NEWS & VIEWS

November 21, 2024

What Administrative Changes Can Be Made to Medicaid?

There has been much discussion online, in podcasts, on TV, and in the news about what Medicaid looks like under a new Administration. To cut through the noise, here is a brief explainer from KFF on the roles and responsibilities of a presidential administration with regard to Medicaid.

The President is responsible for implementing and enforcing laws written by Congress. One way this Executive Branch power is exhibited is through Federal agencies. Each presidential administration appoints the director and chooses the goals of the agencies under his authority. What could this mean for Medicaid implementation?

1. The Centers for Medicare and Medicaid Services (CMS) is the agency in charge of Medicaid waivers. A presidential administration can prioritize what types of 1115 and demonstration waivers are approved, rescinded, withdrawn, or rejected. For example, CMS could encourage states to submit waivers that include work requirements, capped financing, and more flexibility on how Medicaid funds are spent.
2. Regulations relating to Medicaid can be delayed or rolled back, or an administration could choose to issue new regulations. For example, a new Administration could roll back a rule commonly referred to as "continuous enrollment".
3. An administration has the authority to issue sub-regulatory guidance. For example, an administration could work towards reducing enrollment by encouraging states to conduct eligibility verification in between annual renewal periods.

Agency Rulemaking as an Overlooked

Source of Health Disparities

Federal and state agency rulemaking – the process of issuing legal binding rules and regulations – has a significant impact on health policy. In a new Milbank Quarterly Guest Opinion, Simon F. Haeder of Texas A&M University and Susan Webb Yackee of the University of Wisconsin, Madison, highlight the influence of outside business interests in the rulemaking process.

Teacher Shortage Impacts on Students with Disabilities - Public Comment

On Friday, November 15, the U.S. Commission on Civil Rights held a briefing on the federal response to teacher shortage impacts on students with disabilities. In addition to hearing from government officials, current and past educators, researchers, and impacted persons, the Commission has opened up the public comment period to hear from anyone wanting to share information for consideration. 

2025 ISHN Conference Call for Proposals is Open!

The theme, Health at Home & Beyond, acknowledges that home is not limited to a physical dwelling. Young people thrive in spaces of learning, working, playing, and reverence. Home can represent any space where Hoosier kids feel safe, secure, nurtured, and heard. It is incumbent upon the adults in their lives to create those environments. Join this year’s conference to support the next generation of school and health professionals and the children they serve. The conference is June 9-11, 2025 at Embassy Suites Plainfield. Submission deadline is January 6, 2025.

Call for Sponsors is Open!

Sponsorship levels and perks are below. Submission deadline is April 1, 2025.

Members Cannot be Billed

A recent IHCP bulletin reminds providers that federal and state regulations prohibit providers from charging Indiana Health Coverage Programs (IHCP) members for any unpaid amount for IHCP covered services. This applies to both members in managed care and in fee-for-service programs. Also, providers cannot charge members for missed appointments, or for copies or transfers of medical records.

There are a few exceptions. Providers may bill a member for noncovered services if they have explained, prior to providing the service, that the specific service will not be covered or that they are a non-IHCP provider. More examples are provided in the bulletin. 

Military Family Relief Fund

The Indiana Department of Veteran’s Affairs is offering their annual Operation Holiday Program to assist veterans and their families with incomes at or below 200% of the federal poverty level. Qualifying veterans will receive $200 for a holiday meal plus $300 per dependent child from the Miliary Family Relief fund. Applications are due by December 13^th. 

High Health Care Costs Despite Coverage

Thanks to the Affordable Care Act, the U.S. uninsured rate has dropped to a record low! However, millions of Americans are still facing high health care costs despite having coverage. According to the Commonwealth Fund’s latest Biennial Health Insurance Survey:

• Nearly one in four working-age adults are underinsured, meaning their health plan’s high out-of-pocket costs make it difficult to afford care. Two-thirds of these individuals are in employer plans. 
• More than half of uninsured or underinsured adults skip recommended treatments or don’t fill prescriptions because of the cost. 
• Many people have medical debt: 44 percent of underinsured adults carry debt and face financial hardship. 

The report includes more details from the survey as well as ideas on what can be done to protect people from the high cost of health care.

Building Healthy Futures: Addressing Mental Health and Substance Use Disorders During Pregnancy and Postpartum

The United States has one of the highest maternal mortality rates among high-income countries, significantly driven by mental health and substance use disorders (SUD). These behavioral health conditions contribute to over 20 percent of postpartum deaths, primarily through suicide and SUD overdoses.

This report from the Center for Health Care Strategies (CHCS) examines access to care challenges and outlines key recommendations to support evidence-based, person-centered perinatal services for individuals with mental health disorders and/or SUD. Examples and recommendations can guide states, health plans, health systems, providers, and community-based organizations in improving maternal health and building healthier futures for moms and babies nationwide.

988 Lifeline Upgrade

Much has changed since the Suicide & Crisis Lifeline launched in 2005, including an abbreviation to 988 and how people call to receive care.

Instead of using a landline, 80% of calls come from cellphones, which prompted an upgrade from the Federal Communications Commission.

Thanks to a new rule change, people who call 988 will now be connected with a call center in their immediate area, rather than based on their area code.

AI and Health Communications

The Centers for Disease Control’s (CDC’s) latest Listen Up! podcast episode, AI for Good: Maximizing AI in Health Communication, answers important questions such as:

• What applications hold the most promise for health communication?
• What are the risks and pitfalls?
• What digital fluency is needed to understand these tools?

Structural Determinants of Health

With support from the County Health Rankings & Roadmaps, the Indiana Public Health Association is hosting a Structural Determinants of Health training. Learning objectives include:

• Defining Structural Determinants of Health, Power, and Health Equity
• Understanding how to apply these concepts to present day context using case studies
• Identifying how we can intentionally work to change structural determinants of health

The training is on December 4, 2024 from 2 - 4 pm ET on Zoom.

Did you know, Indiana Health Coverage Programs are prohibited from charging an IHCP member, with a few exceptions? (If not, head back up to the Outreach & Enrollment section for the bulletin.)

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