Our analysis of federal data suggests that COVID-19 is becoming a bigger threat again in nursing homes amid the surge of the highly contagious omicron variant, raising concerns about the impact on residents and staff. COVID19 is spreading in nursing homes faster than among the general population, with 18.75 cases per 1,000 nursing home residents reported in the week ending Jan. 2 – a 225 percent increase from the prior week. Staff case rates were up 277 percent over the same period. We explore the latest trends in cases and deaths in nursing homes.
What will happen to Medicaid enrollment when the continuous enrollment requirement tied to federal pandemic funding for states ends? After being hit hard by the pandemic the first two years, how will long-term care settings deal with the virus this year? How will providers respond to the vaccine mandate for health care staff? A number of issues are at play this year that could affect coverage and financing under Medicaid, from the course of the pandemic to state decisions about Medicaid expansion and the fate of the Build Back Better Act. We highlight the key ones to watch.
An estimated 6.7 million children in the U.S. have special education plans, and over two-thirds of these children have special health care needs. Over half of children with special education plans are covered by Medicaid. We explain how Medicaid and special education services intersect and explore the pandemic’s implications for kids receiving such services.
Before the pandemic, 10 percent of enrollees had a gap in Medicaid coverage of less than a year. Enrollment “churn” went away during COVID-19 because of continuous enrollment requirements tied to special Medicaid funding. But disenrollments will resume when the requirements end. The Build Back Better Act includes provisions to phase out the requirement and place limits on how quickly states could disenroll people.
The Biden Administration has emphasized Section 1115 waivers that expand, rather than restrict, Medicaid coverage and access to care. States’ pending Section 1115 waivers involve eligibility expansions, behavioral health, health equity and addressing social determinants of health. How the Biden Administration handles them could indicate how it will use waivers to advance its policy priorities.
Most states reported having at least one Medicaid delivery system and payment reform initiative in place as of July 2021 aimed at improving quality and costs. However, the research about the effects of such efforts is not conclusive. State efforts to advance Medicaid delivery system and payment reform initiatives will continue to be shaped by the COVID-19 pandemic’s effects, including lack of stability in utilization patterns, labor shortages, and provider capacity.
Twenty-six states have filed four lawsuits challenging a federal rule that would require most health care providers who participate in Medicare and Medicaid to ensure that their staff are fully vaccinated against COVID-19 by Jan. 4, 2022, with some exceptions. The rule would apply to staff who provide any care, treatment, or other services for providers or patients, including contractors and volunteers. The regulations have been put on hold by federal courts, and the pending lawsuits create uncertainty about whether the new requirements ultimately will be implemented. We examine the rule and the litigation.
Even as Medicaid enrollment rose to record highs, outpatient prescription drug utilization fell by 4.2 percent in 2020 – accelerating a decline that began in 2018. Seven of the 10 most prescribed drug groups saw annual declines in utilization, while the other three saw increases. Groups that saw large declines included antibiotics, allergy immunotherapy & antihistamines, sympathomimetic agents, and adrenals and combinations. We examine how the pandemic has affected Medicaid prescription drug utilization and spending.
The Build Back Better Act would close the Medicaid coverage gap for three years, providing subsidized ACA marketplace coverage to 2.2 million uninsured people in the 12 states that have not expanded Medicaid under the Affordable Care Act. But providing a permanent pathway to coverage may fall back to states in the long term. Our Policy Watch explains the latest developments.
State Medicaid programs continue to reshape policy in response to the COVID-10 pandemic and at the same time advance broader initiatives and priorities, including efforts to address the social determinants of health and health equity. The 21st annual KFF survey of Medicaid directors in states and D.C. highlights policies in place and changes implemented or planned for the current fiscal year. Findings appear across five sections of the report: delivery systems, benefits and telehealth, social determinants of health, provider rates and taxes, and pharmacy.
In recent focus groups, paid direct care workers and unpaid caregivers describe daily work defined by low pay, physical demands and mental stress that has been made worse by the pandemic. KFF conducted the four focus groups to help provide context for the ongoing debate in Congress about increasing federal funding for Medicaid home and community-based services (HCBS). Medicaid is the nation’s primary payer for such services. New funding could help raise wages, provide training opportunities and offer supports to family caregivers.
Most (63%) of the 22 million adults with Medicaid coverage in the U.S. who are not eligible for both Medicare and Medicaid, and who do not receive federal disability payments, were already working full- or part-time prior to the pandemic, according to the most recent data available. Among those not working, caregiving responsibilities were a primary reason, as well as illness, disability or school attendance. The industries in which many Medicaid enrollees work, including construction, restaurants, and food services, have been among those hit hardest by the pandemic.
The COVID-19 pandemic exacerbated existing health disparities for a broad range of populations, but specifically for people of color. We examine how adults are faring on a range of social determinants of health. Black and Hispanic adults fared worse than White adults across almost all measures.
Medicaid represents $1 out of every $6 spent on health care in the U.S. and is the major source of financing for states to provide coverage of health and long-term care for low-income residents. We explain how financing for the program works.
Our 19th annual survey of Medicaid and CHIP program officials provides data on eligibility levels in every state. It also examines key aspects of state enrollment and renewal procedures in place during the COVID-19 public health emergency.