#Section 1115 Waivers

[syrtissolutions]

MEDICAID'S PROPOSED WORK REQUIREMENTS

In 2018, the Trump Administration and GOP made several attempts to rescind the ACA and impose federal spending caps on the Medicaid program to cut down costs. These efforts were ultimately unsuccessful; however, a few of the states expanded their Medicaid programs and proposed work requirements during this time.

According to KFF, one out of five Americans receive health care through Medicaid. The program has become the country's largest source of health care coverage and accounts for 27% of state expenses. Due to program expansion and costs, House Republicans revived their push for work requirements over the spring during debt ceiling negotiations with Democrats. They also suggested reforming the work requirements for people receiving food and cash assistance through SNAP and TANF.

The Medicaid work requirement provision did not make it through negotiations; however, President Biden agreed to the expanded work requirements for food and cash support in exchange for a two-year suspension of the debt ceiling. In spite of the outcome in Washington, some states are still pursuing work requirements for their Medicaid programs through special waivers.

Even though Medicaid is a jointly funded government program between the federal government and states, the states are responsible for administering it, and the Social Security Act permits them the flexibility to tailor their Medicaid programs through what are referred to as Section 1115 waivers. These waivers require approval from the Secretary of Health and Human Services and can change eligibility requirements or suspend provisions of federal law under the condition that the projects promote the goals of the Medicaid program.

States first used Section 1115 waivers to implement work requirements in 2017 under the Trump Administration. During that time, twelve states received approval from HHS. Shortly after, the Trump Administration was sued by health care advocates and civil rights groups, rescinding the work requirement legislation in Arkansas and Kansas. Because of this, other states were also restricted from implementing their provisions.

GA's Medicaid Program Work Requirements

Shortly after President Biden transitioned into office, he reversed several other waivers that granted states approval to implement Medicaid work requirements. Georgia was among the states affected by the decision and sued the administration. The District Court for the Southern District of Georgia ruled in favor of the state, citing that the administration did not consider whether reversing the waiver would bring about less Medicaid coverage. Georgia has become the only state with a work requirement for Medicaid eligibility, and the state's strategy, Pathways to Coverage, launched at the beginning of this month.

Work requirements have once again become a topic of debate among health care professionals and government officials. Some see the requirements as barriers to health coverage that go directly against the objectives of the Medicaid program. They argue that Medicaid is designed to provide insurance, not encourage employment. Meanwhile, work requirement supporters say that the program has expanded far beyond its original objective, and states must rein in costs. Presently, state's are navigating eligibility determinations that will significantly impact enrollment. Setting the work requirement debate aside, all states should be looking for ways to improve efficiency and cost avoid in their Medicaid plans to ensure that vulnerable populations receive the coverage they need.

Find out more here. 

[distilinfo]

Medicaid Access Extended to Incarcerated Individuals with CMS Waivers

On July 2, the Department of Health and Human Services (HHS) introduced a pivotal initiative to provide Medicaid and Children's Health Insurance Program (CHIP) coverage to incarcerated individuals before their release. This Medicaid Reentry Section 1115 Demonstration Opportunity waiver allows states to offer coverage up to 90 days pre-release, aiming to bridge healthcare gaps and ensure continuous support as individuals reintegrate into society. Illinois, Kentucky, Oregon, Utah, and Vermont are the first to implement these waivers, connecting inmates with community-based providers. Massachusetts extends coverage to 12 months post-release, and up to 24 months for the chronically homeless. This initiative addresses significant health challenges, including high rates of substance use and chronic conditions, by expanding access to essential treatments and behavioral health services. As more states consider similar measures, the impact on public health and reentry outcomes is anticipated to be substantial. Learn more at DistilInfo Healthplan.

Read more: https://distilinfo.com/healthplan/cms-waivers-medicaid-incarcerated/

Discover the latest payers’ news updates with a single click. Follow DistilINFO HealthPlan and stay ahead with updates. Join our community today!

[autisticadvocacy]

“After the court decision, more than 11,000 additional comments were filed with HHS, the vast majority of them revealing why the waiver project would reduce Medicaid coverage, restrict access to health care services, and harm the health of Kentuckians.”

