Washington, DC Update 9/7/23

The Senate returns to Washington, D.C. this week, and the House returns September 12^th. The chambers appear at odds over appropriations and the federal budget. Buckle up!

CMS Letter to State Medicaid Directors - Ex Parte Renewals

The Centers for Medicare & Medicaid Services (CMS) sent a letter to all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands requiring them to determine whether they have an eligibility systems issue that could cause people, especially children, to be disenrolled from Medicaid or the Children’s Health Insurance Program (CHIP) even if they are still eligible for coverage, and requiring them to immediately act to correct the problem and reinstate coverage.



Specifically, the letter states:

“. . . some states are conducting ex parte renewals at the household level, without regard to differing eligibility statuses and income thresholds for individuals within the household. As a result, while a state may have sufficient information during the ex parte process to renew Medicaid or CHIP coverage for some individuals in a multi-member household, states are sending renewal forms requesting information for all household members, and, if the renewal form is not returned, states are disenrolling all individuals in the household, including those who should have been determined to be eligible through the ex parte process. As discussed in more detail below, these actions violate federal renewal requirements and must be addressed immediately.

To date, CMS has identified that this issue most commonly affects:

• Children in households with at least one adult enrolled in Medicaid.
• Eligible individuals in a household in which additional documentation is needed to verify eligibility for the other household members.

Each of these examples is a violation of federal Medicaid and CHIP renewal regulations at 42 C.F.R. §§ 435.916(a)(2) and 457.343. The regulations require that states complete a redetermination of eligibility based on available information for each individual in the household, regardless of the eligibility of others in the household unit: “[t]he agency must make a redetermination of eligibility without requiring information from the individual if able to do so based on reliable information contained in the individual's account or other more current information available to the agency” (emphasis added). Regulations related to the determination of eligibility at 42 C.F.R. §§ 435.911(c) and 457.350(b)(1) also specify that the agency must furnish Medicaid “[f]or each individual…whose eligibility is being renewed,” if found eligible.”

In the letter, CMS lays out four options for state action:

1. Pause procedural disenrollments for those individuals impacted,
2. Reinstate coverage for all affected individuals,
3. Implement one or more CMS-approved mitigation strategies to prevent continued inappropriate disenrollments, and
4. Fix state systems and processes to ensure renewals are conducted appropriately and in accordance with federal Medicaid requirements.

The Georgetown Center for Children and Families Say Ahhh! Blog on this issue provides great explanation and insight: Breaking News: CMS Reveals States Are Incorrectly Processing Ex Parte Renewals; Kids Are Most at Risk

CMS: Communications Toolkit

The toolkit includes important messages and sample materials (like drop-in articles, social media messages, and flyers) for states and other partners to use. The toolkit is available in English and Español/Spanish. Some of the toolkit materials, including drop-in articles, a fact sheet, and a post card, are also available in 中文/Chinese, हिन्दी/Hindi, 한국어/Korean, Tagalog, and TIẾNG VIỆT/Vietnamese.

Find more translated materials here.

Toolkits

• Reaching Children and Families in School-Based and Early Education and Care Settings: Education and early education professionals can use this toolkit to educate parents and families on steps they can take to reach parents and families about what is happening right now with Medicaid and CHIP.
• Faith-Based Toolkit: Faith-based organizations can use this toolkit to share important Medicaid and CHIP information with those in their congregations, communities, and with those they serve.

Slide Decks

• Training Slides for Partners to Use: What is Happening With Medicaid and the Children’s Health Insurance Program (CHIP) Right Now?  Use this slide deck and talking points to educate your community about what is happening right now with Medicaid and CHIP. These slides cover what people enrolled in these programs need to do to renew their coverage with their state Medicaid or CHIP office, or how they can find other health coverage if they are no longer eligible for coverage with Medicaid or CHIP.
• Outreach to Families and Children on Medicaid Renewals: Community groups are encouraged to use this slide deck and talking points in their outreach to children and families about what is happening right now with Medicaid and CHIP.

