RISE reviews the latest headlines that impact Medicare, Medicare Advantage, Medicaid, and the Affordable Care Act marketplace.

CMS greenlights controversial Nebraska Medicaid expansion, work requirements plan

The Centers for Medicare & Medicaid Services (CMS) on Tuesday approved Nebraska’s new Medicaid expansion program, which will offer additional benefits to those newly eligible for coverage if they agree to follow work and wellness requirements. The controversial tiered-system, which is effective Oct. 20 through March 31, 2026, applies to adults who aren’t medically frail or pregnant, ages 21 through 64, and who are eligible under the Medicaid adult group expansion—having income at or below 138 percent of the federal poverty level. They will be offered vision services, dental benefits, and over-the-counter medications if they participate in wellness initiatives (attend an annual health visit and complete a health risk assessment) and personal responsibility activities (maintain affordable employer-sponsored coverage, if available, and not miss more than three scheduled health appointments in a six-month period).

Although CMS lauded the program by providing a means to lift beneficiaries from poverty and improved health and independence, critics say the system will make it harder for Nebraskans to access health care. “The Heritage Health Adult waiver is unnecessary and is a step in the wrong direction,” said Nebraska Appleseed’s Health Care Access Program Director Molly McCleery in a statement. “The waiver proposal was submitted to the federal government for approval despite hundreds of comments opposing the complicated project. By the Department of Health and Human Services’ own estimates, the waiver will result in tens of thousands of people being locked out of dental, vision, and over the counter drug benefits. The waiver does not ‘enhance’ benefits; it is indeed designed to deprive enrollees of those benefits.”

Despite the criticism, legal experts told Modern Healthcare that the Cornhusker State may overcome legal challenges because unlike other work requirements approved by the Trump administration, no one will lose coverage under the policy.

MA plans to increase supplemental benefit offerings in 2021

A new analysis from Avalere finds that one in three Medicare Advantage (MA) plans will offer new types of supplemental benefits in 2021 that are specifically related to the COVID-19 pandemic, such as no cost-sharing for COVID-19 testing and care packages. MA plans have increasingly offered supplemental benefits since 2018, including meals, transportation, in-home support services, and over the counter (OTC) benefits. A majority of MA plans will offer an OTC benefit in 2021, and nearly half will offer a transportation benefit, according to the report, which analyzed MA plan benefits data in the Q1 2021, Q1 2020, Q4 2019, and Q4 2018 plan benefit package files released by the Centers for Medicare & Medicaid Services. The report also found that in 2021, 94 percent of MA plans will include additional telehealth benefits. Click here to read the full analysis.

BMA report shows increase in MA enrollment among minority and dually-eligible beneficiaries

A report commissioned by the Medicare Alliance’s Center for Innovation in Medicare Advantage (MA) and released by the actuarial firm Milliman shows a 60 percent increase in MA enrollment from 2013-2019, while traditional Medicare saw a 5 percent enrollment increase during the same timeframe.  The report reveals minority beneficiary enrollment increased by 111 percent, with 2019 minority beneficiaries making up 31.5 percent of MA enrollment. Furthermore, enrollment of dually-eligible beneficiaries who qualify for both Medicare and Medicaid in MA jumped 125 percent from 2013-2019. Read the full report here.

CMS data reflects the impact of COVID-19 on Medicare members’ daily lives

New data released by the Centers for Medicare & Medicaid Services reveals that 21 percent of more than 11,000 Medicare beneficiaries reported forgoing medical care due to the COVID-19 pandemic. The data comes from the Medicare Current Beneficiary Survey COVID-19 Summer 2020 Supplement, a nationally representative, cross-sectional telephone survey of 11, 114 Medicare beneficiaries administered from June 10 through July 15.

The most common type of neglected care was dental care (43 percent), followed by regular check-ups (36 percent), treatment for an ongoing condition (36 percent), and diagnostic or medical screening test (32 percent). The most common reason Medicare members cited for forgoing care was not wanting to risk being at a medical facility (45 percent).

Nearly all the seniors surveyed said they had taken actions to protect themselves from COVID-19, including regular handwashing/use of hand sanitizer (98 percent), followed by social distancing and wearing facemasks (each at 93 percent).

In addition to forgone care and preventive health behaviors, the survey asked about the impact of the pandemic on daily life and well-being, availability of telemedicine appointments, access to technology, and sources of information about the pandemic. Click here to view an infographic with a snapshot of the survey results.

New law creates a 988 hotline for mental health emergencies

President Trump this week signed the National Suicide Hotline Designation Act of 2020, which designates 9-8-8 as the universal telephone hotline number for national suicide prevention and mental health emergencies. The Federal Communications Commissions aims to have the hotline up and running by July 2022.  The hotline will allow people to dial 988 for help, like calling 911 for emergencies. “This is a win for every American who has been affected by a mental illness,” said Seth Moulton, D-Salem, U.S. Representative for Massachusetts’ 6th congressional district, one of the bill’s primary sponsors, in a statement. “It is a national step forward out of the shadows of stigma that prevent too many people from getting help and into a new era when mental health care is easy to get and normal to talk about.”

ACA premiums lower for third consecutive year

The Centers for Medicare & Medicaid Services (CMS) released a report that shows lower premiums on HealthCare.gov in 2021. The average premium for the second lowest cost silver plan dropped by 2 percent for the 2021 coverage year. In addition, 22 more issuers will offer coverage in 2021 for a total of 181 issuers offering plans on the exchange. The findings show three years of declining average premiums since 2018.  As more issuers offer coverage, CMS said that more than three quarters of HealthCare.gov enrollees will have access to at least three issuers in 2021.