Medicaid Coverage “Cliff” Poses Threat to Low-Income Medicare Beneficiaries

Nearly one-third of Medicare beneficiaries do not meet the criteria for Medicaid eligibility but have so little income that they are unlikely to be able to afford their share of their Medicare costs, such as co-pays and deductibles.

This is known as the “Medicaid coverage cliff,” and because they care for so many low-income seniors, the Medicaid coverage cliff poses a bigger threat to private safety-net hospitals, and to the patients they serve, than it does to the typical community hospital.

Becker’s Hospital Review, drawing from a recent study published in the journal Health Affairs, takes a brief look at what the Medicaid cliff is and how it may affect the well-being of those affected by this cliff.  Learn more in the Becker’s Hospital Review article “5 things to know about the Medicaid coverage ‘cliff’.”

Federal Health Policy Update for Friday, March 26

Beginning this week, NASH is expanding its regular updates to encompass a broader scope of federal health policy endeavors to include other matters of importance to providers.  Feel free to share this newsletter with others in your organization or to send us the email addresses of those you think might be interested and we will send it directly to them.

The following is the latest such information from the federal government as of 2:30 p.m. on Friday, March 26.

NASH Advocacy

The Senate voted 90-2 to extend the moratorium on the two percent sequester of Medicare payments through the end of 2021.  The House will take up the bill when it returns to Washington, DC in mid-April.  The current moratorium will expire on March 31, but CMS is expected to use its authority to hold Medicare payments for up to 14 days to give the House time to pass the legislation.  NASH sent a thank you note to all 90 senators who voted for the bill.

The White House

COVID-19

Department of Health and Human Services

COVID-19

Centers for Medicare & Medicaid Services

COVID-19

Health Policy News

  • CMS has posted the latest edition of MLN Connects, its online publication with the latest information about Medicare reimbursement policy.  The following is the table of contents of the March 25 edition, with links to the individual articles:

News

Compliance

Claims, Pricers, & Codes

MLN Matters® Articles

Centers for Disease Control and Prevention

COVID-19

Food and Drug Administration

COVID-19

  • The FDA announced that “Given the sustained increase in [COVID-19] viral variants in the United States that are resistant to bamlanivimab administered alone, and the availability of other authorized monoclonal antibody therapies that are expected to retain activity to these variants, the U.S. Government, in coordination with Eli Lilly and Company, will stop the distribution of bamlanivimab alone starting today, March 24, 2021.”  Using the other monoclonal antibody therapies, the FDA reasons, will increase the likelihood of successful treatment against COVID-19 variants.  Go here to see the FDA’s announcement and explanation and for links to resources that describe the available monoclonal antibodies and their differences in greater detail.

NASH Asks HHS for Provider Relief Fund Grants

Phase 3 distributions of Provider Relief Fund grants are long overdue and sorely needed by private safety-net hospitals, the National Alliance of Safety-Net Hospitals has declared in a letter to new Department of Health and Human Services Secretary Xavier Becerra.

NASH’s letter to Becerra notes that the COVID-19 emergency has posed a special challenge to private safety-net hospitals and that in too many cases, those safety-net hospitals have not received appropriate support from the CARES Act’s Provider Relief Fund.  In its letter, NASH asks Secretary Becerra to direct HHS staff to distribute the more than $20 billion remaining in the Provider Relief Fund as soon as possible and to make safety-net hospitals a priority in that distribution.

Learn more from NASH’s letter to Secretary Becerra.

New Medicare Policy May Save Money for Government But Cost Patients More

A new Medicare policy expected to save money for the federal government may end up doing so at the expense of Medicare beneficiaries who may find themselves faced with costs that Medicare previously paid.

Under the new policy, selected procedures that Medicare once authorized only when performed on an inpatient basis can now be performed on an outpatient basis.  The underlying rationale for the policy, which took effect on January 1 and will be phased in over the next three years, is that such an approach should foster competition and possibly lower Medicare costs.

