Tag: Medicaid

A New Medicare Proposal Would Cover Training for Family Caregivers

Even with extensive caregiving experience, Patti LaFleur was unprepared for the crisis that hit in April 2021, when her mother, Linda LaTurner, fell out of a chair and broke her hip.

LaTurner, 71, had been diagnosed with early-onset dementia seven years before. For two years, she’d been living with LaFleur, who managed insulin injections for her mother’s Type 1 diabetes, helped her shower and dress, dealt with her incontinence, and made sure she was eating well.

In the hospital after her mother’s hip replacement, LaFleur was told her mother would never walk again. When LaTurner came home, two emergency medical technicians brought her on a stretcher into the living room, put her on the bed LaFleur had set up, and wished LaFleur well.

That was the extent of help LaFleur received upon her mother’s discharge.

She didn’t know how to change her mother’s diapers or dress her since at that point LaTurner could barely move. She didn’t know how to turn her mother, who was spending all day in bed, to avoid bedsores. Even after an occupational therapist visited several days later, LaFleur continued to face caretaking tasks she wasn’t sure how to handle.

“It’s already extremely challenging to be a caregiver for someone living with dementia. The lack of training in how to care for my mother just made an impossible job even more impossible,” said LaFleur, who lives in Auburn, Washington, a Seattle suburb. Her mother passed away in March 2022.

A new proposal from the Centers for Medicare & Medicaid Services addresses this often-lamented failure to support family, friends, and neighbors who care for frail, ill, and disabled older adults. For the first time, it would authorize Medicare payments to health care professionals to train informal caregivers who manage medications, assist loved ones with activities such as toileting and dressing, and oversee the use of medical equipment.

The proposal, which covers both individual and group training, is a long-overdue recognition of the role informal caregivers — also known as family caregivers — play in protecting the health and well-being of older adults. About 42 million Americans provided unpaid care to people 50 and older in 2020, according to a much-cited report.

Read the full article from KFF Health News.

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Changes to Continuous Eligibility for Kids Under Age Six

In April 2023, the Centers for Medicare & Medicaid Services (CMS) approved Washington’s 1115 Waiver request to extend continuous eligibility for any child under six who is enrolled in a free Apple Health (Medicaid) program.

Children under the age of six on free Apple Health will now receive continuous eligibility through their sixth birthday, regardless of changes in household income, if they were eligible in the month of application.

Note: There have been no changes to continuous eligibility for kids over age six on free Apple Health or for those on Apple Health for Kids with premiums, also known as Children Health Insurance Program (CHIP). Coverage for these groups continues to be renewed for 12 months at a time.

What is being done to keep kids covered?

In June 2023, the Health Care Authority (HCA) began work to maintain continuous eligibility for children under the age of six. A manual process is in place to identify eligible children who have lost coverage and reinstate them.

Once the system supports continuous eligibility for kids under age six, children who are active on free Apple Health Kids and meet the eligibility criteria will have their certification period automatically extended through the month they turn six.

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Apple Health (Medicaid) Renewal Letters Have Begun Mailing

Some clients will automatically renew; and others will need to update their information

OLYMPIA – The Washington State Health Care Authority (HCA), Washington Health Benefit Exchange (Exchange), and the Department of Social and Health Services (DSHS) have begun mailing letters to Washington Apple Health (Medicaid) clients reminding them to update their contact information and renew coverage to see if they still qualify.

For the first time in over three years, people on Apple Health could lose coverage if their family income has gone up. Federal requirements during the COVID-19 public health emergency (PHE) led to income checks being suspended to keep clients enrolled in Apple Health during the pandemic. However, last December’s federal omnibus spending bill directed states to resume evaluating eligibility of Medicaid enrollees on April 1 to wind down COVID-19 pandemic emergency measures.

Washington has until April 2024 to process eligibility redeterminations for all 2.3 million Apple Health clients. It’s the largest benefit renewal process the state has ever attempted. Here is what you need to know during this effort.