Outreach to Special Populations

• Reaching Out to Asian American, Native Hawaiian, and Pacific Islander People about Medicaid and CHIP Renewals (English): Use this one-page handout to help reach Asian American, Native Hawaiian, and Pacific Islander people and share information about Medicaid and CHIP renewals. 
• Reaching Out to Black Americans about Medicaid and CHIP Renewals (English): Use this one-page handout to help reach Black Americans and share information about Medicaid and CHIP renewals.
• Reaching Out to Hispanic or Latino People about Medicaid and CHIP Renewals (English and Spanish): Use this one-page handout to help reach Hispanic or Latino people and share information about Medicaid and CHIP renewals.
• Reaching Out to People with Disabilities about Medicaid and CHIP Renewals (English): Use this one-page handout to help reach people with disabilities and share information about Medicaid and CHIP renewals.
• Reaching Out to People Who Live in Rural Areas about Medicaid and CHIP Renewals (English): Use this one-page handout to help reach people who live in rural areas and share information about Medicaid and CHIP renewals.

Additional resources, materials and form for requesting CMS speaker can be found here.

Medicaid Unwinding Homepage: The centralized location where states and stakeholders can learn more about Medicaid and CHIP renewals and access resources.

HHS: Suicide Prevention and National Recovery Month

September is Suicide Prevention month and National Recovery Month. Health and Human Services Secretary Becerra issued statements recognizing each observance:

• Suicide Prevention statement
• Recovery Recognition statement

Resources to assist in recognizing and honor this month:

• American Foundation for Suicide Prevention
• Blog from the Well Being Trust that includes great data, strategies and links to additional resources
• Article from the American Psychological Association laying out data about the alarming trends for youth overall, in specific populations of youth and offering links to resources, such as mental health first aid for youth and Safetalk suicide prevention course.

Disaster Toolkit and Support for State Medicaid and CHIP Agencies: To prepare for current and future disasters, CMS has developed an inventory of Medicaid and Children’s Health Insurance Program (CHIP) flexibilities and authorities available to states in the event of a disaster to support Medicaid and CHIP operations and ensure continuity of coverage for people served through Medicaid and CHIP programs during times of crisis. For more information and to access the inventory and toolkit, visit: https://www.medicaid.gov/state-resource-center/disaster- response-toolkit/index.html

CMS: Connecting Kids to Coverage - TV and Radio Scripts

Looking for a new way to reach families in your community? Explore using television and radio PSAs or radio live reads to reach families where they are and share important information about Medicaid and CHIP. The Campaign has created several radio scripts, digital videos, and television and radio PSAs that can be distributed through your local radio and TV stations or to local businesses. These materials cover a variety of topics including mental health, dental care, vision care, and overall enrollment information and are available in English and Spanish.

Check out this tip sheet on how to use digital videos in your outreach and read this guide on putting PSAs to work in your community.

Visit the Connecting Campaign Outreach Tool Library for a variety of targeted resources to use in your outreach and enrollment efforts, available in multiple formats and languages.

HHS: Proposed Rule Nursing Home Staffing Standards

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), issued a proposed rule that seeks to establish comprehensive staffing requirements for nursing homes—including, for the first time, national minimum nurse staffing standards—to ensure access to safe, high-quality care for the over 1.2 million residents living in nursing homes each day.

Under CMS’s proposal, nursing homes participating in Medicare and Medicaid would be required to:

• Meet specific nurse staffing levels that promote safe, high-quality care for residents. Nursing homes would need to provide residents with a minimum of 0.55 hours of care from a registered nurse per resident per day, and 2.45 hours of care from a nurse aide per resident per day, exceeding existing standards in nearly all states.
• Ensure a registered nurse is on site 24 hours per day, 7 days per week and to complete robust facility assessments on staffing needs. Facilities would continue to be required to provide staffing that meets the needs of the individual residents they serve, which may require higher levels of staffing above the proposed minimum standards. 

