CMS expanding Medicaid initiatives in Massachusetts and Oregon

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The Centers for Medicare and Medicaid Services has approved Medicaid Section 1115 demonstration initiatives in Massachusetts and Oregon, both of which aim to test improvements in coverage, access and quality.

The idea is to ensure more eligible people retain Medicaid coverage, including by approving Oregon's demonstration to keep children enrolled in Medicaid up to age 6 – potentially preventing gaps in coverage that can cause children to lose access to care in their formative early years.

These initiatives also take steps to address unmet health-related social needs, such as by giving the two states new authority to test coverage for evidenced-based nutritional assistance and medically tailored meals, clinically tailored housing supports and other interventions for certain beneficiaries where there is a clinical need.

These efforts coincide with the White House Conference on Hunger, Nutrition and Health, where the Biden Administration released its national strategy to end hunger, improve nutrition and physical activity and reduce diet-related diseases and disparities – all goals supported by the new initiatives.

WHAT'S THE IMPACT?

President Biden issued executive orders in April and January 2021 directing federal agencies to take action to expand affordable, quality health coverage, including by strengthening Medicaid and the Affordable Care Act. The new Medicaid demonstrations are a component of that effort.

The goal of both demonstrations is to improve enrollment and continuity of coverage. In Oregon, children determined eligible for Medicaid will be able to stay continuously enrolled until they turn 6 years old, without their families needing to renew their coverage. The thinking is that this will minimize red tape for both families and the state and help ensure access to care throughout early childhood. Those older than 6 will be able to keep their coverage for up to two years, even if their household income fluctuates.

Massachusetts will provide up to 12 months of continuous coverage for Medicaid and Children's Health Insurance Program (CHIP) beneficiaries upon release from correctional settings, and 24 months of continuous eligibility for beneficiaries with a confirmed status of chronic homelessness. These steps are meant to eliminate coverage gaps.

The commonwealth will also receive expanded authority to provide certain time-limited housing supports, clinical nutrition education and medically-tailored food assistance services when medically appropriate. These services will be available to a range of at-risk populations, including postpartum individuals for up to 12 months. Massachusetts will also provide additional meal support for certain households when an eligible beneficiary is a child or pregnant woman with special clinical needs.

Oregon will expand health-related social needs coverage for certain food assistance, housing supports and other interventions that are medically appropriate for people experiencing certain life transitions, including those who are homeless or at risk of homelessness.

In both states, the time-limited housing and nutritional support services provided in the demonstration can be expected to stabilize the housing and nutritional circumstances of these Medicaid enrollees, CMS said.

Massachusetts will also be implementing a Hospital Quality and Equity Initiative for private acute hospitals and the commonwealth's only non-state-owned public hospital, Cambridge Health Alliance. That's expected to reduce health inequities by improving outcomes in populations that are likely to face barriers to quality healthcare, according to the agency.

THE LARGER TREND

The Kaiser Family Foundation in May found that Medicaid enrollment has grown during the COVID-19 pandemic. Enrollment is expected to see a growth of about 25%, or 22.2 million enrollees, from 2019 through 2022, mainly due to the continuous enrollment requirement in place during the public health emergency.

KFF analysts project that, from fiscal year 2020 through fiscal year 2022, states will have collectively spent $47.2 billion to cover additional people enrolled in Medicaid because of the continuous enrollment requirement, and will have received $100.4 billion in new federal funds to cover those costs and provide general fiscal relief through enhanced Medicaid matching funds.

Based on the analysis, KFF estimates that enrollment will have risen to a projected 110.3 million by the end of 2022. That would be 22.2 million more people than were enrolled in 2019, before the pandemic.

Roughly 15 million people could lose Medicaid coverage when the COVID-19 public health emergency ends, and only a small percentage are likely to obtain coverage on the Affordable Care Act exchanges, found an August report from the Department of Health and Human Services.

Using longitudinal survey data and 2021 enrollment information, HHS estimated that, based on historical patterns of coverage loss, this would translate to about 17.4% of Medicaid and CHIP enrollees leaving the program.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com