[jonathandesverneyusanews]

Medicaid Emergency Authority Tracker: Approved State Actions to Address COVID-19

Medicaid Emergency Authority Tracker: Approved State Actions to Address COVID-19

This page aggregates tracking information on approved Medicaid emergency authorities to address the COVID-19 Coronavirus emergency. We include details on Medicaid Disaster Relief State Plan Amendments (SPAs), other Medicaid and CHIP SPAs, and other state-reported administrative actions; Section 1115 Waivers; Section 1135 Waivers; and 1915 (c) Waiver Appendix K strategies. This page is updated on…

[professionalhealthcarephri]

How To Ensure Proper Home Care in Arlington, MD and Washington, DC?

A majority of Americans past the age of 65 sign up for Medicare to ensure affordable health care. Unfortunately, being enrolled in a Medicare plan is not the perfect solution for senior citizens of limited means. Paying out-of-pocket costs may prove to be too expensive for comfort. Many elderly individuals are shocked to learn that Medicare will not cover assisted living or in-home care. One of the preferred alternatives here would be to think about Medicaid waivers in Baltimore and Arlington, MD.   The questions that are definite to arise in the mind of concerned people are: What is Medicaid Waiver? ​ Well, it is not synonymous with Medicare, as many people believe. On the contrary, it is a specific public health insurance plan that helps US citizens and families earning a low income. Unlike Medicare, it is not wholly financed by the Federal Government. Instead, the expenses are shared by both the Federal and state governments. Its operation and implementation are handled entirely by the state, however. This explains why its administration may differ between states. It is not freely available to all seniors, though. The person who aspires to be eligible for the program must be eligible for it by meeting the criteria for low income. The rules of Medicaid can thus be waived to include individuals or groups to obtain healthcare assistance offered via Medicaid Programs. How many types of Medicaid waivers are available? The actual types of available waivers are too numerous to be included in a single list. The following remains the most popular that is used by millions of US citizens across the States: Section 1115 – States utilize this type of waiver to research facts and discover novel ways of delivering Medicaid healthcare to people or find alternative means of funding them. Section 1915(b) waivers- This type of waiver permits the states to hire the services of different organizations for providing managed care services. Section 1915(c)- Also termed as "Home and Community-Based Services (HCBS) waivers," it helps states to provide the required home care or community-based services to people who need long-term care. This is hugely popular as it allows the concerned individual to receive care while staying in their homes or at a community shelter instead of being admitted to a living assistance facility. Who is eligible for Medicaid waivers? The eligibility criteria vary from state to state. The HCBS waivers are usually provided for older adults of 65 years or more, disabled individuals, and people with debilitating development disorders. Individuals who require expensive medical equipment and round-the-clock health care for survival are also considered to be eligible for Medicaid waivers. One may choose to hire affordable caregivers to provide home care in Arlington, MD, and Washington, DC, to meet the patient's needs with compassion. The health aides are professionals having the required skills to tend to elderly patients 24X7. They are sure to work closely with physicians and other medical specialists with the single objective of ensuring comfort for their patients.  

[your-dietician]

High Risk Pregnancy – Mitigating Risks for Type 1 Diabetes + Black Maternal Health Outcomes – Diabetes Daily

New Post has been published on https://depression-md.com/high-risk-pregnancy-mitigating-risks-for-type-1-diabetes-black-maternal-health-outcomes-diabetes-daily/

High Risk Pregnancy – Mitigating Risks for Type 1 Diabetes + Black Maternal Health Outcomes – Diabetes Daily

This content originally appeared on Beyond Type 1. Republished with permission.

By Kayla Hui, MPH

In 2020, Ariel Lawrence, a diabetes advocate and creator of Just A Little Suga–a storytelling platform that centers people of color with diabetes–found out that she was pregnant. Although Lawrence was excited, she couldn’t help but feel anxious. As a Black woman living with type 1 diabetes, Lawrence worried about how the intersection of having diabetes and being a Black woman would impact her and her baby.

According to Christopher Nau, MD, a doctor of maternal fetal medicine based in Cleveland, Ohio, timely access to diabetes and maternal health care is crucial, especially for Black women who—due to multiple factors including systemic racism and implicit bias— are three times more likely to die from childbirth compared to white women in the U.S.

“Once I found out that I was pregnant, I was experiencing a lot of anxiety. And although I was working with the care team to make sure that my management was tighter and my blood sugars were in range, the reality was that there were moments where it wasn’t in range, there were high blood sugars, and sometimes, there were high blood sugars for extended periods of time,” Lawrence tells Beyond Type 1.

