ACA Medicaid Expansion Cut Young Adult Uninsurance in Half

The number of uninsured young adults fell nearly 50 percent after the Affordable Care Act authorized states to expand their Medicaid programs, a new study has found.

According to the Urban Institute, the uninsured rate among people between the ages of 19 and 25 fell from 30.2 percent to 16 percent between 2011 and 2018, with most of the decline coming between 2013 and 2016, when the first round of states expanded their Medicaid programs.

The decline in the rate of uninsured young adults mirrored declines in the overall U.S. uninsured rate, which fell from 27.7 percent to 11.3 percent in states that expanded their Medicaid programs.  This decline has contributed greatly to the ability of private safety-net hospitals to serve their communities.

Learn more about how implementation of the Affordable Care Act affected the insurance status of young adults in the Urban Institute report “Impacts of the ACA’s Medicaid Expansion on Health Insurance Coverage and Health Care Access Among Young Adults.”

NASH Unveils 2021 Advocacy Agenda

NASH has introduced its 2021 agenda.

In the coming year, NASH will:

  • Work to ensure that private safety-net hospitals receive the federal resources and regulatory assistance they need to help their low-income, medically underserved communities through the COVID-19 crisis.
  • Advocate the development and implementation of laws, regulations, and programs that enhance the ability of private safety-net hospitals to serve their communities more effectively.
  • Pursue enhanced access to Medicaid and to affordable, high-quality health insurance.
  • Urge Congress and the administration to work with safety-net hospitals and do more to address the social determinants of health to bring about health equity and better health outcomes in diverse and underserved communities.

To see NASH’s complete 2021 advocacy agenda, go here.

Coronavirus Update for Friday, February 5

The following is the latest COVID-19 information from the federal government as of 2:30 p.m. on Friday, February 5.

NASH Advocacy

  • This week NASH wrote to congressional leaders on behalf of private safety-net hospitals asking them to include in the administration’s COVID-19 relief bill:
    • more resources for the Provider Relief Fund
    • additional targeted funding for safety-net hospitals
    • help with staffing
    • an extension of the current moratorium on the Medicare sequestration
    • forgiveness for safety-net hospitals for loans they received under the Medicare Accelerated and Advance Payment Program

See NASH’s letter to congressional leaders here.

NASH will engage in additional advocacy in the coming days.

The White House

Provider Relief Fund

A new proposal has been adopted by the Senate to include $35 billion for the Provider Relief Fund in the administration’s proposed $1.9 trillion COVID-19 relief bill.

Centers for Medicare & Medicaid Services

HHS and CMS COVID-19 Stakeholder Calls

HHS Clinical Rounds Peer-to-Peer Virtual Communities of Practice

HHS’s Office of the Assistant Secretary for Preparedness and Response sponsors COVID-19 Clinical Rounds Peer-to-Peer Virtual Communities of Practice that are interactive virtual learning sessions that seek to create a peer-to-peer learning network in which clinicians from the U.S. and abroad who have experience treating patients with COVID-19 share their challenges and successes.  These webinar topics are covered every week:

  • EMS:  Patient Care and Operations (Mondays, 12:00-1:00 PM eastern)
  • Critical Care:  Lifesaving Treatment and Clinical Operations (Tuesdays, 12:00-1:00 PM eastern)
  • Emergency Department:  Patient Care and Clinical Operations (Thursdays, 12:00-1:00 PM eastern)

Go here for information about signing up to participate in the sessions and go here for access to materials and video recordings of past sessions.

CMS Stakeholder Calls

CMS hosts recurring stakeholder engagement sessions to share information about the agency’s response to COVID-19.  These sessions are open to members of the health care community and are intended to provide updates, share best practices among peers, and offer participants an opportunity to ask questions of CMS and other subject matter experts.

CMS COVID-19 Office Hours Calls

Tuesday, February 23 at 5:00 – 6:00 PM (eastern)

Toll Free Attendee Dial In:  833-614-0820; Access Passcode:  2528725

Audio Webcast link:  go here

Tuesday, March 16 at 5:00 – 6:00 PM (eastern)

Toll Free Attendee Dial In:  833-614-0820; Access Passcode:  4177586

Audio Webcast link:  go here

Tuesday, April 6 at 5:00 – 6:00 PM (eastern)

Toll Free Attendee Dial In:  833-614-0820; Access Passcode:  2769397

Audio Webcast link:  go here

Food and Drug Administration

Centers for Disease Control and Prevention

The National Academies of Sciences, Engineering, and Medicine

NASH Presents COVID-19 Relief Needs to Congress

The next COVID-19 relief bill should include more resources for the Provider Relief Fund, additional targeted funding for safety-net hospitals, help with staffing, an extension of the current moratorium on the Medicare sequestration, and forgiveness for safety-net hospitals for loans they received under the Medicare Accelerated and Advance Payment Program.

