Supreme Court ruling: Mifepristone remains available as case winds through the courts
The Supreme Court on Friday temporarily blocked a lower court ruling in the Alliance for Hipprocratic Medicine v. FDA from going into effect. The ruling preserves women’s access to the abortion pill, Mifepristone, while the Department of Justice appeals a U.S. District Court decision that suspended the Food and Drug Administration’s approval of the drug, which has been widely available since 2000.
The action from the Supreme court “is an important step in the right direction as we vigorously fight to defend the FDA’s independent, expert authority to review, approve, and regulate a wide range of prescription drugs. We are confident the law is on our side and remain focused on prevailing in court,” said U.S. Department of Health and Human Services Secretary Xavier Becerra.
RELATED: Supreme Court puts a temporary hold on lower court ruling restricting access to abortion pill
The case will now go back to the Fifth Circuit Court of Appeals. An expedited hearing is scheduled for May 12. A KFF policy brief explains that the Fifth Circuit will consider the FDA and Danco Laboratories LLC (a party in the litigation, which also holds the new drug application for Mifeprex, the brand name for mifepristone) appeal of the district court’s decision to temporarily pause the agency’s approval of the abortion pill with the litigation proceeds. The district court must still consider the case on its merits.
OIG: HumanaChoice received $27.3M in MA overpayments for 2015 and 2016
A recent audit by the Office of Inspector General (OIG) examined high-risk diagnosis codes that HumanaChoice submitted to the Centers for Medicare & Medicaid Services (CMS) for the risk adjustment program. The OIG sampled 210 unique enrollee-years with the codes HumanaChoice received higher payments (close to $700,000) for 2015 and 2016.
The audit found that the diagnosis codes submitted for 157 of the 210 sampled enrollee-years were not supported in the medical records and resulted in more than $480,000 of net overpayments. The OIG determined the errors occurred because of the organization’s policies and procedures that were in place to prevent, detect, and correct noncompliance with CMS program requirements.
Based on the sample results, the OIG estimates that HumanaChoice received at least $27.3 million of net overpayments for 2015 and 2016. However, because CMS has changed its regulations and only allows recouping extrapolated overpayments beginning with payment year 2018, the OIG recommends that the MA plan refund the federal government the $480,295 of net overpayments; identify similar instances of noncompliance that occurred before or after the audit period; and identify areas its compliance procedures could be improved. HumanaChoice disagreed with the audit methodology, findings, and recommendations.
HHS: Proposed Medicaid work reporting requirements would jeopardize health coverage for 21M Americans
A new HHS analysis finds that nearly 21 million Americans’ health overage and access to care would be jeopardized if the Medicaid work reporting requirements proposed by Congressional Republicans were implemented.
The information, based on data from CMS, estimates the harmful effects on all states that have expanded Medicaid under the Affordable Care Act. Overall, the results show that approximately 21 million people nationwide would be at risk of losing Medicaid coverage under the substantial bureaucratic red tape of the proposed new work reporting requirements if they were put in place.
Only one state has ever fully implemented work reporting requirements, and nearly one in four adults subject to the policy lost their health coverage—including working people and people with serious health conditions—with no evidence of increased employment. In fact, research shows that more than 95 percent of enrollees subject to the policy already met the requirements or should have qualified for an exemption–but many lost coverage because they couldn’t navigate the red tape. According to a recent HHS report, the vast majority of working-age Medicaid enrollees are already employed, have a disability, or are parents. However, loss of Medicaid coverage can force patients to change providers, skip medications, or face financial difficulties, and coverage loss has been tied to worse quality of care and worse health. In contrast, Medicaid coverage can support work by keeping people healthy while they are working or looking for work, studies have shown.
The dramatic effect on coverage raises concerns that extreme proposals to add such requirements across the U.S. would undermine the progress made during the Biden-Harris Administration to expand coverage and access to high-quality affordable health care. The national uninsured rate reached an all-time low under President Biden and the Administration continues to work to expand coverage. HHS is committed to working with states to test new innovative ways to deliver health care, lower costs for Americans, and expand coverage; in contrast, efforts like Congressional Republicans’ budget proposal would make it harder for people to get health insurance and could take coverage away from millions of Americans.