Lawrence’s blood sugar level concerns lingered since getting diagnosed with type 1 when she was in the tenth grade. “In college, there was a nurse who had said to me, type 1 diabetes and pregnancy don’t mix,” Lawrence recalls. “At that point in my diabetes journey, I remember struggling to get my A1c below a 7.2. So for the longest, there was this question of can I actually do what I need to sustain a healthy pregnancy while living with diabetes?”

According to research, Black women are four times more likely to receive zero to five prenatal care visits when compared with white women. In addition to receiving statistically lower levels of care, “Black women are less likely to get into care early in the first trimester, which is important specifically for someone who has diabetes,” Nau says.

One of the contributing factors to poor health outcomes for pregnant Black people is systemic racism. Compared to pregnant white people, pregnant Black people are more likely to experience unfair treatment and discrimination within the healthcare system, such as being spoken to disrespectfully by healthcare personnel, being ignored after expressing fears/concerns, and experiencing poor bedside manner.

In addition to systemic racism, implicit bias–attitudes and stereotypes of other groups that manifest in overt and intentional discrimination–hampers maternal health for Black pregnant people. Implicit bias can impact a medical professional’s judgement to provide treatment and care in a timely manner. It can also hinder patient and provider communication.

When racial biases are expressed in a condescending manner, it can decrease the likelihood that patients will feel valued or heard and providers will recommend treatment options for patients.

Research shows that implicit bias is directly correlated with lower quality of care. A 2012 study found that cesarean deliveries–deliveries that can lead to more negative health outcomes for the pregnant individual and baby, including maternal mortality–were more common among Black and Latina women than white women.

From 2007 to 2016, there were 40.8 pregnancy-related deaths for Black women per 100,000 live births, triple the mortality rate compared to white women, who had 12.7 pregnancy-related deaths per 100,000 live births.

“I’m concerned as a Black woman with my own health, and whether or not I’ll live to share the experience of my birth because there have been so many women who unfortunately have passed away,” Lawrence says.

When Black pregnant people with diabetes do not receive timely maternal and diabetes care, Nau says that their blood sugar levels can rise, increasing the risk of miscarriage and birth defects increases. “The risk can be as high as 20 to 25 percent in someone who’s very poorly controlled,” Nau explains.

As a result, fetuses can have birth defects, such as cardiac malformations. Poorly controlled diabetes may also result in increased risk for stillbirth, respiratory distress, and jaundice, Nau explains. He adds that babies are at risk of hypoglycemia, also known as low blood sugar, initially after delivery.

When pregnant people have consistently elevated blood glucose levels, it can also increase the chances of having a c-section. When a baby is delivered by a c-section, pregnant people may take longer to recover post childbirth.

Strength of a Medical and Health Support System

Aware of the maternal health outcomes for Black women, Lawrence hired a doula, which helped ease her anxiety surrounding pregnancy. “I was aware that when it came to Black maternal health outcomes, Black women are more likely to experience a C-section and have complications as a result,” Lawrence says. “To help minimize my anxiety, I decided to find a doula.” For Lawrence, having a doula meant having an advocate and support system.

According to DONA International, doulas offer physical, emotional, and partner support throughout the pregnancy, birth, and early postpartum period. Research shows that women who use a birth doula are less likely to have a c-section, use pain medication, need pitocin, and more likely to rate their childbirth experience positively.

During the birthing process, Lawrence’s doula liaised and communicated between Lawrence and medical professionals to ensure that Lawrence knew what the doctors were doing.

Coupled with a doula, Lawrence also leaned on her therapist for support. “I was afraid that something bad might happen. So, I had a therapist supporting me through that,” Lawrence says.

Improving Maternal Health Outcomes for Black Pregnant People With Diabetes

Alissa Erogbogbo, MD, medical director of operations at Hospitalist Group, says that there are opportunities to improve maternal health outcomes for Black pregnant people with diabetes through legislation. She says that an ideal bill would include postpartum follow up. “Whether it’s a nurse that they follow up with, a phone call to make sure they [pregnant people] are checking their blood sugars, there’s a lot of opportunity to really decrease the maternal mortality rate,” Erobogbo says.

