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Beyond Medicare and Social Security: Cutting Medicaid After the Pandemic Would be Political Madness
STAT News | By Arielle Kane
During his State of the Union address, President Biden called out Republican proposals to cut Social Security and Medicare in their quest to reduce federal spending. Republican lawmakers in the chamber protested loudly, knowing these programs are political third rails — too controversial to discuss — and they have been sparring over it ever since.
But the president and Democrats in Congress should not miss the opportunity to make Medicaid the third rail. If they want to capitalize on the popularity of the program and protect families’ health care, Medicaid cuts must be off the table because it:
- Covers 91 million Americans, making it the largest source of health care coverage in the country
- Covers 42% of all births
- Pays for 54% of long-term care and covers 6.9 million people ages 65 and older
Provides coverage to more than 10 million people with disabilities who rely on Medicaid for their health care
Several Republicans have said they want to use the upcoming legislative battle over raising the debt ceiling as an opportunity to cut overall spending, particularly in programs like Medicaid.
But politically savvy lawmakers would be wise to remember the health care fights of 2017 — and the results of the 2018 midterm elections that followed — proving that cutting coverage for pregnancy and childbirth, for older adults, and for people with disabilities is a pathway to political collapse. Even in deep red states like South Dakota, Idaho, and Missouri, the electorate has approved Medicaid expansion even when their elected lawmakers opposed it. That’s because Medicaid is a lifesaver for millions of families.
That’s never been clearer than over the past three years when Medicaid protected families during an enormous public health crisis. The Covid-19 pandemic upended the economy and tripled the unemployment rate. But largely because of Medicaid, the rate of uninsured reached an all-time low in 2022. That is a stark difference from the last economic upheaval during the Great Recession of 2008-2009, when 9.3 million people lost their jobs and, subsequently, their health insurance. Millions more families now know firsthand how essential Medicaid is for their health and financial well-being and they will not look favorably if their elected representatives decide to cut that lifeline.
The Medicaid program faces a daunting challenge in the coming months as the process of checking the eligibility for Medicaid of its 91 million enrollees starts back up again April 1. At the same time, 1 in 4 state Medicaid programs report staff vacancy rates greater than 20%. Millions of people are likely to lose coverage because of administrative hurdles during the eligibility determination process, and they will be hard-pressed to get someone on the phone to assist with their application. It’s political madness to cut Medicaid generally, but particularly so during this herculean lift across all state Medicaid agencies.
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Q&A: Actuarial Analysis of a Medicaid Palliative Care Benefit
National Academy for State Health Policy | by Ella Taggart
When state policymakers are considering a new benefit to their state’s Medicaid program, they often ask “how much does it cost?” A new actuarial analysis, written by CBIZ Optumas with contribution from Torrie Fields of TF Analytics under a subcontract with NASHP, answers this question for offering a palliative care benefit to Medicaid enrollees. The actuarial analysis, Palliative Care in Medicaid Costing Out the Benefit: Actuarial Analysis of Medicaid Experience, found that — along with improved quality of life for people with serious illness — Medicaid palliative care benefits can also yield cost savings.
Given that the paper contains dense actuarial analyses, this Q&A summarizes the key takeaways for state policymakers and others.
What is palliative care, and how is it covered by Medicaid?
Palliative care is specialized medical care that can provide relief from the stress and symptoms of serious illness through services such as pain and symptom management, counseling, social services, advanced care planning, and care management. Its goal is to help people at any stage of illness maintain quality of life and avoid unnecessary and often unwanted treatment. Unlike hospice, palliative care is not determined by the prognosis of the patient and can be offered alongside curative treatment.
No state Medicaid program offers a comprehensive palliative care benefit to beneficiaries, though many states provide a limited set of services under the umbrella of palliative care. California was the first state to require coverage of community palliative care through Medicaid managed care organizations, and Hawaii recently submitted a state plan amendment to the Centers for Medicare & Medicaid Services (CMS) to cover a community-based palliative care benefit in its Medicaid program. Other states are also expressing interest in a stand-alone Medicaid benefit for palliative care, which the actuarial analysis explores in detail.
What did the analysis find?
