RISE reviews recent headlines that have an impact on Medicare and Medicaid.

340 organizations ask Congress to allow telehealth changes to continue beyond COVID-19

Health care stakeholders representing national and regional organizations sent a letter to Congress this week demanding that leaders make telehealth flexibilities created during the COVID-19 pandemic permanent. Congress waived statutory barriers to allow for expanded access to telehealth at the beginning of the pandemic, which gave federal agencies with the flexibility to allow health care providers to deliver care virtually. Although a Department of Health & Human Services representative tweeted that HHS is expected to extend the public health emergency before it expires later this month, there has been no formal announcement. The stakeholders said in the letter that if Congress doesn’t act before the public health emergency declaration expires, current flexibilities will immediately disappear. “We need your support in ensuring that seniors and providers do not go over the telehealth ‘cliff’—losing access to these critical services when they are still needed by so many.”

Oklahoma votes to expand Medicaid during the pandemic

Oklahoma this week approved a ballot initiative to expand Medicaid to its low-income residents, the first state to do so by amending its Constitution. The amendment approved will prevent the Republican-controlled legislature from rolling back coverage, the AP reported. Oklahoma is one of 14 states that didn’t expand Medicaid under the Affordable Care Act.  Last year Medicaid expansion supporters launched an initiative petition to get the measure on the ballot. An estimated 215,000 residents would qualify for Medicaid, and Oklahoma will begin enrolling members no later than July 1, 2021. To fund the proposal, the legislature is expected to increase a fee that hospitals pay from 2.5 percent to 4 percent, according to the AP.

Avalere report: Eligibility and entitlement lead to variability of Medicare FFS risk scores

A new Avalere analysis of the Centers for Medicare & Medicaid Services Hierarchical Condition Category (HCC) model shows that fully dual-eligible beneficiaries have the highest risk scores. To understand how costs vary across different groups of Medicare enrollees, Avalere calculated the average risk score for each segment of community beneficiaries in Medicare Fee for Service using the CMS HCC model v23. To calculate these risk scores, Avalere used diagnoses from 2018 claims for a cohort of individuals enrolled in Medicare FFS in 2019.  The risk scores used in the analysis were raw and not adjusted by the normalization factor that the CMS applies when using the risk scores in payment. The report found:

  • Both full and partial dual-eligible beneficiaries have higher than average risk scores than non-duals
  • Aged beneficiaries have higher average risk scores than the disabled across all dual statuses
  • For non-dual and partial dual beneficiaries, the risk scores for the aged are only slightly higher than those for the disabled

House passes bill to strengthen ACA coverage

The House this week passed a bill to expand the Affordable Care Act that would increase the subsidies that help people pay for their premiums and add additional federal funding for Medicaid expansion. The legislation passed 234-178. The vote took place days after the Trump administration filed a legal brief with the Supreme Court to strike down the ACA.  “As President Trump continues to attack the Affordable Care Act and works to tear down protections for people with pre-existing conditions, I am proud to support this legislation that not only defends, but strengthens the ACA,” said Congressman Tim Ryan (OH-13) in an announcement. “The coronavirus has reminded our nation of just how critical health care is to keep Americans safe...While there is still much we need to do to improve our nation’s health care system, this legislation takes major steps forward and will be critical as we continue to combat the coronavirus.”

New report uncovers the state of public health in America

A new investigation from Kaiser Health News and the Associated Press examines the troubling state of the public health infrastructure the nation is relying on to navigate the health and economic threats presented by the COVID-19 pandemic. The multipart investigations find that the public health workforce in the United States is underfunded and under threat, lacking the basic tools to confront the worst pandemic in a century. Among the key findings in the first article of the series:

  • Since 2010, spending on state health departments has dropped by 16 percent per capita, and in local health departments by 18 percent, in 2019 dollars after adjusting for inflation.
  • At least 38,000 state and local public health jobs have been eliminated since the Great Recession in 2008, leaving an inadequate workforce in what was viewed in the mid-20th century as one of the world’s best public health systems.
  • At least 14 states have already cut or are actively considering cuts to health department budgets or positions. States, cities, and counties facing declining revenues amid the economic downturn are laying off and furloughing the already limited staff.

Journalists interviewed more than 150 public health workers, policymakers, and experts, analyzed state and federal financial records, and surveyed statehouses around the country. Their investigation finds that governments at every level have failed to provide the public health system with the resources—both human and financial— that are required to protect the nation from pandemics.