In the U.S, the Medicaid program provides coverage for almost half of all births. Unfortunately, coverage only lasts 60 days postpartum. States have the option to extend Medicaid postpartum coverage for 12 months by applying for a section 1115 waiver. In April 2021, Illinois became the first state to extend Medicaid coverage for up to one full year after pregnancy. Joining Illinois’s postpartum Medicaid expansion are Missouri and Georgia.

However, there is still a long way to go, according to Erogbogbo. A handful of states including Colorado, Texas, Wisconsin, and Florida have enacted legislation to seek federal approval of their 1115 waiver, but the majority of states have taken no direction.

“Most states need to follow that bandwagon. Continuity of care helps you understand how your health is progressing, what preventative measures that you can take,” Erogbogbo tells Beyond Type 1.

While postpartum coverage is available in some states, Medicaid program expansion is far from sufficient. To build on current maternal health efforts, Congresswoman Alma Adams, Senator Cory Booker, and members of the Black Maternal Health Caucus introduced the Black Maternal Health Momnibus Act of 2021, a bill that would not only expand postpartum coverage for up to 24 months postpartum under the Special Supplemental Nutrition Program for Woman, Infants, and Children, but improve maternal health among racial and ethnic groups by addressing the social determinants of health.

If the Momnibus Act is passed, it would implement several actions such as providing funding to community-based organizations that are working to improve the maternal health space, diversifying the perinatal workforce to ensure that pregnant people are receiving culturally sensitive maternity care, improving data collection to better understand the causes of maternal health outcomes, and promoting innovative payment models to incentivize high-quality maternal health care and non-clinical perinatal support.

The bill was first introduced to the house on February 8, 2021 and was referred to the subcommittee on Crime, Terrorism, and Homeland Security on April 23, 2021. Since the bill’s inception, it has been endorsed by over 240 organizations.

The aforementioned policies are not an end-all solution, but serve as a start to addressing disparate health outcomes for Black pregnant people on the policy level. People can also advocate to improve Black maternal and health conditions by:

Resources

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Read more about A1c, childbirth, Intensive management, low blood sugar (hypoglycemia), medicaid, pregnancy, pregnancy with type 1 diabetes.

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[youressentialsblog]

State Options to Expand Medicaid HCBS: Examples & Evaluations of Section 1115 Waivers

State Options to Expand Medicaid HCBS: Examples & Evaluations of Section 1115 Waivers

The coronavirus pandemic’s disproportionate impact on seniors and people with disabilities and chronic illnesses has brought heightened focus on the unmet need for home and community-based services (HCBS). Medicaid serves as the primary source of coverage for HCBS, which help these populations to live independently outside institutions by assisting with daily needs. In addition to determining…

[syrtissolutions]

THE MEDICAID PROGRAM IN 2021

The Coronavirus pandemic and the consequential economic downturn emphasized the importance of the Medicaid program last year. By February, the Medicaid enrollment rate increased to 7.4 percent, and 76.5 million people were enrolled in the jointly funded program. In 2021, the new administration, economic climate, and ongoing public health crisis are sure to impact the safety net program. Some of the crucial areas to monitor in the new year will be enrollment, coverage, eligibility, Section 1115 demonstration waivers, and program financing. Here is an overview of what to expect and what state Medicaid plans can do to rein in costs.

ENROLLMENT, COVERAGE, ELIGIBILITY

Millions of Americans became unemployed and lost their employer-sponsored healthcare coverage because of the pandemic. In response to the public health crisis, the Families First Coronavirus Response Act (FFCRA) was implemented to protect eligibility standards and provide continuous coverage to current Medicaid beneficiaries. The provisions of the FFCRA are set to expire in April but can be extended by Congress.

President Biden has proposed adjustments to the ACA that would expand coverage. The first proposal is to increase ACA marketplace premium assistance, and the second proposal is to introduce a public option plan similar to Medicare. This option would offer coverage automatically to low-income individuals in states that did not expand their Medicaid programs. In addition, the new administration has plans to reduce the coverage gap by replacing the 90% Medicaid federal match rate with a temporary 100% increase.

Along with the new administration's initiatives, there are two bi-partisan efforts to expand Medicaid coverage in Congress. H.R. 4996, Helping MOMS Act of 2020, will enable states to provide one year of postpartum coverage under Medicaid. It also eliminates the cap on the total rebate amount for single source and innovator multiple source drugs under the Medicaid Drug Rebate Program. H.R. 1329, Medicaid Reentry Act, will permit Medicaid payment for medical services provided to an incarcerated individual during the 30-day period prior to the individual's release.

