Targeted Options for Increasing Medicaid Payments to Providers During COVID-19 Crisis
Anne Karl, Jocelyn Guyer and Avi Herring, Manatt Health
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, with outpatient visits falling 60 percent in April 2020. 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. This toolkit has been updated as of August 26, 2020 to reflect more recent federal guidance and examples of specific strategies states implemented between April and August 2020.
SHVS also hosted a companion webinar, the slide deck for which has been updated as of August 26, 2020.
This expert perspective reviews the information sharing considerations for states in implementing the Consolidated Appropriations Act’s (CAA) requirements to provide targeted case management and screening and diagnostic services for children and youth who are incarcerated and enrolled in Medicaid or CHIP. The expert perspective highlights key areas of CAA implementation that require information sharing, which states will need to consider as they work towards coming into full compliance.
On November 14, 2024, CMS released its second installment in its series of Medicaid and CHIP guidance intended to support state efforts to verify eligibility and conduct renewals in compliance with federal Medicaid and CHIP requirements. A new expert perspective summarizes the latestCMCS Informational Bulletin and accompanyingslide deck which address the continued use of unwinding-relatedsection 1902(e)(14) waiversbeyond thepreviously established expiration date of June 30, 2025.