How the renewal process works

Washingtonians on Apple Health will get their renewal notifications at different times. To manage the workload, the renewals are being spread out over the next 12 months.

Some clients will be automatically renewed based on the most recent information already on file with the state. If the state does not have enough information on file, clients will need to take action to complete the renewal process to stay insured.  

  • If clients are auto renewed, they will get a notification saying their health coverage was renewed. For most, health coverage will be renewed for 12 months. The requirement will continue for clients to report any changes within 30 days.
  • If clients are not auto renewed, they will get a renewal notice in the mail. They must respond to complete their renewal by the 60-day deadline. If at the end of 60 days the client hasn’t responded, the state will send a notice informing them their Apple Health benefits are ending.

How to know when it’s time to renew

Your renewal month typically matches the month your Apple Health coverage started. Clients can check their most recent Apple Health notice to confirm their renewal date. The month before their renewal date, clients will receive a notice about their Apple Health renewal. For example, if a client’s coverage is up for renewal on May 31, 2023, they should act now to avoid a loss in coverage.

Starting April 2023 through March 2024, HCA and DSHS will evaluate current Apple Health client eligibility for continued coverage and renew or terminate coverage as appropriate.

What steps do clients need to take?

We encourage Apple Health clients to take the following steps:

  • Update their contact information as soon as possible.
  • Check their mail or email. Starting in April and through March 2024, clients will receive information about their Apple Health coverage via mail or email. This notification may require them to take action in order to maintain coverage.
  • Complete their renewal by the deadline on their notice.

“It’s imperative that Washingtonians enrolled in Apple Health take time to update their contact information to ensure they receive upcoming notices related to their health care coverage,” said Sue Birch, HCA director. “If people learn they are no longer eligible for Apple Health, there are other options for low-cost health coverage.”

“We know how important it is to have access to health care when we need it most, and we are committed to making sure people stay connected to this vital benefit,” said Jilma Meneses, DSHS secretary. “We are ready to answer any questions or concerns people might have, and to provide as seamless a process as possible.”

“We want to ensure all Washingtonians stay covered, whether it is Apple Health, employer sponsored, or a new qualified health plan,” said Ingrid Ulrey, CEO at Washington Health Benefit Exchange powering Washington Healthplanfinder. “If you receive a letter from HCA, Washington Healthplanfinder, or DSHS, make sure you open it, and visit Healthplanfinder right away so we can help you with your insurance needs. For those who are now above income eligibility, they will have the opportunity to enroll in high-value, low-cost Cascade Care Plans, now available for as low as $10 or less per month.”

To help Washingtonians transition to other health insurance, HCA has partnered with DSHS and Washington Healthplanfinder to connect people to other coverage. To ensure clients receive important notices about their health care coverage, including other coverage options, Apple Health clients can update their contact information using one of the following options:

  • For individuals who are aged, have blindness or a disability, or are eligible for Medicare:
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Proposed Work Requirements Could End Federal Medicaid Coverage for 1.7 Million People

A new KFF analysis finds that an estimated 1.7 million Medicaid enrollees could become ineligible for federal Medicaid under proposed work requirements and presents state-by-state projections, based on estimates of coverage loss from the Congressional Budget Office (CBO). 

States could continue to provide Medicaid to those enrollees but would not receive federal matching funds for doing so. It is unclear if any states would choose to do that, though CBO estimated over half of enrollees would continue to be covered at the states’ expense. If states did choose to continue coverage for those individuals, states collectively could face $10.3 billion in new costs in 2024. 

The work requirements were included in the Republican-backed debt ceiling legislation that passed the House of Representatives on April 26.

Five states would pay nearly half of the estimated $10.3 billion in new costs: California (326,000 enrollees at a cost of $1.6 billion), New York (186,000, $1.1 billion), Illinois (116,000, $692 million), Pennsylvania (83,000, $537 million) and Washington (72,000, $578 million).

