RISE summarizes recent regulatory-related headlines.
HHS report: 1.5M seniors who use insulin will see savings this year due to Inflation Reduction Act
The U.S. Department of Health and Human Services (HHS) released a new report that shows major savings ahead for Medicare beneficiaries thanks to the provision in the Inflation Reduction Act that puts a $35 cap on a month’s supply of insulin. If the cap had been in place in 2020, HHS said 1.5 million seniors across the country would have saved an average of $500 on insulin for the year.
The insulin provision of the law went into effect January 1, 2023, for beneficiaries in Medicare Part D. Beginning July 1, under Medicare Part B, beneficiary cost sharing will also be limited to $35 for a month’s supply of insulin. Research produced from the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) determined that had the provisions be in place in 2020, total savings to Medicare beneficiaries would have been $734 million in Part D and $27 million in Part B—an average savings of approximately $500 for those Medicare beneficiaries.
The ASPE research includes selected findings from a recent report to Congress that examined the critical role that insulin plays in the treatment of diabetes, reviewed evidence on how insulin affordability affects adherence to insulin treatment and downstream health consequences, and described policy efforts to improve the affordability of insulin. It also provides information on savings by state and by demographic characteristics, including gender, race and ethnicity, and age. The states with the most people with Medicare projected to benefit from the new Inflation Reduction Act insulin cost savings are Texas (114,000 beneficiaries), California (108,000), and Florida (90,000). North Dakota ($805), Iowa ($725), and South Dakota ($725) have the highest average annual out-of-pocket savings.
In 2019, about 37 percent of insulin fills for people with Medicare required cost-sharing exceeded $35 per fill, including 24 percent that exceeded $70 per fill.
Nationally, the average out-of-pocket cost was $58 per insulin fill in 2019, typically for a 30-day supply. Patients with private insurance or Medicare paid about $63 per fill on average.
Feds uncover massive nursing diploma fraud scheme
More than two dozen people have been charged in the Southern District of Florida for their alleged participation in a wire fraud scheme that created an illegal licensing and employment shortcut for aspiring nurses.
According to three recently unsealed indictments returned by a South Florida federal grand jury and information filed by federal prosecutors, defendants engaged in a scheme to sell fraudulent nursing degree diplomas and transcripts obtained from accredited Florida-based nursing schools to individuals seeking licenses and jobs as registered nurses (RNs) and licensed practical/vocational nurses (LPN/VNs).
The Department of Justice said the bogus diplomas and transcripts qualified purchasers to sit for the national nursing board exam and, after passing it, to obtain licenses and jobs in various states as RNs and LPN/VNs. The overall scheme involved the distribution of more than 7,600 fake nursing diplomas issued by three South Florida-based nursing schools: Siena College in Broward County, Fla., Palm Beach School of Nursing in Palm Beach County, Fla., and Sacred Heart International Institute in Broward County. These schools are now closed.
Each defendant faces up to 20 years in prison.
“Not only is this a public safety concern, it also tarnishes the reputation of nurses who actually complete the demanding clinical and course work required to obtain their professional licenses and employment,” said U.S. Attorney for the Southern District of Florida Markenzy Lapointe, who added that “a fraud scheme like this erodes public trust in our health care system.”
KFF study: It takes a year for most people who are disenrolled from Medicaid to obtain new health coverage
Roughly two-thirds (65 percent) of people who were disenrolled from Medicaid or the Children’s Health Insurance Program (CHIP) in a recent year became uninsured for all or part of the 12 months that followed, a new Kaiser Family Foundation analysis finds.
The analysis of enrollment data from the 2016-2019 Medical Expenditure Panel Survey (MEPS) suggests that many of the millions of people across the U.S. who are expected to lose Medicaid following the end of the pandemic-era continuous enrollment provision could end up without health coverage for months or more. By 12 months out, however, most people who were disenrolled will have obtained coverage again, either through re-enrolling in Medicaid or transitioning to private insurance.
Beginning April 1, 2023, state Medicaid programs will resume disenrollments for the first time since March 2020. Some people will lose coverage during this “unwinding” because they are no longer eligible for Medicaid and will become uninsured if they do not transition to other coverage, such as the Affordable Care Act (ACA) marketplaces or employer-sponsored insurance. Others will likely lose coverage for administrative reasons—despite still being eligible for Medicaid.
The new study also finds that 41 percent of people who were disenrolled from Medicaid or CHIP, including some who initially transitioned to other coverage, eventually re-enrolled in the program before a year had passed—a phenomenon of cycling in and out of Medicaid coverage known as “churn.”
In a previous analysis, KFF estimated that between five and 14 million people will lose Medicaid coverage when states “unwind” the continuous enrollment provision this year.
Although the new findings highlight that many people do not transition to and retain other coverage after they disenroll from Medicaid/CHIP, states’ policies for the unwinding will have a major impact on how successful people will be in moving to other coverage.
State Medicaid agencies can take several steps to reduce coverage disruptions and churn, including improving state eligibility systems, streamlining renewal procedures, communicating with enrollees about the need to complete a renewal, and facilitating transitions to the ACA marketplace or separate CHIP coverage for people found ineligible for Medicaid. The federal government has issued guidance aimed at reducing coverage disruptions for Medicaid enrollees and has imposed new reporting requirements to monitor states’ unwinding processes.
California receives CMS waiver to offer Medicaid coverage to incarcerated individuals before their release
HHS, through the Centers for Medicare & Medicaid Services (CMS), has approved a first-of-its-kind section 115 demonstration amendment in California, which will provide a set of critical pre-release services and improve access to critically needed care for people returning home from jails and prisons.
In an announcement, CMS said Medi-Cal will be able to cover substance-use treatment before a Medicaid beneficiary is released from jail, prison, or youth correctional facility. The state will also be able to help connect the person to community-based Medicaid providers 90 days prior to their release to ensure they can continue their treatment after they return to the community.
“In partnership with HHS, the state of California is leading the way in providing coverage to justice-involved individuals. This is the first time in history Medicaid will be providing coverage to justice-involved individuals before they’re released. It is a step forward in closing gaps in services this underserved community experiences, and I encourage other states to follow California’s lead,” HHS Secretary Xavier Becerra said in an announcement.