SECTION 1115 DEMONSTRATION WAIVERS

Section 1115 demonstration waivers make it possible for states to waive key provisions of federal Medicaid law and the flexibility to form their own Medicaid policies to accommodate their unique priorities. These waivers must follow statutory requirements, are required to be budget neutral to the Federal government, and are permitted for an initial five-year period. Under the former administration's time in office, demonstration waivers included changes such as work requirements and eligibility restrictions. The new administration will most likely reverse these waivers and revise the demonstration waiver policy while issuing new state guidance. Under the Biden administration, Section 1115 wavers are expected to advance public option proposals, make coverage more affordable, and expand program eligibility.

STATE MEDICAID FINANCING

The pandemic driven economic downturn has caused significant budget strains for states. To make up for these deficits, states rely on the Federal government for relief to manage their Medicaid programs. In the current public health emergency, the federal match percentage increased to 6.2 percent. This provision was included in the FFCRA and was extended through June 2021. While President Biden favors increasing the FMAP, it cannot be accomplished solely by administrative action. To increase the FMAP, the new administration will need legislation from Congress or a simple majority vote from the Senate in a budget reconciliation bill.

FURTHER EFFICIENCY AND COST AVOIDANCE

Along with federal assistance and budget cuts, states generally suppress costs by reducing Medicaid benefits, decreasing provider rates, and introducing restrictions. However, these approaches to lower costs are prohibited due to MOE protections under the FFCRA. With that said, states should focus on cost avoidance technology solutions and additional efficiency in their Medicaid plans.

One area in particular where states could realize substantial savings is in program oversight and mitigating improper payments. According to CMS, FY 2020 Medicaid improper payments totaled $86.49 billion. The vast majority of these improper payments occur in the coordination of benefits due to the fact that Medicaid plans struggle to identify liable third parties of pharmacy and medical claims. Medicaid plans do not have access to reliable, complete, and accurate data, so they cannot help but make claims payments in error, and it costs them millions.

Medicaid enrollment has surged over the last year, and due to the ongoing public health emergency, it's not clear as to when enrollment numbers will taper back. As reliance on the safety net program rises, the new administration and states will need to consider policy and program adjustments to ensure healthcare coverage for the most vulnerable while also preserving the program's resources. States must look to improving efficiency and cost avoidance before reducing access to care and benefits.

Until recently, Medicaid administrators have struggled with ensuring that pharmacy and medical claims are paid properly. With the introduction of ProTPL, Medicaid plans no longer have to struggle with TPL discovery. If you are interested in details on how you can improve the efficiency of your plan and save on claims paid improperly, contact Syrtis Solutions.

See more information here. 

[autisticadvocacy]

“Over 18,000 people lost Medicaid coverage in Arkansas in 2018 due to the work and reporting requirements imposed under a Section 1115 demonstration waiver. “

[professionalhealthcarephri]

Benefits of Using Professional Services for Home Care in Arlington and Lanham, MD

The escalating costs of health care can be daunting for a family with limited means of income. Hiring a professional caregiver may be the best alternative to moving into an assisted living facility, but the involved expenses are too significant to be feasible for lower-income groups. It is helpful to obtain a Medicaid waiver in Baltimore and Arlington, MD that permits the elderly patients to age in place. Unfortunately, the associated rules are often difficult to understand for most people, with the application procedure being even more confusing. ​ It is essential to check the facts to understand this beneficial program before deciding to apply for it once eligibility is ensured. A few things that the low-income groups need to be aware of include: What is a Medicaid waiver? It is a part of the Medicaid program offered by the Federal Government. Some of the selected laws that apply to the usual Medicaid are waived here. The purpose of waiving the rules makes each State fulfill its objectives. Medical expenses for the eligible individuals/groups are thus reduced greatly, with older adults and pregnant women getting improved health care. The States can utilize the waiver to provide the required assistance to citizens who may not be eligible to receive the original Medicaid. The elderly residents can claim in-home care courtesy of the waiver instead of shifting to a distant facility. Medicaid waiver Types Section 1115- The States can use new approaches to deliver the required medical aid and financing. The waiver is only approved if the costs to the Federal Government do not exceed its budget for Medicaid and waivers already in place. The popularity of these types of waivers is on the rise now. Many states are eager to use the extra funding provided by the Federal Government based on the Affordable Care Act. Section 1915(c)- Also known as “Home and Community-Based Services (HCBS),” this waiver allows the States to provide home care and community service t individuals in need. People with severe health conditions and the elderly and infirm receive long-term care in the comfort of their own homes as a result. Section 1915(b)- Known as “Freedom of choice waivers” alternatively, the states make provisions for care via managed care service providers. In other words, effective care is outsourced to agencies that meet the criteria. The State Medicaid Fund pays the professionals providing the care. The options for a beneficiary to choose a care provider are somewhat limited as a result. Combined Section 1915(b) & 1915(c)- The State Government provides HCBS services to qualified individuals by outsourcing the services to private managed care organizations. Individuals recovering from surgery or diagnosed with severe physical and mental illness may hire experienced health aids for home care in Arlington and Lanham, MD. Living at home ensures comfort with the concerned patient being pleased to live in familiar surroundings. Such an arrangement can ensure one’s peace of mind as well.