But some of those procedures still require meaningful after-care that can range from prescription drugs to post-surgical monitoring to facility fees to home care and more – costs included in Medicare reimbursement for inpatient surgery but not included in the price of outpatient surgery.  Thus, while patients generally face the same maximum deductible for inpatient and outpatient procedures, they may be more likely to be forced to spend that full deductible if they choose to have the surgery performed on an outpatient basis.

This also could pose a challenge for private safety-net hospitals, which serve especially large numbers of low-income patients.  Many of those patients already have difficulty paying their Medicare co-payments, and this could leave safety-net hospitals with additional uncompensated care costs.

Learn more about how this situation came about, its implications for Medicare beneficiaries, and the possibility of this unusual situation being corrected in the Washington Post article “New cost-cutting Medicare rule may add costs to patients.”

MACPAC Issues Recommendations to Congress

The Medicaid and CHIP Payment and Access Commission has submitted its annual report to Congress on Medicaid and the Children’s Health Insurance Program.

The report includes recommendations for:

  • improving Medicaid’s responsiveness during economic downturns
  • addressing concerns about high rates of maternal morbidity and mortality;
  • reexamining Medicaid’s estate recovery policies
  • integrating care for people who are dually eligible for Medicaid and Medicare
  • improving hospital payment policy for the nation’s 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 array of issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP).”  Its mandate calls for it to address matters such as Medicaid and CHIP payment, eligibility, enrollment and retention, coverage, access to care, quality of care, and the programs’ interaction with Medicare and the health care system generally.

Because safety-net hospitals care for so many more Medicaid and CHIP participants than the typical community hospital, MACPAC’s deliberations are especially important to them.

Learn more about MACPAC’s recommendations in its Report to Congress on Medicaid and CHIP.

2019 Change in Public Charge Rule to Disappear

Shortly after taking office the Biden administration stopped enforcing 2019 changes in the so-called public charge rule and now the Supreme Court has agreed to a Justice Department request to dismiss an upcoming case challenging that rule.

The public charge rule, as updated in 2019, calls for all legal immigrants enrolled in Medicaid and certain other safety-net programs to be designated public charges and denied access to permanent U.S. residency and green card status.  Hospitals – including private safety-net hospitals and the National Association of Safety-Net Hospitals – feared that the revised rule would have a chilling effect on the willingness of some legal citizens and legal non-citizens to seek out government health care programs for which they legally qualify.  This, they feared, could lead to many low-income legal citizens and non-citizens choosing not to seek the care to which they are entitled by law and ignoring serious illnesses and injuries until they become a crisis.  This could lead to continuing health problems for such individuals and a potential surge of uncompensated care for the safety-net hospitals to which such individuals turn when their medical conditions absolutely require medical attention – a surge that could jeopardize jobs at those hospitals and access to care in the generally low-income communities safety-net hospitals serve.

Between this action by the Justice Department and the Supreme Court agreement not to hear the case, it appears that the next step will be for the administration, which has already directed its agencies to review such regulations, either to revise or rescind the 2019 changes in the public charge rule.

NASH expressed its opposition to the 2019 changes in the public charge rule on several occasions, including in this letter to the Department of Homeland Security when the changes were proposed and in this 2019 position statement.

Learn more about the public charge rule and recent actions affecting it in the article “Supreme Court agrees to dismiss challenge to Trump public charge rule,” from the online publication The Hill.

NASH Stresses Three Needs From COVID Relief Bill

Extension of the current moratorium on Medicare sequestration.

Additional resources for the Provider Relief Fund.

Another delay in hospital repayment of funds they received from the federal government through the Medicare Accelerated and Advance Payments Program.

These are the three greatest needs of NASH members and private safety-net hospitals that NASH communicated to members of Congress on Thursday afternoon as the Senate begins consideration of the COVID-19 relief bill.

Learn more from NASH’s message to members of Congress.

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.

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.