Washington, DC Update 8/9/23 | |
It's August Recess, and Members of Congress are in their home states. The Senate will be back on Tuesday, September 5, followed by the House on Tuesday, September 12. | |
Unwinding of Medicaid Continuous Coverage and the PHE | |
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NHeLP: Lawsuit Against Medicaid - Tennessee
A.M.C. v. Smith was brought by the National Health Law Program (NHeLP), Tennessee Justice Center, National Center for Law & Economic Justice, and pro bono counsel Selendy Gay Elsberg PLLC in 2020. The lawsuit challenges TennCare’s notices, refusal to grant appeals, and the limited access to the program for people with disabilities.
In response to the state’s recent efforts to dismiss the case (in a filing known as a “Motion for Summary Judgment”), NHeLP and its co-counsel submitted new evidence this week, including stories from several TennCare enrollees describing the barriers they face to renewing their coverage during the unwinding.
This short explainer to provides a brief overview of the case and highlights the harms caused by Tennessee’s Medicaid unwinding process. Learn more about this case and access legal documents here.
The Consolidated Appropriations Act, 2023 (CAA, 2023) requires state monthly reporting about activities related to eligibility renewals, call center operations and transitions to Marketplace coverage, from April 1, 2023, through June 30, 2024. CMS is also providing information such as changes in Medicaid, CHIP and Marketplace enrollment; state operational data; and additional renewal metrics. These data show how states are resuming regular eligibility operations following the end of the Medicaid continuous enrollment condition.
CMS Summary documents on the March and April 2023 Renewal Data released in July
Data Overview:
Unsure of how to read or interpret the first official batch of Medicaid renewal data? What is the data telling us beyond the concern about disenrollment? Georgetown Center for Children and Families (CCF) has blogs that address these questions.
Much of the discussion of data has focused on the number of disenrollments; however, in this blog, CCF dives into the call center data released at the same time. States have been required to report call center data monthly as part of CMS’s performance indicator project; however, most of these data have never been publicized. Call center statistics can provide insights into states’ unwinding and provide an early warning if things are going wrong. For example, when call abandonment rates increase, it is likely that enrollees are not getting the assistance they need to complete their renewal forms.
In this second blog, CCF analyzes the initial data released by CMS in this first batch regarding marketplace enrollment. Although CMS noted that “[m]any people leaving Medicaid or CHIP may transition to Marketplace coverage;” the early data is not promising. For example, according to CMS, nearly 715,000 beneficiaries lost their Medicaid coverage in the 18 states that began unwinding renewals in April. Separately, CMS reports that only about 68,000 people that could be identified as being enrolled in Medicaid or CHIP in March applied for federal marketplace coverage in HealthCare.gov states that started unwinding in April.
Unwinding Data For your State
The Kaiser Family Foundation (KFF) Medicaid Enrollment and Unwinding Tracker presents the most recent data on monthly Medicaid enrollment, renewals, disenrollments, and other key indicators reported by states during the unwinding of the Medicaid continuous enrollment provision. The unwinding data are pulled from state websites, where available, and from the Centers for Medicare & Medicaid Services (CMS). To view data for specific states, click on the State Data tab.
CMS: Medicaid Renewal Webinars - Special Populations
Join the Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), and Children’s Health Insurance Program (CHIP) Renewal webinars focused on special populations. This webinar series will provide partners with strategies to reach out to diverse communities and audiences to share information about Medicaid and CHIP renewals. Each webinar will also include a “train-the-trainer” presentation, during which CMS will walk through a set of downloadable slides that partners can use to educate others in their communities about Medicaid and CHIP renewals.
All sessions run from 3-4 pm EST:
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Thursday, August 10th: Reaching Black American Populations
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Thursday, August 17th: Reaching Aging and Disability Populations
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Thursday, August 24th: Reaching Rural Populations
Who should attend? If you or your organization serves or interacts with people with Medicaid or CHIP, then these calls are for you. RSVP: Click here
When you register, please select each webinar you would like to attend from the list at the top of the page. Please send all questions to [email protected].
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CMS: HCBS Appendix K Extension
Last week CMS issued a letter to State Medicaid Directors announcing an update to CMS’s policy regarding the end date for flexibilities approved in states’ section 1915(c) Home and Community-Based Services (HCBS) waiver Appendix K amendments. States have relied extensively throughout the PHE on flexibilities permitted under Appendix K to authorize actions in their home and community-based services programs such as the use of telehealth or remote service provision, increased payment rates, expansion of self-direction service delivery models, addition or expansion of services, and expansion of provider networks to include family members and legally responsible individuals. Under prior policy, these flexibilities were set to expire six months after the expiration of the COVID-19 PHE. However, as described below, these flexibilities may remain in effect for a longer period of time.
