors found that clients waited an average of 72 days to be approved for the program, although the department said most application delays were due to missing information from the applicants.

The in-home assistance program, which has been around for nearly 50 years, is plagued by high turnover. About 1 in 3 caregivers leave the program each year, according to University of California-Davis researcher Heather Young, who worked on a 2019 government report on California’s health care workforce needs.

Author(s): Laurie Udesky

Publication Date: 9 Dec 2022

Publication Site: Kaiser Health News

What happens when the public health emergency associated with COVID-19 ends?

Mary Pat Campbell

Link: https://contingencies.org/the-great-unwinding/

Excerpt:

The ongoing COVID-19 pandemic has now spanned three years. A lot has changed and will continue to change once society and every industry, especially health care, adjusts to the new post-COVID world. With the pandemic, a federal public health emergency (PHE) was declared, and legislation was then passed that had a major impact on how health care is administered from both an operational and financial perspective. Many temporary provisions were put into place that mostly impact Medicaid but ultimately affect all health insurance payers. As we look ahead to a point at which the PHE ends, those temporary provisions start to end in what many in the industry are calling the “unwinding of the PHE.” This article aims to provide an overview of the flexibilities that have been offered as a result of legislation tied to the PHE, examine the impacts of increased Medicaid enrollment, and assess how the risk profile of covered lives for all health insurance payers has changed.

The PHE that has been in effect because of the virus SARS-CoV-2 (which causes the disease COVID-19, or simply COVID), was declared on March 12, 2020, retroactively effective as of Jan. 31, 2020. 

….

Where does this leave us now? At the time of this writing, the PHE is under its ninth renewal (90-day extensions) and is set to expire July 15, 2022. HHS has previously informed states that at least 60 days’ notice will be provided, which means the end of the PHE will occur July 2022 or later. States receive the additional FMAP bump through the end of the quarter in which the PHE ends, which is slated to be Sept. 30, 2022. Before the omicron wave, many thought the PHE would end in early 2022. Popular opinion seems to have shifted to a later time period, with mid-to-late 2022 being the likely end of the PHE. Any continued uncertainty with the pandemic, such as another wave of cases, is likely to extend the PHE.

As we get close to the end of the PHE though, the focus shifts from case counts and test kits to the virus becoming endemic and moving past the PHE. This puts, front and center, the unwinding of all of the operational and financial elements that have been tied to the PHE since FFCRA was passed. When the unwinding starts, it will radically change the risk profile of Medicaid and all other health payors. Measuring and mitigating against this changing risk profile is where the nature of our profession as actuaries becomes critical. The biggest driver in the changing risk profile is the enrollment growth that has occurred with Medicaid since the pandemic began, as a number of these new members are at risk of losing their coverage.

Author(s): Colby Schaeffer

Publication Date: May/June 2022

Publication Site: Contingencies

Despite a First-Ever ‘Right-to-Repair’ Law, There’s No Easy Fix for Wheelchair Users

Mary Pat Campbell

Link: https://khn.org/news/article/power-wheelchair-users-right-to-repair-law-no-easy-fix/

Excerpt:

The multibillion-dollar power-wheelchair market is dominated by two national suppliers, Numotion and National Seating and Mobility. Both are owned by private equity firms that seek to increase profits and cut spending. One way they do that is by limiting what they spend on technicians and repairs, which, when combined with insurance and regulatory obstacles, frustrates wheelchair users seeking timely fixes.

The $70 billion durable medical equipment market has been an attractive target for private equity investment because of the aging U.S. population, the increasing prevalence of chronic conditions, and a growing preference for older adults to be treated at home, according to the investment banking firm Provident Healthcare Partners. Medicare’s use of competitive bidding favors large companies that can achieve economies of scale in manufacturing and administrative costs, often at the price of quality and customer service.

Regulations set by Medicare and adopted by most Medicaid and commercial health plans have led to lower-quality products, no coverage for preventive maintenance, and enough red tape to bring wheelchairs to a halt.

Power wheelchair users have long been fighting for the right to repair their wheelchairs themselves or through independent repair shops. Medicare and most insurance companies will replace complex wheelchairs only every five years. The wheelchair suppliers that have contracts with public and private health insurance plans restrict access to parts, tools, and service manuals. They usually keep a limited inventory of parts on hand and wait until health plans approve repair claims before ordering parts.

Some chairs require a software passcode or a physical key for any repairs. Wheelchair users who make fixes themselves may void their warranty or lose out on insurance payments for repairs.

Author(s): Markian Hawryluk

Publication Date: 2 June 2022

Publication Site: Kaiser Health News

2021 Academy Legislative/Regulatory Review

Mary Pat Campbell

Link: https://www.actuary.org/sites/default/files/members/alerts/pdf/2022/2022-CP-1.pdf

Excerpt:

The American Academy of Actuaries presents this summary of select significant regulatory and
legislative developments in 2021 at the state, federal, and international levels of interest to the U.S.
actuarial profession as a service to its members.

Introduction

The Academy focused on key policy debates in 2021 regarding pensions and retirement, health, life,
and property and casualty insurance, and risk management and financial reporting.


Responding to the COVID-19 pandemic, addressing ever-changing cyber risk concerns, and analyzing
the implications and actuarial impacts of data science modeling continued to be a focus in 2021.


Practice councils monitored and responded to numerous legislative developments at the state, federal,
and international level. The Academy also increased its focus on the varied impacts of climate risk and
public policy initiatives related to racial equity and unfair discrimination in 2021.


The Academy continues to track the progress of legislative and regulatory developments on actuarially
relevant issues that have carried over into the 2022 calendar year.

Publication Date: 15 Feb 2022

Publication Site: American Academy of Actuaries