HHS releases proposal to expand health care for DACA recipients
HHS, through CMS, has released a notice of proposed rulemaking to expand access to health care by reducing barriers for Deferred Action for Childhood Arrivals (DACA) recipients. The proposed change applies to the Health Insurance Marketplaces, the Basic Health Program, and some Medicaid and Children’s Health Insurance Programs (CHIP).
“DACA recipients, like all Dreamers, are Americans, plain and simple. The United States is their home, and they should enjoy the same access to health care as their fellow Americans,” said HHS Secretary Xavier Becerra in an announcement. “Every day, nearly 580,000 DACA recipients wake up and serve their communities, often working in essential roles and making tremendous contributions to our country. They deserve access to health care, which will provide them with peace of mind and security.”
If finalized, the proposed rule would remove the current exclusion that treats DACA recipients differently from other individuals with deferred action who would otherwise be eligible for coverage under select CMS programs. If the rule is finalized as proposed, it could lead to 129,000 previously uninsured DACA recipients receiving health care coverage. Over the last decade, DACA has provided peace of mind and work authorization to more than 800,000 Dreamers.
The proposed rule would amend the definition of “lawfully present” to include DACA recipients for the purposes of Medicaid and CHIP. In effect, this would extend Medicaid and CHIP coverage to children and pregnant women in states that have elected the “CHIPRA 214” option for children and/or pregnant individuals, the Basic Health Program, and Affordable Care Act Marketplace coverage. DACA recipients would need to meet all other eligibility requirements to qualify for coverage. Additionally, DACA recipients would be eligible for financial assistance through the Marketplace, such as advance payments of the premium tax credit and cost-sharing reductions if they meet all other eligibility requirements.
If the rule is finalized as proposed, DACA recipients would qualify for a special enrollment period to select a qualified health plan through a Marketplace during the 60 days following the effective date of the final rule.
KFF report: 24M may lose Medicaid as continuous enrollment provision unwinds
Eight to 24 million people across the United States could be disenrolled from Medicaid during the unwinding of the program’s continuous enrollment provision, according to a new Kaiser Family Foundation (KFF) analysis.
The estimates are based on KFF’s recent survey of state Medicaid and Children’s Health Insurance Program (CHIP) officials, conducted with the Georgetown University Center for Children and Families. The survey focused on states’ eligibility and enrollment policies, and their approaches to the unwinding of pandemic-era protections that prevented states from disenrolling people from Medicaid during the public health crisis. It included questions about how many people states estimate will lose Medicaid coverage in the months following the expiration of those protections in March.
Among states that responded to the survey, the midpoint estimate was that 18 percent would be disenrolled, suggesting that total Medicaid enrollment could fall by about 17 million people nationally during the unwinding, including five million children and 12 million adults, KFF announced.
The new analysis offers three illustrative scenarios for how state-level Medicaid enrollment could decline between March 2023 and May 2024, ranging from eight percent to 28 percent of total enrollees, which is plus or minus 10 percentage points from the midpoint and similar to the varying projections reported by states. While neither the lowest nor highest rate of disenrollment is an expected national outcome, the range may be helpful in examining what the variation could be across states.
The new findings are consistent with HHS estimates that as many as 15 million people will be disenrolled during the unwinding process, including 6.8 million who will likely still be eligible. (KFF’s analysis does not estimate how much of the Medicaid coverage loss would be among people who are still eligible versus those who are no longer eligible.)
The unwinding of the continuous enrollment provision will play out differently across the states based on policy choices states have made and variation in their administrative infrastructures. Some states have adopted multiple policies that are more likely to promote continued coverage among those who remain eligible. Other states have adopted fewer of these policies, which will likely lead to a larger number of people losing Medicaid coverage, including some who remain eligible.
According to another new KFF analysis, eight states meet at least eight of the nine key metrics that will support continued Medicaid coverage for those who remain eligible. Seven states meet only three or four of the metrics. The nine metrics come from the same survey of state Medicaid and CHIP officials and include things such as taking 12-14 months to complete all renewals, following up with enrollees who haven’t responded to a renewal request before terminating coverage and completing 50 percent or more of renewals using ex parte, or automated, processes.
Among the 17 million children and adults who could be disenrolled from Medicaid, it remains uncertain how many will transition to other health coverage or become uninsured. A recent KFF analysis found that nearly two-thirds of people experienced a period of uninsurance after being disenrolled from Medicaid or the CHIP.