What's going on in waiver land
With the rescinding of HRSN guidance, states are worried about the status of their existing 1115 waivers.
It’s Day 52 of the Trump administration, and there’s a new concern circulating among health care folks: the potential for the federal government to rescind Medicaid 1115 waivers. Many of these waivers or “demonstrations,” which give states flexibility to test innovative Medicaid delivery models tailored to state priorities, address health-related social needs (HRSN). With CMS’ new directive to evaluate 1115 waiver applications on a case-by-case basis instead of using the now-rescinded HRSN guidance under which many of these demonstrations were crafted, there are concerns that the inroads states and their provider partners have made on HRSN through existing 1115 waivers will face an existential threat.
Editor’s note: Welcome to the first edition of The 80 Million weekly Medicaid newsletter, powered by Manatt Health. We aim to be the proverbial water cooler where you can talk to your colleagues around the country about Medicaid policy and its impact on your organization — whether you’re part of state government, a provider system, health plan, life sciences company or any of the myriad entities in the health care ecosystem that Medicaid touches. Our free newsletter and soon-to-be paywalled content will feel like talking to your smartest friend (who happens to be deeply entrenched in Medicaid). We’re so happy you’re here. — Patricia Boozang, Senior Managing Director, Manatt Health
Cutting Medicaid Could Hurt Millions of Americans Who Need Long-term Care
Long-term care (LTC) services, also referred to as long-term services and supports (LTSS), are a broad range of medical, personal care, rehabilitation or social services a person with physical or cognitive limitations may need. An estimated 70% of Americans will need LTC services in their lifetime.1 For example, a frail, older woman might receive LTC services like: (1) a personal care aide who comes to her home to help her bathe and dress each morning; (2) home modifications to minimize her risk of falling; and (3) transportation to her medical appointments. These services enable her to remain in her home — near family to prevent social isolation — and attain the highest possible quality of life.
LTC and LTSS services can be provided in other settings, such as a nursing home, an assisted living facility or adult day health center. Across the nation, these services are provided not just by paid workers, but also by unpaid family members, friends and neighbors, often because families have no insurance coverage for these services and the cost of paying for them out of pocket is prohibitive.
Keep reading at The 80 Million.
ICYMI: HHS Intends to Issue More Rules Without Public Notice and Comment; Impact on Medicaid Uncertain
Public comment plays an important part in how the federal Medicaid policy makers draft and implement program rules. These comments enhance policy quality, accuracy, and effectiveness by incorporating diverse perspectives and real-world insights from the organizations and parties who need to implement the proposed policy. CMS has often modified proposed rules in response to public comment, and in some cases has opted to drop a proposed rule entirely after significant public opposition.
Public notice and comment processes also promote stakeholder buy-in and transparency and reduce certain types of litigation risks. All these benefits lead to better policy impacts for the 80 million Medicaid enrollees and better policy implementation by state Medicaid programs, providers, health plans and other stakeholders delivering Medicaid services.
Keep reading at The 80 Million.
IN THE KNOW
Washington State is seeking approval to cover traditional healers through Medicaid following four states (California, New Mexico, Arizona and Oregon) receiving 1115 waivers … California released a comprehensive policy and care map called the Birthing Care Pathway to cover pregnant and postpartum Medi-Cal members from conception through 12 months postpartum … Manatt experts led a webinar on how nurses can lead whole-person health in Medicaid. Watch here.
IN THE NEWS
Nursing homes and the AMA, once Medicaid defenders, hang back as GOP mulls big cuts – KFF Health News
Medicaid under fire: Deep cuts proposed as state waits for approval to add work requirements – Dayton Daily News
Georgia touts its Medicaid experiment as a success. The numbers tell a different story. – ProPublica
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