[youressentialsblog]

Medicaid Emergency Authority Tracker: Approved State Actions to Address COVID-19

Medicaid Emergency Authority Tracker: Approved State Actions to Address COVID-19

During the COVID-19 Public Health Emergency, states used a number of Medicaid emergency authorities to address the coronavirus emergency. Between March 2020 and July 2021 we tracked details on Medicaid Disaster Relief State Plan Amendments (SPAs), other Medicaid and CHIP SPAs, and other state-reported administrative actions; Section 1115 Waivers; Section 1135 Waivers; and 1915 (c) Waiver Appendix…

[syrtissolutions]

TRUMP ADMINISTRATION INDICATES POTENTIAL LIMITS TO MEDICAID 1115 WAIVER APPROVALS

From the very start of Donald Trump's presidency, he has pledged to give states the flexibility they need to draft their own Medicaid policies. HHS, collaborating with governors and state legislatures, could make dramatic state-by-state modifications to Medicaid utilizing section 1115 waivers allowed under federal law.

Section 1115 waivers grant states the possibility to waive key provisions of federal Medicaid law. The modifications made possible by Section 1115 waivers are not as dramatic as those included in the failed bills. For example, states can not use 1115 waivers to completely restructure Medicaid under block grants or per capita caps, neither can the federal government use them to do away with federal reimbursements for Medicaid expansion; however, they are still significant.

Under the Trump's administration, CMS has approved 1115 waivers that the former administration consistently rejected. Many states, for instance, have been authorized to make employment a requirement for Medicaid enrollment. (The state of Kentucky; however, is currently in court proceedings over the new policy.)

The Trump administration is also permitting Kentucky to require beneficiaries to disclose income changes while Arkansas is disenrolling beneficiaries for the remainder of the calendar year if they do not comply with the work requirement.

The list below is what CMS has previously declined, and what is still under deliberations:

MEDICAID 1115 WAIVERS THAT HAVE BEEN TURNED DOWN BY CMS

Lifetime limits

In May, CMS rejected an 1115 waiver request from Kansas to establish a three-year time limit for people enrolled in the Medicaid program.

Joan Alker, executive director of the Center for Children and Families at Georgetown University, said in a statement that she was "... pleasantly surprised by that."

Utah, Wisconsin and Arizona have also handed in similar 1115 waiver applications to CMS for lifetime limits, which Alker anticipates will also get rejected.

In a statement by Seema Verma regarding Kentucky's effort to sanction lifetime limits on Medicaid enrollees, she stated "We seek to create a pathway out of poverty, but we also understand that people's circumstances change, and we must ensure that our programs are sustainable and available to them when they need and qualify for them."

Partial expansion

CMS declined Arkansas' bid to decrease the number of people who qualify for the state's Medicaid program. Arkansas was looking to reduce the eligibility requirement from 138 percent of the federal poverty to 100 percent; however, it was not a firm denial, instead, CMS said it could not back the waiver application "at this time."

When states vote to expand Medicaid the federal government covers 90 to 100 percent of the program's costs. If Arkansas were authorized to simply cover people up to 100 percent of poverty, the formerly enrolled members who lose their Medicaid coverage would be eligible for federal health insurance subsidies. This would move the liability to pay healthcare expenses from the state to the federal government. This scenario is most likely not attractive to the Trump administration.