Read the full article from KFF.

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Your Apple Health: What you need to know about the Public Health Emergency

During the Covid-19 Public Health Emergency, Washington State changed some rules about Apple Health (Medicaid). If you or a family member had Medicaid for health insurance, you did not have to renew every year. If you paid a premium for Medicaid health insurance, premium payments stopped during the Public Health Emergency. Some people received temporary health insurance coverage if they qualified for other benefits.

The PHE ended March 31, 2023, and now:

  • Beginning April 2023, you must renew your Apple Health/Medicaid insurance
  • If you usually paid a premium, premiums are starting up again
  • You may need a new eligibility review

If you do not renew, do not complete a required eligibility review or if you do not pay a premium when it is due, you may lose your health insurance coverage for you or your family member.

What to do:

  • Update your contact information with your insurance provider so your provider can send you important information about renewal, eligibility reviews and premiums
  • Renew your insurance when your provider tells you
  • Premiums for certain Apple Health/Medicaid insurance plans are starting again (Apple Health for Kids with premiums/Children’s Health Insurance Program, Apple Health for Workers with Disabilities (HWD). Watch your mail or email for notices or premium bills from your provider

If you are on one of these Apple Health/Medicaid plans, call:

  • Amerigroup: 1-800-600-4441
  • Community Health Plan of Washington: 1-800-440-1561
  • Coordinated Care: 1-877-644-4613
  • Molina:1-800-869-7165
  • UnitedHealthcare: 1-877-542-8997

If you usually get notices from WA State Health Care Authority email askmedicaid@hca.wa.gov with your name, date of birth, and updated contact information.

If you usually get notices from Washington Healthplanfinder:

  • Log in to your Washington Healthplanfinder account at wahealthplanfinder.org
  • Call Washington Healthplanfinder at 1-855-923-4633

If you are age 65 and older, have blindness or a disability, get Medicare, and get healthcare coverage through Department of Social and Health Services (DSHS):

  • Update contact information at waconnection.org or call 1-877-501-2233 or
  • Visit your local Community Service Office
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Medicare Advantage Special Needs Plans for dual eligible (Medicare and Medicaid) clients

Medicare Advantage Special Needs Plans are available to clients who are eligible for Medicare and Medicaid (dual eligible). Special Needs Plans provide additional benefits to clients beyond what traditional Medicare and Medicaid provide including, but not limited to, care coordination, gym memberships, transportation to medical appointments and meal delivery.

Click the below link to learn more.

dual-eligible-special-needs-plan

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Feds Move to Rein In Prior Authorization, a System That Harms and Frustrates Patients

When Paula Chestnut needed hip replacement surgery last year, a pre-operative X-ray found irregularities in her chest.

As a smoker for 40 years, Chestnut was at high risk for lung cancer. A specialist in Los Angeles recommended the 67-year-old undergo an MRI, a high-resolution image that could help spot the disease.

But her MRI appointment kept getting canceled, Chestnut’s son, Jaron Roux, told KHN. First, it was scheduled at the wrong hospital. Next, the provider wasn’t available. The ultimate roadblock she faced, Roux said, arrived when Chestnut’s health insurer deemed the MRI medically unnecessary and would not authorize the visit.

“On at least four or five occasions, she called me up, hysterical,” Roux said.

Months later, Chestnut, struggling to breathe, was rushed to the emergency room. A tumor in her chest had become so large that it was pressing against her windpipe. Doctors started a regimen of chemotherapy, but it was too late. Despite treatment, she died in the hospital within six weeks of being admitted.

Though Roux doesn’t fully blame the health insurer for his mother’s death, “it was a contributing factor,” he said. “It limited her options.”

Few things about the American health care system infuriate patients and doctors more than prior authorization, a common tool whose use by insurers has exploded in recent years.

Prior authorization, or pre-certification, was designed decades ago to prevent doctors from ordering expensive tests or procedures that are not indicated or needed, with the aim of delivering cost-effective care.

