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The Need for Medicaid Expansion During COVID-19

ACP Chapter Action Tool Kit

Prepared by ACP’s Division of Governmental Affairs and Public Policy

April 17, 2020

Summary

Medicaid is a crucial component of the nation’s response to COVID-19. It is important that states take action to close coverage gaps and encourage physician participation so that COVID-19 testing and treatment and other medically necessary services are available to those who need it. State chapters can urge their policymakers to strengthen Medicaid when our health system needs it most.

Medicaid programs vary from state to state. State chapters should check whether their state has already adopted the following policy recommendations:

Expand Medicaid Eligibility to Close Coverage Gaps

Most states have expanded Medicaid eligibility to eligible people with incomes up to 138% of the federal poverty level. However, 14 states have not yet expanded Medicaid eligibility. Medicaid is a vital link to COVID-19 testing and treatment.  If your state is a non-expansion state, now is the time to push policymakers to expand the program so that more people have access to comprehensive, affordable coverage. Additionally, states can use 1115 waiver authority to expand coverage for certain populations. After the September 11 terrorist attacks, New York was granted an 1115 waiver to temporarily expand Disaster Relief Medicaid coverage.

As a result of the Families First Coronavirus Response Act (FFCRA), which was signed into law, states now have the option to temporarily expand coverage to uninsured individuals for COVID-19 testing without cost-sharing through the Medicaid program. The federal government will pay 100% of the state’s cost. State chapters may advocate for their state to take this opportunity, although full coverage expansion is preferable.

Reduce or Eliminate Cost-Sharing for COVID-19 Testing and Treatment

States can establish limited cost-sharing for Medicaid beneficiaries. FFCRA requires state Medicaid programs to cover diagnostic testing of COVID-19 at no cost-sharing. States should go further and eliminate all cost-sharing for COVID-19 treatment. Doing so will enable states to qualify for additional federal Medicaid funding provided under the FFCRA.

Expand Medicaid Enrollment Opportunities and Simplify the Application Process

States can encourage use of presumptive eligibility to temporarily enroll people in Medicaid at hospitals, community health centers, and other settings and act as a pathway to getting full coverage. Hospitals may become a “qualified entity” and make presumptive eligibility determinations regardless of state action. States should ensure these processes are in place for all, including adults. States should step up outreach and enrollment assistance to ensure the public is aware of opportunities to enroll during the COVID-19 emergency.

Expand Opportunities for Physicians and Other Clinicians to Participate in Medicaid and Eliminate Administrative Burdens

Since this administration has declared a public health and national emergency due to COVID-19, the federal government may temporarily waive certain rules to address Medicaid workforce shortages, expand coverage, and remove administrative barriers.  Section 1135 waivers give states the option to temporarily suspend prior authorization requirements for fee-for-service plans, suspend certain “provider” screening requirements, provide care in alternative settings, and allow certain out-of-state providers to care for the state’s Medicaid enrollees, among other provisions. As of April 14, 2020, 49 states had an approved waiver, but not all state waivers included important provisions like suspension of prior authorizations. Chapters may urge their state Medicaid program to request a comprehensive 1135 waiver if the state has not done so.

States should also take action to eliminate other barriers, like referral limitations, for benefits provided via fee-for-service and managed care organization arrangements.

Adopt Medicaid Pay Parity

Medicaid reimbursement rates are generally lower than those of Medicare and commercial payers. Low payment rates disincentivise physicians to participate in Medicaid. The Affordable Care Act temporarily required Medicaid to pay for evaluation and management services at Medicare rates. Some states continued the pay parity policy after the program expired in December 2014. ACP strongly supports paying for Medicaid primary care services at Medicare rates. Chapters could urge their Medicaid programs to increase Medicaid primary care payment to the level of Medicare to ensure there is an adequate supply of Medicaid-participating physicians during the public health emergency.

Cover Telehealth Services, Audio-only Telephone Visits, at In-person Rates

Medicaid should cover patient visits delivered through telehealth to ensure patients have access to their physicians when in-person visits are not advised. As a result of the COVID-19 emergency, many states are temporarily eliminating restrictions on telehealth services. California has required Medicaid managed care plans to cover telehealth visits at in-person rates. New York Medicaid is covering evaluation and management services delivered by telephone when medically appropriate. ACP has called on Medicaid programs to cover and sufficiently reimburse telephone evaluation and management services and other telehealth services for new and established patients. States have ample flexibility to adopt telehealth during the COVID-19 emergency and chapters could push their states to expand access to these services.

Action:

ACP chapters should urge state officials to:

• If your state is a non-expansion state, expand the Medicaid program so that more people have access to comprehensive, affordable coverage.
• Temporarily expand coverage to uninsured individuals for COVID-19 testing without cost-sharing through the Medicaid program.
• Step up outreach and enrollment assistance to ensure the public is aware of opportunities to enroll during the COVID-19 emergency.
• Expand opportunities for physicians to participate in Medicaid.
• Eliminate administrative burdens including temporarily waive all prior authorization requirements during this period of national emergency.
• Increase Medicaid primary care payment to the level of Medicare to ensure there is an adequate supply of Medicaid-participating physicians during the public health emergency.
• Cover telehealth services, including audio-only telephone visits, at in-person rates.

Resources