Medicaid News: Work Requirements Hearings Suspended by SCOTUS, Reporting Requirements Under Review

This week, the Supreme Court suspended hearings on Medicaid work requirements as other Trump era Medicaid policies come under fire. Plus, states aren’t quite meeting reporting requirements and more reporting adjustments could be on the way.

The U.S. Supreme Court suspended its review of the Medicaid work requirements and removed the oral arguments in the case from the March calendar. Inside Health Policy reports that Medicaid stakeholders were waiting to see what SCOTUS would do following the Biden administration’s action to revoke the Arkansas and New Hampshire Medicaid work requirement waivers on March 17. From Mary Beth Musumeci, associate director for the Kaiser Family Foundation Program on Medicaid and the Uninsured:

Long awaited order from #SCOTUS this morning in the #Medicaid work requirement waiver cases in AR and NH – though still not a final decision. The Court says that the cases are on hold, pending another order of the Court still to come. It could be that the court has reached a decision – perhaps to send the cases back to [the Department of Health and Human Services] as the federal government has asked – but is waiting to allow time for another justice to dissent.

Arizona’s work requirement program through the Arizona Health Care Cost Containment System (AHCCCS) — called AHCCCS Works — was put on hold in 2019 after being slated to go into effect in January 2020.

According to PBS Indianapolis, some people predict this will be the end of Medicaid work requirement programs. The Centers for Medicare and Medicaid Services (CMS) can legally grant permission for states to experiment with programs in order to expand their Medicaid programs to cover more people. Although this was the loophole for work requirements to come to be, an estimated 70,000 people lost coverage. From Adam Mueller, advocacy director for Indiana Legal Services:

It certainly seems like CMS has taken a position that the work requirements do not fulfill the objectives of the Medicaid act.

The joint project between former CMS director Seema Verma and Mike Pence to expand Indiana’s Medicaid program with “personal responsibility” provisions that require enrollees to pay premiums and maintain health savings accounts is also under heavy scrutiny. Modern Healthcare says Indiana’s expansion program — The Healthy Indiana Plan — did not demonstrate any indication of improving health and access than other state expansion programs, nor did it demonstrate improved results beyond states that did not expand Medicaid.

From the Federal Evaluation of the Healthy Indiana Plan:

The gains in health insurance coverage in Indiana under HIP 2.0 in 2017-18 were significantly larger than would have been expected if Indiana had not expanded Medicaid and generally comparable to what would have been expected if Indiana had expanded Medicaid without a demonstration or with a different demonstration. Despite these gains, there is little evidence of systematic changes in health care access and affordability, health behaviors, or health status in Indiana relative to the comparison states in 2017-18.

The Office of Inspector General determined that most states did not provide complete or accurate payment data on managed care payments to the CMS Transformed Medicaid Statistical Information System (T-MSIS). More from HME News:

Specifically, about half of states did not provide complete or accurate information about the amounts that managed care plans pay to providers for services. Nearly three-quarters of states provided incomplete or inaccurate information about the maximum amounts  that managed care plans allow for services.

More rules that will change Medicaid payments are also on the horizon, according to HME News. Medicaid base payment rates fall way behind traditional Medicare or commercial insurance, provider say, which makes supplemental payments necessary for federally-qualified health centers and other safety net providers to stay operational. States will likely be required to improve data reporting in order to demonstrate whether Medicaid base payments are high enough.

Providers won’t be directly impacted by the reporting changes, but they could be affected if CMS is slow to approve state plan amendments or changes what types of financing and payment arrangements are allowable.

President Joe Biden proposed a $400 billion plan to bolster Medicaid coverage of long-term care outside of institutional settings. In the $2 trillion infrastructure package “the American Jobs Plan”, the money would go to providing access to home and community-based services (HCBS) while also helping the frontline caregiving workforce, Skilled Nursing News reports.