OTHER 1115 WAIVERS CURRENTLY PENDING

Work requirements for non-expansion states

Aside from the denial of allowing lifetime limits on Medicaid enrollees, one more element of Kansas' 1115 waiver application is still pending; namely, a work requirement. But distinct from Arkansas, Indiana and Kentucky, Kansas did not expand Medicaid by way of the Affordable Care Act (ACA); so demanding individuals to maintain an employment (minimally 80-hours per week) would most likely exclude them for the state's Medicaid program given that they would be making too much money.

Oklahoma, Alabama, South Dakota and Mississippi are other states that didn't expand under the ACA exploring work requirements. The Center on Budget and Policy Priorities released a report that highlights the catch-22 of these proposals.

In the state of Mississippi, for example, a single parent can not earn over $370 per month to receive Medicaid. Nonetheless, if they acquired 20-hour per week employment at minimum wage, they would collect $580 a month, which is too much income to qualify for Medicaid.

"They will be complying with the work requirement but still lose coverage. You're in this situation that can't be fixed," said Jessica Schubel, a senior policy analyst for the Center on Budget and Policy Priorities.

CMS' Verma has expressed that she is concerned about this "subsidy cliff" and wants to identify a "pragmatic and empathetic" approach to work requirements and other new Medicaid initiatives.

Drug testing for Medicaid enrollment

Finally, last year Wisconsin was the first state to ask for approval to drug test Medicaid applicants allowing the denial of enrollment if they test positive. Specialists say that there is no way to tell where the federal government will decide the issue. However, CMS has indicated that they would support the use of Medicaid funds to cover neonatal abstinence syndrome (a withdrawal ailment that occurs when an infant is born with an opioid addiction from their mother's use during pregnancy). Medicaid experts say it is hypocritical for the federal government to cover babies with drug-related problems but not their parents.

Click here to keep reading.

[tndidd]

Notice of Change to the State's Section 1915(c) HCBS Comprehensive Aggregate Cap Waiver & Statewide Waiver and Self-Determination Waiver Amendments

These waivers are operated by the Department of Intellectual and Developmental Disabilities (DIDD) under an Interagency Agreement with TennCare, the State Medicaid Agency.  The requested effective date of these changes is July 1, 2021.  The primary purpose of these amendments is to provide for the integration of the Home and Community-Based Services (HCBS) provided under these waivers into managed care, utilizing concurrent 1115 authority as part of amendments to the TennCare III demonstration.  (The individuals served in these waivers are already part of managed care for their physical and behavioral health services.  These changes simply integrate HCBS waiver benefits for individuals with I/DD, with their current health plan also becoming responsible for the delivery of waiver services.) To ease your review, proposed changes are tracked in the Summary Document Proposed Amendments to 1915c Waivers for July 1, 2021, of State’s Section 1915(c) Home and Community Based Services (HCBS): the Comprehensive Aggregate Cap Waiver & Statewide Waiver and the Self-Determination Waivers.   The proposed changes and  comment form can be found at the following link: https://www.tn.gov/tenncare/policy-guidelines/waiver-and-state-plan-public-notices.html The comment period begins February 19, 2021, and ends at close of business (4:30 pm Central) on March 22, 2021.

[professionalhealthcarephri]