CMS issued this guidance in recognition of the number of section 1915(c) waiver actions already submitted and expected to be submitted by states to incorporate Appendix K flexibilities into the ongoing operations of their HCBS programs. The nature of these amendments, namely those to modify services, payment rates and provider qualifications, meets the definition of a “substantive change” defined at 42 CFR § 441.304(d), and therefore requires an effective date no earlier than the date of
CMS approval and requires public notice to be conducted prior to submission of the action to CMS, as defined in § 441.304(f).
The ability for these waiver actions to be submitted, reviewed and approved by November 11, 2023, to prevent a lapse in authority, is highly uncertain. In the name of minimizing disruption to beneficiaries, providers and states, CMS is issuing this extension of the Appendix K expiration date. States are nevertheless strongly encouraged to submit their section 1915(c) waiver actions and section 1115 demonstration amendments as quickly as possible, to minimize Appendix/Attachment K extensions for unreasonably long periods of time. If a state has not submitted a waiver action or demonstration amendment to incorporate Appendix K flexibilities into an underlying program by November 11, 2023, the Appendix K flexibility will expire for that program on that date.
This Disability Scoop article offers a great summary.
HHS: Funding for Human Trafficking
The National Human Trafficking Hotline estimates that 26.7 million people were impacted globally by human trafficking in 2021. Human trafficking is a crime that exploits a person for compelled labor, services, or commercial sex acts. While anyone can be a victim of human trafficking, Black, Latino, American Indian, Alaska Natives, Asians, Native Hawaiians, Pacific Islanders, LGBTQI+ individuals, people with disabilities, and individuals with low income are among the populations that are most vulnerable to human trafficking. Migration or relocation, substance use, unstable housing, abuse, childhood trauma, and mental health issues can also increase the risk. Human trafficking can cause toxic stress that wears down immunity, contributing to risk of liver disease, chronic renal disease, and other autoimmune and neurological disorders.
The U.S. Department of Health and Human Services (HHS), through the Office of the Assistant Secretary for Health (OASH) Office on Women’s Health (OWH), is launching a new challenge worth up to $1.8 million to organizations with successful innovative and life-changing approaches to address human trafficking prevention among women and girls in the United States. The challenge was announced today at the HHS National Human Trafficking Prevention Summit.
The national competition will award programs that demonstrate effectiveness in preventing human trafficking and/or improving health outcomes related to human trafficking among women and girls, sustainable program practices, and the ability of the program to be expanded and/or replicated. The challenge was created in alignment with the priorities highlighted in the White House National Action Plan to Combat Human Trafficking and the National Plan to End Gender-Based Violence. It also supports the goals of the HHS Task Force to Prevent Human Trafficking.
The challenge has two phases. Phase 1 will award twenty $50,000 prizes to existing, innovative programs that have demonstrated outcomes in successfully preventing human trafficking and/or improving health outcomes related to human trafficking among women and girls. Phase 2 will offer eight awards up to $100,000 that will go to the programs in Phase 1 that have successfully expanded and/or replicated to increase the impact of their program in preventing human trafficking and/or improving health outcomes related to human trafficking on women and girls.
The HHS Office for the Administration of Children and Families (ACF) Office of Trafficking in Persons (OTIP) provided expertise to create this challenge. For additional public resources, contact the National Human Trafficking Hotline at 1-888-373-7888, TTY: 711, Text* 233733. SOAR Online also provides resources for healthcare professionals.
HHS: Report on Uninsured Rate
The U.S. Department of Health and Human Services (HHS) released a new report showing that the national uninsured rate reached an all-time low in early 2023. Approximately 6.3 million people have now gained coverage since 2020, coinciding with the beginning of the Biden-Harris Administration in January 2021. This is the first report on the uninsured rate since the historic ACA Open Enrollment period that ended this past January.
The report, which analyzes data from the National Health Interview Survey and American Community Survey, shows the dramatic impact of Biden-Harris Administration’s efforts to increase health care access and lower costs for America’s families. The success is due to President Biden’s historic American Rescue Plan’s enhanced Affordable Care Act (ACA) subsidies and the Inflation Reduction Act’s extension of those subsidies, the continuous enrollment condition in Medicaid, several recent state Medicaid expansions, and substantial enrollment outreach by the Administration in 2021-2023.
