Medicaid

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.

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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.

The months-long decline in COVID-19 deaths among nursing home residents and staff reversed course this summer as the Delta variant dominated, with mortality increasing five-fold from 350 deaths in July to nearly 1,800 in August. Our analysis also finds increases in nursing home COVID-19 cases and deaths were steeper than those in the broader community between July and August.

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.