Benefits of Hospice Care in Baltimore and Arlington

The human body weakens with time causing discomfort and illness in elderly individuals. This is a condition of life that cannot be reversed. Unfortunately, being eligible for Medicare does not reduce the burden of medical expenses when a patient needs to use long-term home care. The expense can be staggering, with most individuals with modest income being unable to afford it. Thankfully, the Medicaid waiver in Baltimore and Arlington can come to one’s rescue here. The term remains obscure, with the majority being unaware of its significance and the pros & cons. ​ Sure one can hope to get the required coverage in the form of a Medicaid waiver that happens to be a scheme of the Federal Government. The program waives specific regulations that reduce healthcare costs while enhancing coverage and improving the option of specialized patient care for pregnant women and senior citizens. The inclusion of waivers comes as a Godsend for different groups of individuals who cannot afford long-term home care. A majority o such patients had to be accommodated in a long-term health facility previously. Medicaid Waiver: Types There are multiple types of waivers, with each serving a particular purpose. The waivers have been formulated to comply with the Social Security Act. Some of the most popular waivers include the following sections:- · Section 1115- Deliverance of new Medicaid care along with financing becomes possible due to this waiver. The concerned State must note that the amount spent does not exceed the Federal Government’s budget for Medicaid programs. This waiver is quite popular at it allows the States to experiment with novel approaches with the aid of extra money obtained due to the “Affordable Care Act.” · Section 1915(c)- Also known as “Home and Community-Based Services (HCBS),” this waiver enables the State Government to provide home as well as community-based services for individuals in need of long-term health care. This comes as a boon to elderly citizens who can continue to reside in their own homes or with a family member instead of being moved into a nursing facility. This waiver also extends to support provided by a living community. · Section 1915(b)- States do not provide long-term care directly to their citizens, however. Instead, the care is provided by an intelligent managed care delivery system. The eligible organizations need to approach Medicaid authorities and sign a contract with them for obtaining payment for the services rendered. The money is spent from the Medicaid fund of the State. · Combination of Sections 1915 b and 1915 c- States provide the required home and community care services with the aid of managed care organizations defined in Section 1915(b) waiver. Man is mortal; this statement cannot be disputed even by people who enjoy good health for years. An older adult who does not want to go through invasive procedures at the end of life may request to be left in peace by denying further treatment. Availing hospice care in Baltimore and Arlington for such patients helps them spend the remaining days in content but may increase the lifespan.

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Texas tries to convince feds to extend Medicaid funding waiver

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Texas will ask U.S. health officials to extend for the next 10 years a federal health care funding agreement, worth billions of dollars annually and set to expire next year, that the state uses to help pay for health care for uninsured Texans, state officials said Wednesday.

The state’s application for extending the 1115 funding waiver will include three chances for the public to comment on the extension application in the coming weeks and will ask for the same deal given to the Texas Health and Human Services Commission in the waning days of the Trump administration, according to a statement by the commission.

Last month, federal health officials rescinded the Trump-era extension to the 1115 waiver agreement — which Texas has had with the U.S. Centers for Medicare and Medicaid Services since 2011 and is up for review every few years — and ordered Texas to collect public input, as the agreement requires, while it renegotiates the new extension beyond its current October 2022 expiration date.

The decision did not stop funding for the current waiver, which will continue to provide $3.87 billion in annual funding for 2021 and 2022 to partly offset free care provided by Texas hospitals to the uninsured, and to pay for innovative health care projects that serve low-income Texans, often for mental health services.

The extension granted in the final days of Trump’s administration would have continued hospital reimbursements until September 2030 but allowed the innovation fund to expire.

The 1115 waiver was meant to be temporary while Texas transitioned to an expanded Medicaid program under the Affordable Care Act of 2010, but that never happened because the U.S. Supreme Court ruled in 2012 that states couldn’t be forced to expand Medicaid. Since then, the state has relied on the waiver for various programs to care for Texas’ uninsured.

Last week, Texas Attorney General Ken Paxton filed a lawsuit against the Biden administration over the decision to rescind the extension, alleging that President Joe Biden was using it as a political weapon to push Texas toward expanding its Medicaid program to include more working adults.

Proponents of Medicaid expansion counter that Texas did not meet public notice requirements and that the 1115 waiver and extension have been used to bat away increasing pressure on conservative state leaders to allow Texans who can’t afford private insurance to become eligible for the government program.

Two public hearings are scheduled on June 2 and June 15. The public may join virtually or in person. The state will also invite virtual public testimony during a medical advisory committee hearing June 10.

Texas, which has the nation’s highest rate of residents without health insurance, is one of only 12 states that have refused to expand Medicaid eligibility to those earning up to 138% of the federal poverty level, as allowed by the ACA.

That’s about $1,500 per month for an individual, or $3,000 a month for a family of four. Currently the threshold in states that have not expanded Medicaid is about $200 per month for a family of two, or about $300 per month for a family of four.

Some 4.2 million people are on Medicaid in Texas — including more than 3 million children. The rest of the recipients are people with disabilities, pregnant women and parents living below 14% of the federal poverty level.

Adults with no disabilities or dependent children don’t qualify for Medicaid, and the vast majority of children on Medicaid have parents who do not qualify. An estimated 1.4 million more Texans who earn too much to qualify for Medicaid but not enough to pay for private insurance would be eligible if Texas were to expand its program.

The above article was published here.

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