This was the message the National Alliance of Safety-Net Hospitals conveyed this week in a letter to congressional leaders.  See that letter here.


The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

MACPAC kicked off its January meeting with a review of a draft chapter for the March 2021 report to Congress and recommendations on a mandatory extension of Medicaid coverage for 12 months postpartum. The Commission received extensive public comment on the recommendations. On Friday, the Commission approved three recommendations as drafted related to postpartum coverage. The Commission recommended that Congress should:

  • extend the postpartum coverage period for individuals who were eligible and enrolled in Medicaid while pregnant to a full year of coverage, regardless of changes in income. Services provided to individuals during the extended postpartum coverage period will receive an enhanced 100 percent federal matching rate;
  • extend the postpartum coverage period for individuals who were eligible and enrolled in the State Children’s Health Insurance Program (CHIP) while pregnant (if the state provides such coverage) to a full year of coverage, regardless of changes in income; and
  • require states to provide full Medicaid benefits to individuals enrolled in all pregnancy-related pathways.

Commissioners then turned their attention to Medicaid estate recovery policies that affect beneficiaries using long-term services and supports (LTSS). Commissioners on Friday approved recommendations to:

  • make estate recovery optional rather than required;
  • allow states with managed long-term services and supports to pursue recovery based on the cost of services where it is less than the capitation payment paid to a managed care plan; and
  • direct the Secretary of the U.S. Department of Health and Human Services (HHS) to establish minimum hardship waiver standards, including a minimum estate value threshold for estate recovery.

Next, the Commission considered recommendations for countercyclical financing adjustments in Medicaid. This would allow federal financial stimulus to be directed to states more quickly during economic downturns and provide states with greater budget predictability. The Commission approved a recommendation that Congress should adopt a statutory mechanism to amend the Social Security Act to provide an automatic Medicaid countercyclical financing model, using the prototype developed by the U.S. Government Accountability Office as the basis. The Commission also recommended this policy change should include:

  • an eligibility maintenance of effort requirement for the period covered by an automatic countercyclical financing adjustment;
  • an upper bound of 100 percent on countercyclical adjusted matching rates; and
  • exclusion of countercyclical adjusted federal matching rate from services and populations that receive special matching rates (e.g., for the new adult group) or are otherwise capped or have allotments (e.g., disproportionate share hospital payments, territories).

After a break on Thursday, Commissioners discussed a draft chapter for the March 2021 report on design considerations for creating a new program for dually eligible beneficiaries and reviewed a report to Congress by the U.S. Secretary of Health and Human Services (HHS) on Medicaid housing supports for individuals with substance use disorder (SUD). The Commission plans to send a letter to HHS and leadership of relevant congressional committees commenting on the Secretary’s report to Congress on Medicaid housing supports for people with SUD who are experiencing or at risk of homelessness.

Next, Commissioners heard a panel discussion on the outlook for state budgets and the implications for Medicaid with Emily Blanford, program principal at the National Conference of State Legislatures; Shelby Kerns, executive director for the National Association of State Budget Officers; and Susie Perez Quinn, government affairs director for the National Governors Association. * The day ended with a presentation on value-based payment for maternity services.

On Friday, Commissioners heard a panel discussion on how Medicaid serves people with intellectual or developmental disabilities with Sharon Lewis, a principal at Health Management Associates; Melissa Stone, director of Arkansas’ Division of Developmental Disabilities Services; and Elizabeth Weintraub, a senior advocacy specialist at the Association of University Centers on Disabilities. * Additional sessions focused on a congressionally mandated MACPAC study of non-emergency medical transportation (NEMT), which will be included in the June 2021 report to Congress. In addition, Commissioners heard a new analyses of care integration for dually eligible beneficiaries, and a discussion of potential new models for payment and coverage of high-cost specialty drugs. The meeting concluded with a discussion of mental health parity in Medicaid.

Supporting the discussion were the following briefing papers:

  1. Postpartum Coverage: Review of Draft Chapter and Recommendation Decisions
  2. Medicaid Estate Recovery Draft Chapter and Recommendations
  3. Automatic Countercyclical Financing Adjustment Review of Draft Chapter and Recommendation Decision
  4. Establishing a Unified Program for Dually Eligible Beneficiaries Design Considerations
  5. Review of the Secretary’s Report on Medicaid Housing Supports for Individuals with Substance Use Disorder
  6. Value-Based Payment for Maternity Care in Medicaid
  7. Mandated Report on Non-Emergency Medical Transportation Further Findings
  8. Integration of Care for Dually Eligible Beneficiaries: New Analyses
  9. Payment and Coverage of High-Cost Specialty Drugs Report from Technical Advisory Panel
  10. Implementation of the Mental Health Parity and Addiction Equity Act in Medicaid and CHIP

Because they serve so many Medicaid and CHIP patients – more than the typical hospital – MACPAC’s deliberations are especially important to private safety-net hospitals.

