RISE summarizes the latest headlines that impact Medicare, Medicare Advantage, and Medicaid.

CMS suspends vaccine mandate for health care workers due to preliminary injunction

In the wake of a federal judge ruling to block a national COVID-19 vaccine mandate for health care workers, the Centers for Medicare & Medicaid Services (CMS) issued a memo to state survey agency directors to suspend enforcement of the mandate as long as the court-ordered injunction remains in effect.

The Dec. 2 memo said that CMS will not enforce the interim final rule that required the vaccination of health care workers in certified Medicare/Medicaid providers and suppliers (including nursing facilities, hospitals, dialysis facilities, and all other provider types covered by the rule) while there are court-ordered injunctions in place prohibiting enforcement of this provision. The rule had required staff working in Medicare- or Medicaid-certified providers to have the shots necessary to be fully vaccinated against COVID-19 by January 4, 2022, and to receive their first shot prior to December 6, 2021. The rule allows for medical and religious exemptions and requires that providers have policies and procedures to operationalize these requirements.

But last week both the United States District Court for the Eastern District of Missouri and United States District Court for the Western District of Louisiana issued preliminary injunctions against the implementation and enforcement of the interim rule. The two injunctions cover all states, the District of Columbia, and the US Territories. CMS said in the memo that it has appealed both decisions and has filed motions for stays of these orders.

“While CMS remains confident in its authority to protect the health and safety of patients in facilities certified by the Medicare and Medicaid programs, it has suspended activities related to the implementation and enforcement of this rule pending future developments in the litigation,” the memo said. “Accordingly, while these preliminary injunctions are in effect, surveyors must not survey providers for compliance with the requirements of the Interim Final Rule. Health care facilities, of course, may voluntarily choose to comply with the Interim Final Rule.”

CMS rolls out plan to encourage Medicare members to get booster shots

Meanwhile, CMS announced a multi-pronged action plan to encourage those with Medicare to get fully vaccinated and get their booster dose. The action plan includes:

  • Sending a letter to all the 63 million Americans who currently have Medicare to get their booster shot as soon as possible
  • Conducting advertising campaigns that targets those with Medicare who are not fully vaccinated against COVID-19 and will include reminders about getting the annual flu shot
  • Including reminders via 1-800-Medicare so that members hear messages about boosters when they call the toll-free number
  • Including a message in Medicare Summary Notices for people with Original Medicare
  • Sending email reminders to more than 14 million people who receive Medicare emails
  • Delivering messaging via social medial: The @MedicareGov Twitter handle will continue to tweet about the importance of COVID-19 vaccine boosters
  • Contacting more than 500 organizations that have the potential to reach more than five million organizations and providing them with resources from the Department of Health & Human Services and the Centers for Disease Control and Prevention
  • Conducting outreach to health plans to help them understand best practices for encouraging COVID-19 vaccinations and parameters for coverage of the vaccines and boosters
  • Continuing to work with nursing homes to increase vaccine and booster uptake, including sending Quality Improvement Organizations to assist nursing homes with low rates of initial and booster vaccinations and disparities in access to vaccinations
  • Conducting media outreach

Medicaid matching funds now available for states for COVID-19 youth counseling visits

CMS will now require states to cover COVID-19 vaccine counseling visits so health care providers can talk to families about the importance of vaccinations for children. Because Medicaid provides health insurance coverage to more than 40 percent of all children in the United States, the matching funds will expand access to individualized medical advice in all communities and give families support to engage with their trusted providers.

CMS said it will now consider certain COVID-19 vaccine counseling visits for children and youth to be COVID-19 vaccination, for which state expenditures can be federally matched at 100 percent through the last day of the first quarter that begins one year after the end of the COVID-19 public health emergency. CMS will match the counseling-only visits at the American Rescue Plan 100 percent federal match rate only when they are provided to children and youth under age 21 as part of the Medicaid early and periodic screening, diagnostic, and treatment (EPSDT) benefit.

Furthermore, CMS will also now require states cover stand-alone vaccine counseling visits related to all pediatric visits under the EPSDT benefit. These states expenditures will be matched at the state’s regular federal medical assistance percentage.

Study: 13M adults delayed or didn’t get needed prescriptions because of costs

A new analysis from the Urban Institute finds high costs prevented or delayed nearly 13 million adults from accessing needed medications.

The 2018–2019 Medical Expenditure Panel Survey found that:

  • More than a quarter of adults with Medicare and 5.3 percent of privately insured adults spend more than one percent of their family income on their individual out-of-pocket prescription drug costs.
  • More than three percent of Medicare beneficiaries—and nearly seven percent of beneficiaries with unmet prescription drug needs—spent more than 10 percent of their family income on prescription drugs.
  • Nearly one in 10 adults who were uninsured all year or part of the year reported unmet prescription drug needs compared with nearly five percent of Medicare beneficiaries, three percent of privately insured adults, and more than five percent of nonelderly adults with Medicaid.
  • For Medicare beneficiaries and privately uninsured adults, unmet prescription drugs were most common among women, people with low incomes, and people with chronic health conditions.