Originally focused on the costliest types of care, such as cancer treatment, insurers now commonly require prior authorization for many mundane medical encounters, including basic imaging and prescription refills. In a 2021 survey conducted by the American Medical Association, 40% of physicians said they have staffers who work exclusively on prior authorization.

So today, instead of providing a guardrail against useless, expensive treatment, pre-authorization prevents patients from getting the vital care they need, researchers and doctors say.

“The prior authorization system should be completely done away with in physicians’ offices,” said Dr. Shikha Jain, a Chicago hematologist-oncologist. “It’s really devastating, these unnecessary delays.”

In December, the federal government proposed several changes that would force health plans, including Medicaid, Medicare Advantage, and federal Affordable Care Act marketplace plans, to speed up prior authorization decisions and provide more information about the reasons for denials. Starting in 2026, it would require plans to respond to a standard prior authorization request within seven days, typically, instead of the current 14, and within 72 hours for urgent requests. The proposed rule was scheduled to be open for public comment through March 13.

Read the full article from KHN.

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What You Can Do to Help Kids Stay on Medicaid in 2023

One of the few silver linings of our bleak public health reality throughout the COVID-19 pandemic is that child health insurance coverage under Medicaid and the Children’s Health Insurance Program (CHIP) is at an all-time high. Due to temporary protections against Medicaid disenrollment, about 41 million children are insured through Medicaid or CHIP as of August 2022–greater than the population of California.  

The long-term benefits of Medicaid enrollment on the health and wellbeing of children–particularly young children between the ages of 0 and 3–are well documented. Medicaid covers half of all babies born in the United States, which is 40 percent of all children. Study after study has shown that childhood Medicaid coverage is associated with long-lasting benefits to overall health, educational attainment, and financial stability.  

However, temporary continuous coverage protections originally implemented as part of the COVID-19 pandemic response will end on March 31, 2023. This means that states will resume normal Medicaid renewal processes for all enrollees. Specifically, states will disenroll people who don’t complete the process or are newly ineligible for coverage. Policy advocates estimate that more than 6.7 million children are at risk of losing coverage if there is not a collective effort to ensure that all eligible children remain enrolled in Medicaid. State administrators, service providers, advocates, and parents/caregivers must all take proactive steps to ensure that children are not improperly disenrolled from Medicaid when states begin the massive administrative undertaking of restarting the re-enrollment process in the coming months. 

Read the full article from the Center for Law and Social Policy.

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Open Enrollment Period for Health Insurance

Open enrollment for most medical plans, including Medicaid and Medicare, starts November 1st and goes through early to mid-December. This is the time to sign up, renew, or change coverage to best suit your family’s situation. If you wish to estimate how much how health insurance will cost your family without giving any information to a government entity, you can visit the KFF Health Insurance Marketplace Calculator, which provides estimates for health care premiums through marketplaces, aka health insurance exchanges.

For individuals who are on, or expect to be on Medicare, the open enrollment for 2023 is open now through January 15th. If enrolled by December 15, coverage will start January 1, 2023. Medicare is generally for those 65 years or older, but certain younger individuals with disabilities, End-Stage Renal Disease, or ALS can be eligible. For step-by-step instructions on how to sign up for Medicaid or change plans in Medicaid, visit the medicaid.gov or healthcare.gov websites.

For more information on health insurance available through the health insurance exchanges, visit either healthcare.gov or wahealthplanfinder.gov. Medicaid, also known as Apple Health in Washington state, is available through the Washington Health Plan Finder. Many uninsured children, aged 18 and under, who are a part of a low-to-medium income family, are likely to be eligible for free health insurance through Apple Health. A full breakdown of the program and income requirements is available.

Help is available for those who are having a difficult time navigating the health insurance landscape.  Washington Health Plan Finder has step-by-step instructions for applying and navigators to help apply.

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