We all need to keep an eye on the weather in our state capitals. That’s because a public health storm is forecasted. It is caused by the opposing forces of the pandemic-related economic downturn and related diminished tax income versus an increased demand by many unemployed Americans newly eligible for Medicaid. The Medicaid tsunami is here!
As explained by the Kaiser Family Foundation (KFF), to support Medicaid and provide fiscal relief, generally, the Families First Coronavirus Response Act (FFCRA) authorized a relief package to help Medicaid meet the demands of new enrollment.
It will remain in effect until the end of the last quarter. The relief package was designated by the government as a Public Health Emergency (PHE). This is currently the end of March 2021 (unless it is renewed).
Most states made specific efforts to help people obtain and maintain coverage. And ten states reported expanding enrollment assistance or member call center capacity.
But regardless of efforts, states may have to make hard decisions about how to cover their enrollees during times of economic shortfalls.
Medicaid adaptations prop up the public health
As we head towards colder weather, our nation is experiencing a massive surge in Covid-19 cases. Unlike the earlier waves of infection that were more localized, this time the infections are widespread. Covid-19 is impacting rural areas that were largely spared before.
It is clear that the most vulnerable individuals among us need a functioning Medicaid program. This is because it allows all Americans to fight the pandemic in the most equitable way possible.
Cuts to Medicaid might seem prudent when state budgets are facing a shortfall. But the short-term savings will pale in comparison to the long-term fiscal – not to mention emotional – pain of not providing health coverage for our most vulnerable populations. More than ever, states need to dedicate themselves to keeping their residents healthy.
States have worked hard since March to use Medicaid as a tool to help patients suffering from COVID-19. These programs are laudable, but now it is time for states to think more long-term.
At-risk populations have long-term health needs that need to be addressed by Medicaid. Protecting public health includes providing important medical services, such as flu shots or even telemedicine for people living with chronic conditions.
When people get regular healthcare, both preventive, and therapeutic, there are better health outcomes and fewer healthcare expenditures.
Telehealth is more than a fad, it’s a vital service in Medicaid
As state Medicaid programs make plans for eligibility changes, expansions, provider rates, and taxes, perhaps one of the most important changes to implement is expanded telehealth access.
Medicaid can stand alongside Medicare as a leader in providing telehealth services. Especially at a time when private health plans are fighting to cut telehealth use.
Related Content: Telehealth Update from ATA President, Joe Kvedar.
Unfortunately, there have been news reports that major private insurers, like United Healthcare, who offered telehealth during the PHE, are now pulling back on those benefits. Similarly, STAT reported that Anthem will stop waiving the cost of copays, coinsurance, and deductibles for virtual visits not related to Covid-19.
Even as we reopen and in-person office visits rebound, telehealth is a lifeline for patients with chronic illness. Patients that the Global Healthy Living Foundation (GHLF) represents live with chronic illnesses including the following:
- all forms of arthritis,
- Crohn’s disease,
- ulcerative colitis,
- cardiovascular disease,
- and many others.
Many of these patients continue to isolate strictly to remain safe from the coronavirus. Telehealth helps our community to have continued access to care, which is vital for people living with one or more chronic diseases that require ongoing management.
According to a poll we conducted this summer, 72 percent of respondents (n=379) had a telehealth appointment since the pandemic started. The mean rating of those visits where 0 was the WORST health care provider visit and 10 was the BEST was 8, suggesting most people were happy with their appointment.
Telehealth expansion in Medicaid and CHIP
On October 14, 2020, the Centers for Medicare & Medicaid Services (CMS) expanded the list of telehealth services that Medicare will reimburse during the public health emergency. CMS also announced providing extra support to state Medicaid and Children’s Health Insurance Program to expand telehealth access.
CMS Administrator Seema Verma said:
“Medicaid patients should not be forgotten, and today’s announcement promotes telehealth for them as well. This revolutionary method of improving access to care is transforming healthcare delivery in America.”
According to the KFF data, many state Medicaid programs plan to extend the telehealth expansion put in place at the beginning of the pandemic by:
- Continuing to allow a patient’s home to be a reimbursable site, an expansion critical to GHLF’s patient community.
- Extending fee-for-service telehealth coverage beyond the public health emergency, meaning it would cover pre-existing chronic conditions.
Right now, many expansions are timebound and tied to the duration of the PHE. This is a problem because we are still studying the impact of Covid-19 on individuals and the community. It is possible that more permanent relief will be required.
We believe that all states should be considering such permanent expansions of telehealth for a wide range of services to ensure all have access to care for their unique conditions.
Telehealth has been embraced by Medicaid
As we call on states to work to keep their residents healthy, telehealth is an instrumental part of achieving that goal. Preliminary Medicaid and Children’s Health Insurance Program (CHIP) data of telehealth utilization during the pandemic revealed that between March and June of 2020 there were more than 34.5 million services delivered via telehealth. This accounts for a more than 2,600 percent increase compared to the same period in 2019.
We cannot defeat a virus when a sizable portion of a state population is unable to seek medical care. That is because private insurance isn’t offered or is unaffordable. We cannot defeat a virus when essential workers who ride our public transit systems, who act as our “gig workers,” who deliver our food potentially are unable to seek out healthcare for themselves. The investment in Medicaid is needed to curb the spread of disease.
States need to squint a bit to see the long-term effect if viruses such as COVID-19, the flu, and others, have free reign over our low-income populations. The effects will be devasting.
Simple care that is not provided now will mean more expensive care later. Worse: it will mean a greater viral spread that will strain our system just as we are experiencing the Third Wave of the epidemic.
By continuing to provide access to telehealth, patients will be able to receive their regular care. This is essential to avoid potential deterioration of their health conditions that would have more impact and distress on our health care system.
A call to action
To our state leaders please, for the sake of your residents, for the sake of our country, and yes, for the long-term sake of your state budgets, please be sure to fully fund Medicaid in your upcoming budgets. To learn more about this issue and others related to access to healthcare, visit the Global Healthy Living Foundation’s 50-State Network.
Disclosure: Steven Newmark has no personal conflicts of interest to disclose. He is an employee of the Global Healthy Living Foundation (GHLF). GHLF receives grants, sponsorships, and contracts from pharmaceutical manufacturers and private foundations. A full list of GHLF funders is publicly available here: https://www.ghlf.org/our-partners/.
Steven R. Newmark, JD, MPA
Steven Newmark, JD, MPA, is the Director of Policy and General Counsel of the Global Healthy Living Foundation. GHLF is a 501c3 with the mission to improve the quality of life for people with chronic illnesses. Steven leads global advocacy and policy initiatives. He was most recently Special Counsel to the President of NYC Health + Hospitals in New York City.
Before that he served as the Senior Health Policy Adviser to New York City Mayor Bill de Blasio. He also served as General Counsel in Mayor de Blasio’s Public Advocate office, and as a Health Sciences Litigation Associate at Orrick, Herrington & Sutcliffe, LLP in New York City where he was part of the team that successfully defended the Vaccine Act before the Supreme Court in Bruesewitz v. Wyeth.
Additionally, he has taught Public Policy at Columbia University and is an Adjunct Professor in U.S. Health Policy at the City University of New York, Baruch College. He received his Juris Doctor from Fordham University School of Law and his Master of Public Policy and Administration, Advanced Policy and Management from Columbia University School of International and Public Affairs. He received his Bachelor of Arts, Philosophy, Politics and Law from the State University of New York at Binghamton.