Medicaid and CHIP Coverage of COVID-19 Vaccine and Treatment: A Roadmap for State Action During and After the Public Health Emergency
Since the early days of the COVID-19 pandemic, the federal government has required states to cover COVID-19 vaccines and treatments for certain eligibility groups under Medicaid and CHIP. Congress significantly enhanced those coverage requirements with the American Rescue Plan Act (ARP) of 2021. This toolkit provides a roadmap for states to identify the types of Medicaid and CHIP policy changes that may be needed to ensure compliance with ARP’s requirements for coverage of COVID-19 vaccines and treatment.
Notice Template Regarding Reconciliation Relief under Section 9662 of the American Rescue Plan
The Internal Revenue Service (IRS) has now released more information about how consumers can receive relief from repayment of excess advance premium tax credits for 2020 under the American Rescue Plan. The information is directly relevant to many 2020 marketplace consumers. While this provision will have a positive impact on marketplace consumers, it could also create confusion given the timing and will require some quick communications. Several state-based marketplaces (SBMs) have expressed interest in language that can be used to provide consumers with information about this new tax relief. State Health and Value Strategies has developed the following template language that SBMs can adapt and use in consumer-facing communications.
Timeline of Key Provisions in the American Rescue Plan Act of 2021
On March 11, President Biden signed an approximately $1.9 trillion COVID-19 relief bill—the American Rescue Plan Act of 2021 (“the American Rescue Plan,” ARPA). The American Rescue Plan includes myriad health care provisions, focused primarily in two areas: first, it provides funding the Biden administration requested to carry out its COVID-19 response plans; second, it enacts significant but largely temporary coverage policies. Although all health care coverage provisions of the bill are temporary, many will have a lasting impact. This timeline provides the start and end dates for key health care provisions to help states plan for implementation and future policymaking.
A Better Way to Manage Medicaid Costs
Many states are experiencing budget shortfalls due to the COVID-19 induced recession. Since Medicaid accounts for a significant portion of states’ budgets, states often look to the Medicaid program for savings. Since the Great Recession, states have invested in initiatives that can improve care and also lower costs—such as improving coordination of behavioral health and physical health services, making home and community-based options more available to those who might otherwise go into nursing homes, addressing social drivers of health, and lowering pharmacy costs. Not all of these initiatives can generate short-term savings, but they offer other actions that states facing budget shortfalls may take to achieve savings. This toolkit outlines state options to address Medicaid spending without harming enrollee health and provider stability and access to care.
Coronavirus (COVID-19) Unwinding Federal Medicaid Flexibilities: Issues and Considerations for States
States quickly mobilized to implement emergency federal authorities (e.g., Section 1135 waivers, 1915(c) Waiver Appendix K, emergency Section 1115 waivers) and state-level regulatory flexibilities to respond to the COVID-19 pandemic; now they must determine which flexibilities to scale back or sustain, taking into account fiscal implications. The interaction of the stimulus package dates, the Public Health Emergency, and the President’s National Emergency Declaration, among other factors, are complex, and states are actively grappling with decision making regarding which flexibilities they need and want to keep, and how. This Excel workbook is intended to serve as a tool for states as they strategize and plan for the next phase of the COVID-19 pandemic. Specifically, states can utilize this template to conduct both a primary analysis as they determine which flexibilities to unwind or maintain and a secondary analysis to plan for operational and implementation implications. The workbook has been updated to reflect the renewal of the Public Health Emergency as of October 2, 2020.
Targeted Options for Increasing Medicaid Payments to Providers During COVID-19 Crisis
The COVID-19 pandemic has caused dramatic changes in utilization that threaten the financial stability of providers and may jeopardize access to care during and after the national emergency. With elective cases generally cancelled, hospitals have sharply lower utilization and revenue. Between March and August 2020, a combination of lost revenue related to fewer elective procedures and emergency department/outpatient encounters, and higher costs related to COVID-19 has put many hospitals in a precarious financial position. In addition, many other providers that rely on face-to-face visits have seen large utilization declines due to social distancing requirements: as of July 2020, outpatient visits remain 10 percent below the pre-COVID-19 baseline, even after accounting for the increased use of telemedicine. Most of the Provider Relief Fund dollars have been distributed, yet providers are still experiencing lost revenue and increased costs related to COVID-19. Under any scenario, Medicaid payment strategies—especially for providers serving high numbers of Medicaid patients—remain a critical tool for states to support providers as new COVID-19 hotspots emerge and utilization patterns change.
Analyzing the Fiscal Impact of COVID-19, the Economic Downturn, and Recent Policy Changes: 50-State Databook
As states and Medicaid programs face significant fiscal uncertainty as a result of the COVID-19 public health crisis, the Databook provides projected changes in federal and state Medicaid and CHIP expenditures during calendar years 2020 and 2021 across all fifty states and the District of Columbia for a given scenario and policy response. Taken together, the Databook provides estimates that span across a range of plausible scenarios reflecting increased enrollment and per enrollee spending growth and changes to the duration of the federal Public Health Emergency.
Pathways to Coverage for COVID-19 Testing and Treatment for Adults in Medicaid Expansion and Non- Expansion States
The Pathways to Coverage for COVID-19 Testing and Treatment for Adults toolkit provides an overview for states of various coverage pathways for individuals, including those who are uninsured, in need of COVID-19 testing and treatment. The toolkit provides varying pathways for Medicaid expansion and non-expansion states.
Medicaid COVID-19 Messaging
A toolkit of messages for Medicaid agency staff to outreach to new consumers and current enrollees in light of COVID-19.
Application Template for Section 1332 Reinsurance Waiver
UPDATED 2/19/2019–State Health and Value Strategies, in partnership with health tax expert Jason Levitis, has created a template to help states develop an application for a state innovation waiver under the Affordable Care Act (ACA) section 1332 to implement a state reinsurance program. Section 1332 gives states flexibility to waive certain ACA provisions and receive federal funding to implement state-based health care policies. Reinsurance programs are a proven method of reducing premiums and promoting competition and market stability. This template seeks to make application development as simple as possible by adapting language from the successful Oregon application and indicating where elements need to be filled in or otherwise customized.