Medicaid has been a critical tool for states as they fight the COVID-19 pandemic. In Medicaid’s role as the largest payer in the nation and the largest source of federal funding to states, states are working to identify ways to use it as a lever for mitigating the effects of the pandemic.1, 2 To assist states as they navigate COVID-19, the Robert Wood Johnson Foundation’s State Health and Value Strategies (SHVS) program has continued its long-standing partnership with Manatt Health to develop a suite of COVID-19 resources on Medicaid and other pressing healthcare issues. Most recently, over the past month, Manatt Health has developed products and state-facing technical assistance on topics including strategies for leveraging Medicaid information technology (IT) to respond to the pandemic, federal and state emergency flexibilities available to state Medicaid programs, the pandemic’s fiscal impact on state budgets and revenue, and options for telehealth policy changes post-pandemic. Brief summaries of these resources are below, and the full range of SHVS-sponsored COVID-19 resources for states developed by Manatt Health and other SHVS partners can be found at SHVS’ COVID-19 State Resources Page.
Recent SHVS COVID-19 Medicaid Resources for States
Strategies for Supporting and Strengthening Medicaid IT During the COVID-19 Crisis
As states face the extraordinary challenges of the COVID-19 crisis, IT is an essential tool to support access to health coverage and the safe and effective evaluation, testing and treatment of patients nationwide. State Medicaid agencies are authorized to receive federal funding for Medicaid IT and associated activities, much of it at an enhanced federal medical assistance percentage (FMAP). Manatt Health’s issue brief and webinar outline potential IT investments for states to pursue when addressing COVID-19, as well as opportunities to secure additional IT funding for Medicaid program operations and health information exchanges.
Federal and State Flexibilities Supporting Medicaid and CHIP COVID-19 Response Efforts: Effective and Expiration Dates
To help states respond to the ongoing COVID-19 pandemic, the White House, the U.S. Department of Health & Human Services and the Centers for Medicare & Medicaid Services have invoked various emergency authorities that allow for temporary flexibilities in the Medicaid program and the Children’s Health Insurance Program (CHIP). Congress also has passed legislation that provides additional federal support for state Medicaid programs. Manatt Health’s summary table describes the effective dates of these provisions, the expiration timeline dictated by law or agency guidance, and current end dates for these flexibilities, which are subject to change as federal and state officials take actions to renew or terminate particular authorities.
Understanding the Fiscal Impact of COVID-19, the Economic Downturn and Recent Policy Changes
States and Medicaid programs are entering a time of substantial fiscal uncertainty as they continue to respond to the COVID-19 pandemic while also preparing for a potentially severe recession that is expected to lead to significant budget shortfalls and surges in Medicaid enrollment. At the same time, the federal government has authorized significant policy changes in response to these twin crises, including an increase in the federal Medicaid matching rate and the establishment of maintenance of effort and continuous coverage requirements, which require states to maintain coverage and benefits for any individual enrolled in Medicaid at the start of the federal disaster period. Manatt Health’s webinar discusses key considerations for states as they seek to model the fiscal impact of this confluence of factors and presents preliminary results from a Manatt Health financial model projecting the fiscal impact of the pandemic, a recession and associated policy changes across a range of possible real-world scenarios.
Virtual Care Post-Apex: Rethinking Telehealth Policy After the COVID-19 Surge
As COVID-19 has spread across the country, telehealth has proven to be an essential tool for maintaining access to health services while conforming with social distancing restrictions and reducing unnecessary exposure risk for healthcare providers and consumers. Nearly all states have, in some way, expanded coverage or reimbursement for telehealth services on a temporary basis during the COVID-19 pandemic, and nationally, telehealth visits now account for 10–20 percent of overall outpatient utilization. State Medicaid programs are now grappling with how to maintain access to telehealth services in a severely budget-constrained environment. States are also considering issues related to telehealth coverage and reimbursement requirements in the commercial market, cross-state licensure flexibilities and consumer uptake of telehealth, as well as addressing technology access issues for historically underserved populations. In addition, as states continue to address health equity issues, states are considering ways to maintain access to telehealth services in a manner that ensures a more equitable healthcare system for all. Along with Georgetown University’s Center on Health Insurance Reforms, Manatt Health presented a webinar reviewing the current telehealth policy landscape and considerations for states as they design their post-apex telehealth policies.
1 Kaiser Family Foundation. Health Insurance Coverage of the Total Population: 2018. Available here.
2 Kaiser Family Foundation. Medicaid Financing: The Basics. March 2019. Available here.