The proposal would also require states to collect and report on compensation for workers as a percentage of Medicaid payments for those working in nursing homes and intermediate care facilities. These policies build on CMS’ recent proposals to support compensation for direct care workers in home- and community-based settings and to publish Medicaid data on average hourly pay rates for home care workers. The proposed rule can be found at Federal Register Nursing Home Minimum Staffing Requirements Proposed Rule (CMS 3442-P).

Related Resources

• This CMS Fact Sheet offers a detailed overview of the proposed rule.
• Results of CMS 2022 Staffing Study of nursing homes
•  ASPE Direct Care Worker Wages Report compares the wages of DCWs to workers in other entry-level jobs.

ACL: DIAL program - More than connecting to vaccinations

ACL started the Disability Information and Access Line (DIAL) to help people with disabilities of all kinds to get connected to information about local resources that support independent living. Launched in 2021 to help disabled people access COVID-19 vaccinations, DIAL also helps connect people to essential services, such as transportation, housing support, disability rights, and more.

DIAL’s staff are trained to work with people of various communications abilities and will spend as much time as needed to ensure effective communication. DIAL’s information specialists can assist people in all languages and are trained to work with callers who are deaf and hard-of-hearing. Connect with a DIAL information specialist from 8:00 AM to 9:00 PM ET, Monday through Friday.

How to reach DIAL:

• Call or text at 888-677-1199.
• Email DIAL@usaginganddisability.org.
• Start a live online chat with an information specialist.
• Connect directly to an agent in American Sign Language using ASL Now or call 888-677-1199 from your videophone.
• Use video relay services by calling 888-677-1199. People who use TTY relay can first dial 7-1-1, and then dial 888-677-1199. 

HHS: Office of Long COVID Research and Practice

Current analysis suggests that anywhere from 7.7 million to 23 million Americans have developed Long COVID, and roughly 1 million people are out of the workforce at any given time because of it. This figure is equal to about $50 billion annually in lost salaries.

One year ago, the U.S. Department of Health and Human Services (HHS) worked with federal partners to create an action path forward to address Long COVID. Two reports outline key aspects of that work:

• Services and Supports for Longer-Term Impacts of COVID-19 outlines over 200 federally funded supports and services that may be available to those impacted by the pandemic and Long COVID.
• The National Research Action Plan lays out current U.S. government conducted or funded research and a pathway for future inquiry. The National Research Action Plan also recommended the formation of the Office of Long COVID Research and Practice.

To continue to help people access supportive services and advance our nation’s understanding of Long COVID and its associated conditions, HHS has established the Office of Long COVID Research and Practice. This office will continue current efforts to lead the whole-of-government response and work across the government to implement the National Research Action Plan.

Georgetown CCF: Bipartisan Safer Communities Act

On June 25, 2022, President Biden signed into law the Bipartisan Safer Communities Act (P.L. 117-159). The Bipartisan Safer Communities Act included a number of provisions related to Medicaid and the Children’s Health Insurance Program (CHIP) including:

• Expanding of the Certified Community Behavioral Health Clinic Medicaid demonstration program,
• Requiring Medicaid and CHIP telehealth guidance,
• Mandating Medicaid and school-based services including guidance, a new technical assistance center, and grants to states, and
• New state implementation and oversight requirements for Medicaid’s Early and Periodic Screening, Diagnostic and Treatment benefit. (NOTE - This is found on pg. 6 of the brief.)

Now, a little over a year into implementation, this issue brief provides background on the Medicaid and CHIP provisions of the Bipartisan Safer Communities Act and an update of where things stand including where more action is still forthcoming. Given the ongoing mental health needs of youth, timely and meaningful implementation of these provisions will remain important to furthering access to mental health care for children and individuals covered by Medicaid and CHIP.

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Family Voices is a national organization and grassroots network of families and friends of children and youth with special health care needs and disabilities that promotes partnership with families--including those of cultural, linguistic and geographic diversity--in order to improve healthcare services and policies for children.