September 29, 2020

MACPAC Discusses COVID-19 Impact on Medicaid

On Sept. 24 and 25, American College of Radiology® staff attended the Medicaid and CHIP Payment Advisory Commission (MACPAC) virtual September meeting. Topics discussed that are relevant to radiology included Estimating the Effects of a Prototype Countercyclical Financing Adjustment for Medicaid, Relief Funding for Medicaid Providers Affected by the COVID-19 Pandemic, Update on Medicaid’s Response to COVID-19 and Integrating Care for Dually Eligible Beneficiaries through Medicare-Medicaid Plans.

MACPAC staff presented on the U.S. Government Accountability Office’s (GAO) prototype model, estimated the effects of this model if it had been implemented this year under current economic conditions and compared results to the fiscal relief provided to states under the Families First Families First Coronavirus Response Act (FFCRA, P.L. 116-127). Medicaid is a countercyclical program, where enrollment and spending increase during economic downturns due to growth in low-income population and loss of employer-sponsored insurance. Medicaid spending automatically adjusts in response to economic fluctuations, but the Federal Medical Assistance Percentage (FMAP) formula does not.
The report concluded 36 states receive between a two to six percentage point increase in the FMAP formula under the GAO model for fourth quarter of fiscal year (FY) 2020. It was determined the FFCRA would provide more fiscal relief to states in the aggregate than the GAO model for FY 2020. The Commissioners believe a recommendation to Congress is warranted as the FMAP formula is insufficient to assist states.

A presentation on provider relief funds provided an update with a focus on the extent to which funding has been targeted to safety-net providers that serve a high share of Medicaid and uninsured patients. The presentation concluded by examining options for state Medicaid programs to make additional payments to providers that supplement federal relief funding. Recent outpatient visit data suggest that visits by Medicaid enrollees have not recovered as much as those of other payers. The analysts discussed funds distributed through the CARES Act and Paycheck Protection Program. Phase II of the distribution included $15 billion to Medicaid/CHIP providers. They determined 38% of Medicaid/CHIP providers were eligible to receive funding, however, only 14.8 % of potentially eligible provider tax identification numbers (TINs) applied for funds as of August 30. As of Sept. 11, 2020 , only $2.2 billion has been allocated to Medicaid providers. The Commission will continue monitoring of federal relief funding as data become available, further examine how particular types of providers have been affected by the pandemic and explore Medicaid authorities to ensure stability of safety-net providers.

The Commission and its staff have prepared a webpage dedicated to Medicaid’s Response to COVID-19. Commission staff provided a review of MACPAC work during the pandemic and activities since the April meeting. These included letters regarding the provider relief fund, a letter regarding extending public health emergency (PHE) and a catalog of Medicaid changes to state telehealth policies. In an August letter to the Department of Health and Human Services Secretary Alex Azar, MACPAC requested that the Secretary give state Medicaid programs sufficient advance notice as to when the PHE will end, and early and clear guidance on requirements for returning to normal. There was a discussion on telehealth expansion; most feedback received to date from providers and patients has been favorable, including telephone-only evaluation and management services. Many would like these telehealth flexibilities to be extended past the end of the PHE. There are state legislative activities in New York and Ohio for ongoing use of telephonic telehealth and developing rules for expanded telehealth use. The Commission discussed a number of considerations if telehealth is expanded, including equitable access, privacy, limitations of telehealth, beneficiary and provider acceptance, and data. There was also discussion on racial and ethnic disparities. The Centers for Medicare and Medicaid Services (CMS) has taken an interest in collecting racial data to reduce disparities. Sources of data come from Centers for Disease Control and Prevention COVID-19 Hospitalization and Death by Race/Ethnicity and CMS’ Preliminary Medicare COVID-19 Data Snapshot, which show minorities have more cases and hospitalizations when compared to white people. COVID-19 has escalated these disparities in treatment and care for minorities. Specifically, dually eligible beneficiaries have more cases and hospitalizations compared to Medicare-only enrollees. The Commission wants to continue to look at all these areas in more depth and will focus on strategies to help close gaps in care.

Commissioners and staff continue to discuss dually eligible beneficiaries. This is a diverse population that includes people with multiple chronic conditions, physical disabilities, mental illness and cognitive impairments such as dementia and developmental disabilities. Medicare is the primary payer for acute and post-acute care services. Medicaid wraps around Medicare by providing assistance with Medicare premiums and cost sharing and by covering some services that Medicare does not cover, such as long-term services. States are testing several integrated care models that aim to improve care for beneficiaries and reduce costs. In their June 2020 Report to Congress on Medicaid and CHIP, policy issues and options are considered. Individuals who are dually eligible for Medicaid and Medicare often experience fragmented care and poor health outcomes due to lack of coordination across the two programs. Integrating care has the potential to improve the health of these individuals and reduce federal and state spending on their care, but as of 2019, only about 10% of dually eligible beneficiaries received care through such integrated models. Panelists updated the Commission on two integrated care models in Ohio and Illinois. Ultimately, the Commission outlined three focus areas based on the presentations, including increased enrollment in integrated products, support for performance evaluation and data to address outcomes and savings, and consideration on if Medicare-Medicaid Programs should be permanent instead of a demonstration. States continue to need resources for analytics and outreach efforts. The Commission is also interested in identifying clinical interventions/innovations through these integrated models.

The Commission will meet next Oct. 29 and 30. Learn more and access September meeting materials online.