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department  of Health and Human Services, and the states on a wide variety of issues affecting Medicaid and the State Children’s Health Insurance Program.  Find its web site here.


NASH Writes to President About COVID-19 Plan

NASH has written to President Biden and Vice President Harris to express its support for their planned response to the COVID-19 public health emergency as expressed in the administration’s new “National Strategy for the COVID-19 Response and Pandemic Preparedness.”

NASH also conveyed its support for the strategy’s emphasis on measures to promote health equity in diverse, low-income, underserved communities – the very communities so often served by private safety-net hospitals.

Go here to read NASH’s letter to the President and Vice President.

NASH Comments on Proposed Changes in S-10 Uncompensated Care Reporting

NASH has expressed support for several new federal proposals on hospital uncompensated care data reporting and conveyed its opposition to other proposed changes in federal data collection requirements in a new letter to the Centers for Medicare & Medicaid Services.

In response to changes CMS has proposed in the uncompensated care data hospitals must submit to the federal government, NASH expressed:

  • Support for CMS’s proposal to clarify aspects of how hospitals must report data on the uncompensated care they provide on the Medicare cost report’s S-10 form.
  • Expressed concern that some of the new data reporting requirements violate current HIPAA requirements.
  • Asked CMS to defer reporting on the rates hospitals negotiate with Medicare Advantage plans until after the end of the COVID-19 public health emergency.

NASH is especially interested in proposed changes in uncompensated care data reporting on the S-10 form because that form is used in the calculation of private safety-net hospitals’ Medicare disproportionate share payments (Medicare DSH).  Those Medicare DSH payments are a vital tool in helping these hospitals serve the low-income and uninsured residents of the communities in which they are located.

Learn more about NASH’s response to CMS’s proposed new information collection activities in this NASH letter to CMS.

NASH Asks Congress to Help Hospitals Keep Provider Relief Fund Grants

Safety-net hospitals could lose some or all of their CARES Act Provider Relief Fund grant money and the National Alliance of Safety-Net Hospitals is asking members of Congress to intervene to prevent it.

At issue are financial reporting requirements that at first directed hospitals to estimate their anticipated revenue losses and extra expenses associated with the COVID-19 pandemic in one way and then shifted to a new approach.  The first grant distribution was based on the original reporting requirements, and now, hospitals fear that the change in reporting requirements could leave them vulnerable to a demand that they return some, much, or all of that grant money.

The Department of Health and Human Services announced one set of reporting requirement in June and then proposed modifying them in September.  In response to widespread expressions of concern, including from NASH, HHS revised those proposed changes – but not enough, according to many stakeholders, leaving them concerned that HHS would ask them to return some of their grant money.  Now, NASH is asking the same members of Congress who asked HHS to reconsider the reporting requirements to do so again.

See NASH’s letter members of Congress asking them to sign onto a bipartisan letter asking HHS to revise its reporting requirements once again.  Go here to see the letter members of Congress are being asked to sign.

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

MedPAC’s proposed Medicare 2021 payment recommendations dominated the December agenda, including:

  • hospital inpatient and outpatient payments
  • ambulatory surgical center payments
  • physician and health professional payments
  • hospice payments
  • home health care payments
  • inpatient rehabilitation facility payments
  • long-term care hospital payments

In addition, MedPAC discussed Medicare’s policy for transfers between post-acute-care facilities and hospice and received a staff update on the Medicare Advantage program.

MedPAC is an independent congressional agency that advises Congress on issues involving Medicare.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.  Because so many patients of private safety-net hospitals are insured by Medicare, MedPAC’s deliberations are especially important to those hospitals.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues and for a transcript of the two days of meetings.

GAO: CMS Should Pay More Attention to States’ Financing of Medicaid

The federal government does not adequately monitor how states finance their Medicaid programs.

It also lacks a sufficiently clear understanding of how they pay providers of Medicaid-covered services.

These are among the conclusions in a new study on Medicaid financing and payments by the U.S. Government Accountability Office.

According to the GAO report,

GAO estimated that states’ reliance on provider taxes and local government funds decreased states’ share of net Medicaid payments (total state and federal payments) and effectively increased the federal share of net Medicaid payments by 5 percentage points in state fiscal year 2018.  It also resulted in smaller net payments to some providers after the taxes and local government funds they contribute to their payments are taken into account. While net payments are smaller, the federal government’s contribution does not change. This effectively shifts responsibility for a larger portion of Medicaid payments to the federal government and away from states.

To address this challenge, the GAO urged CMS to collect more complete and consistent information about both state financing of their Medicaid programs and the manner in which states pay Medicaid providers.  CMS neither agreed nor disagreed with the GAO’s recommendation.

Such a study could have implications for private safety-net hospitals located in states that have increased their dependence on provider taxes to fund their Medicaid programs in recent years.

Learn more about what the GAO found and recommended in its new report “Medicaid:  CMS Needs More Information on States’ Financing and Payment Arrangements to Improve Oversight.”