A comprehensive palliative care Medicaid benefit is expected to be, at minimum, overall cost neutral to the state. However, effective administration of a Medicaid palliative care benefit for the highest service utilizers could produce cost avoidance savings ranging between $231 and $1,165 per member per month, with potential return on investment ranging between $0.80 and $2.60 for every $1 spent on palliative care. As Medicaid members with serious illness use increasingly high levels of costly inpatient and emergency department services as they approach end-of-life, palliative care can serve to both reduce those costs and improve quality of life for those with serious illness and their families.
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Private Equity Targeted in CMS Nursing Home Ownership Regulation
Modern Healthcare | By Alex Kacik
Nursing homes would have to disclose whether private equity firms or real estate investment trusts own or help operate their facilities under a proposed rule the Centers for Medicare and Medicaid Services issued Monday.
President Joe Biden's administration contends that promoting transparency in nursing home ownership would improve safety and quality. Research has linked private equity and REIT ownership to lower staffing levels and subpar quality care.
“We are pursuing all avenues to shine a light on this industry. We will keep doing everything we can to ensure all Americans receive the dignity, care and respect they deserve,” Health and Human Services Secretary Xavier Becerra said in a news release. Biden unveiled a slate of nursing home proposals during his State of the Union address in 2022 but few of them have come to fruition.
HHS debuted a public database of skilled nursing facility ownership information in September that draws from what facilities that treat Medicare and Medicaid beneficiaries are already required to disclose to regulators. The proposed rule lays out stricter reporting requirements: Nursing homes would have to disclose outside investors with ownership stakes in their facilities as well as any entities that provide administrative or clinical consulting services…
More cash-strapped nursing homes have been selling their real estate assets to investment trusts, which then lease back the spaces to operators. Registered nurse staffing levels decline by as much as 6.3% within three years of a REIT investment, according a study published in Health Affairs last month.
Nursing homes also frequently turn to private equity firms amid financial distress. Despite an increase in corporate investment, roughly 400 nursing homes closed between 2020 and last month, according to CMS data. Nursing and residential care facilities shed more than 210,000 jobs over that span, Bureau of Labor Statistics data show.
Researchers and policymakers have warned that quality declines when private equity firms invest in nursing homes. A JAMA study published in November found that residents of nursing homes acquired by private equity firms were 11.1% more likely to have preventable emergency department visits and 8.7% more likely to experience preventable hospitalizations.
CMS is accepting comments on the proposed rule, which is scheduled to appear in the Federal Register on Wednesday, through April 14.
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Public Health Emergency Resource Update
On January 30, 2023, the Biden-Harris Administration announced its intent to end the national emergency and public health emergency (PHE) declarations related to the COVID-19 pandemic on May 11, 2023. The Centers for Medicare & Medicaid Services has resources available to help you prepare for the end of the PHE, some of which have been updated based on recent action by Congress.
On December 29, 2022, H.R. 2716, the Consolidated Appropriations Act (CAA) for Fiscal Year 2023 was signed into law. This legislation included an extension of the major telehealth waivers and the Acute Hospital Care at Home (AHCaH) individual waiver that were initiated during the PHE.
We will continue to execute the process of a smooth operational wind down of the flexibilities enabled by the COVID-19 emergency declarations. The following materials reflect recent changes and are currently available on the CMS Emergencies Page:
Updates will continue to be provided as we approach the end of the PHE. We encourage you to regularly visit the CMS Emergencies Page for the most up to date information. |
Recording and Slides of the Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule Education Session
We are sending this announcement on behalf of our colleagues in the Office of Burden Reduction and Health Informatics. Questions should be submitted to [email protected].
We’re pleased to provide you with the recording (password: 4%2M!3c?) and slides of the February 9, 2023, virtual education session hosted by the CMS Office of Burden Reduction and Health Informatics on the Advancing Interoperability and Improving Prior Authorization Processes proposed rule. Thanks to those of you who were able to attend the event and to everyone with an interest in the proposed rule.
As a reminder, we welcome your feedback on the proposed policies introduced in the CMS Advancing Interoperability and Improving Prior Authorization Processes proposed rule (CMS-0057-P). Comments must be received within the 90-day comment period, which closes on March 13, 2023. When commenting, please refer to file code: CMS-0057-P.
You may use one of the following methods to officially submit comments:
• Electronically through regulations.gov;
• Regular mail; or
• Express or overnight mail.
Please see the proposed rule for mailing addresses. Note, we do not accept comments via fax nor via the Health Informatics and Interoperability Group inbox. |
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