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.
On December 6, the Centers for Medicare & Medicaid Services published and made effective an interim final rule (IFR) with comment period regarding states’ ongoing unwinding efforts to redetermine eligibility for all Medicaid enrollees nationwide. This expert perspective summarizes the IFR, which interprets and implements the state reporting requirements and CMS enforcement authorities that Congress enacted last winter in the Consolidated Appropriations Act of 2023.
The 11th annual open enrollment period (OEP) is underway, providing consumers with an opportunity to enroll in health coverage for plan year 2024 through the Affordable Care Act Marketplaces. To support consumers during this OEP, State-Based Marketplaces (SBMs) are innovating to make health coverage more affordable and easier for consumers to enroll. This expert perspective highlights new initiatives being implemented by SBMs during the plan year 2024 OEP, including establishing or improving state subsidy programs to reduce out-of-pocket costs, expanding coverage for undocumented populations, or implementing policies to improve the enrollment process.
As the unwinding of the Medicaid continuous coverage requirement continues, both states and the federal government are tracking and monitoring the impacts of the resumption of eligibility redeterminations and disenrollments. Given the time-lags and caveats of CMS data, many states are publishing their own state data dashboards. To date, 46 states (including the District of Columbia) have released unwinding data in either an interactive dashboard or static pdf format, or are making public their required CMS Monthly Unwinding Data reports. This expert perspective includes an interactive map with links to state reporting, as well as a table tracking the unwinding indicators and disaggregated data that states are reporting on. SHVS will continue to update this EP as more states publish their unwinding data.