Key findings from the report, published by HHS’s Office of the Assistant Secretary for Planning and Evaluation (ASPE), include the following:
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The nation’s uninsured rate declined significantly in early 2023, relative to 2020, reaching an all-time low of 7.7 percent for U.S. residents of all ages in the first quarter (January-March) of 2023.
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Approximately 6.3 million people – including 5.5 million adults ages 18-64 and 0.7 million children ages 0-17 – have gained health coverage since 2020. These gains in health insurance coverage are concurrent with the implementation of the American Rescue Plan’s enhanced Marketplace subsidies, the Inflation Reduction Act’s continuation of those subsidies, the continuous enrollment condition in Medicaid, recent state Medicaid expansions, and substantial Marketplace enrollment outreach by the Biden-Harris Administration from 2021 to 2023.
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Uninsured rates among adults ages 18-64 declined from 14.5 percent in late 2020 to 11.0 percent in early 2023. The uninsured rate among children ages 0-17, which had increased during 2019 and 2020, fell from 6.4 percent in late 2020 to 4.2 percent in early 2023.
- Changes in uninsured rates from 2020 to 2023 were largest among individuals with incomes below 100% of the Federal Poverty Level (FPL) and incomes between 200% and 400% FPL. These gains follow record breaking sign-ups for health coverage in the ACA Marketplaces during the 2022/2023 Open Enrollment Period, with the increased Marketplace enrollment contributing to the substantial growth of private coverage.
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Other CYSHCN Policy-Related Materials | |
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Kaiser Family Foundation (KFF): Trends on Childhood Vaccination
This week the U.S. Food and Drug Administration (FDA) approved the first monoclonal antibody shot to protect young children against respiratory syncytial virus (RSV). While rates have now fallen, the three respiratory viruses (RSV, influenza, and COVID-19) surged among children last winter. Routine vaccinations, including the COVID-19 and flu shot, and the new RSV injection can provide important protection for children as they head back to school and into the winter season this year. This issue brief examines the most recent trends in children’s routine vaccinations, including COVID-19, and explores what to watch as children head back to school this year.
Child Trends: Equitable Access to Early Childhood Programs
Comprehensive, coordinated data can help policymakers answer critical questions about equitable access to early childhood programs, workforce development needs, or school readiness. In their new brief from the Early Childhood Data Collaborative at Child Trends, co-authors analyze how states have used Preschool Development Grant (PDG) funding to plan, implement, or expand early childhood data integration. They found that 79 percent of states that received PDG funds plan to use that funding to implement or expand an early childhood integrated data system (ECIDS), which coordinates information about program participation, childcare supply, and workforce characteristics from multiple data systems. Most states planned to use their ECIDS to obtain an accurate count of children served across early learning programs and to improve program quality via accurate data to evaluate early learning initiatives.
Child Trends: Declines in Child and Adolescent Mental Health
Recent data have revealed dramatic and troubling declines in the mental well-being of children and adolescents over the past decade. However, social indicators of well-being—including housing, income, and food stability; access to education and health care; and high-quality relationships—have improved over the same period. In a new Child Trends brief, Nathaniel Anderson (University of California Los Angeles), Kristin Anderson Moore (Child Trends), and co-authors argue that policies that focus on improving these social indicators, while important, may not be as effective as previously thought at directly addressing young peoples’ mental health needs. The authors suggest that, by expanding the scope of data that track child and adolescent well-being, policymakers can design more effective and equitable solutions that support children's and adolescents’ mental health.
NAM: Assessing Meaningful Community Engagement
The National Academy of Medicine (NAM) has released a suite of resources on meaningful community engagement, generated by Leadership Consortium: Collaboration for a Learning Health System as part of the Assessing Meaningful Community Engagement project. Building off the project’s conceptual model, NAM has now released seven impact stories, 28 assessment instruments and a guide on how best to use the resources. These new resources advance health systems’ ability to consistently measure the impact of their community engagement work.
Camden Coalition: You Can’t Have Equity Without Community Engagement
This recent blog from the Camden Coalition debriefs the American Hospital Association’s Accelerating Health Equity (AHE) conference, which included the kick off of INSPIRE: Initiating National Strategies for Partnership, Inclusion, and Real Engagement, a new national partnership that aims to codify best practices for effective and mutually beneficial community engagement. To initiate the project, Camden Coalition and the Center led a listening session and crowd-sourced experiences about community engagement work at the conference. The learnings from this listening session provided an important foundation for developing our national strategy to build partnerships between health care organizations and people with lived experience.
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