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Tag: coverage

  • More States to Consider Extending Postpartum Medicaid Coverage Beyond 2 Months | Healthiest Communities Health News

    More States to Consider Extending Postpartum Medicaid Coverage Beyond 2 Months | Healthiest Communities Health News

    Lawmakers in quite a few conservative-led states — such as Montana, Wyoming, Missouri, and Mississippi — are expected to contemplate proposals to deliver a yr of steady health and fitness protection to new mothers enrolled in Medicaid.

    Medicaid beneficiaries nationwide are confirmed continual postpartum coverage for the duration of the ongoing COVID-19 public well being unexpected emergency. But momentum has been building for states to increase the default 60-day required coverage period of time forward of the emergency’s eventual conclude. Somewhere around 42{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of births nationwide are protected below Medicaid, the federal-state wellness insurance policy plan for low-revenue individuals, and extending postpartum coverage aims to decrease the chance of pregnancy-relevant fatalities and diseases by making certain that new mothers’ health-related treatment is not interrupted.

    The thrust arrives as a provision in the American Rescue Plan Act helps make extending postpartum Medicaid coverage much easier because states no longer require to utilize for a waiver. A renewed target on maternal health amid significant U.S. maternal mortality fees also is driving the proposals, as is the expectation that much more women of all ages will need postpartum treatment as state abortion bans proliferate in the wake of the U.S. Supreme Court’s final decision to get rid of federal protections.

    30-five states and Washington, D.C., have presently extended, or program to prolong, postpartum eligibility in their Medicaid courses. That selection contains Texas and Wisconsin, which did not employ the ARPA provision but have proposed restricted extensions of 6 months and 90 times, respectively.

    The 15 states that restrict postpartum Medicaid eligibility to 60 days are predominantly a swath of Republican-led states that stretch from the Mountain West to the South. But that could change when legislative periods start out in the new 12 months.

    In Montana, Republican Gov. Greg Gianforte and Division of Community Overall health and Human Solutions Director Charlie Brereton provided 12-thirty day period postpartum eligibility in the governor’s proposed state finances. It would price $9.2 million in federal and condition funding in excess of the upcoming two yrs, in accordance to the proposal, with the federal federal government covering just about 70{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}.

    A 2021 U.S. Division of Wellness and Human Services report estimated about 2,000 females in Montana would reward from the adjust. Point out well being office spokesperson Jon Ebelt stated state officials’ estimate is 50 percent that variety. The reason for the disparity was not straight away distinct.

    Brereton considers the “extension of protection for new mothers to be a professional-everyday living, pro-family members reform,” Ebelt reported.

    To come to be law, the proposal should be authorised by point out lawmakers the moment the legislative session begins in January. It has currently acquired enthusiastic aid from the senior Democrat on the committee that oversees the wellness department’s spending budget. “Continuous eligibility for females immediately after they have a infant is genuinely important,” stated point out Rep. Mary Caferro in the course of the Children’s Legislative Discussion board in Helena on Nov. 30.

    The top Republican on the committee, point out Rep.-elect Bob Keenan, stated he has not dug in on the governor’s spending budget proposal but extra that he ideas to study his fellow lawmakers and overall health treatment companies on the postpartum extension. “I wouldn’t dare venture a guess as to its acceptance,” he explained.

    Nationwide, additional than 1 in 5 mothers whose pregnancies have been lined by Medicaid shed their insurance policies in just 6 months of giving start, and 1 in 3 being pregnant-connected deaths happen among a week and a 12 months immediately after a delivery occurs, in accordance to federal health officers.

    The U.S. had the highest overall maternal mortality level, by considerably, between rich nations in 2020, at 23.8 fatalities for each 100,000 births, in accordance to a report by the Commonwealth Fund, a basis that supports investigate concentrated on health care challenges. The charge for Black women in the U.S. is even bigger, 55.3 fatalities.

    “Many maternal deaths outcome from skipped or delayed chances for cure,” the report explained.

    The maternal mortality price in Montana is not publicly offered because the Facilities for Ailment Control and Avoidance suppressed the state facts in 2020 “due to trustworthiness and confidentiality constraints.” Ebelt, the point out health office spokesperson, could not offer a amount in advance of this article’s publication.

    Annie Glover, a senior research scientist for the College of Montana’s Rural Institute for Inclusive Communities, explained the governor’s proposal to lengthen postpartum Medicaid protection could make a considerable variance in bettering total maternal overall health in Montana. The university was awarded a federal grant this calendar year for these attempts, specifically to lessen the mortality charge among the Native People, and Glover mentioned the state measure could further more minimize prices.

    “The cause truly has to do with preserving accessibility to care throughout this extremely significant period,” Glover explained. That goes for helping moms with postpartum despair, as very well as medical problems like significant blood stress that have to have follow-ups with a doctor very well just after shipping, she mentioned.

    In Wyoming, a legislative committee voted 6-5 in August to introduce a invoice in the up coming session dissenters cited the charge and their reluctance to even more entangle the state in federal government packages.

    About a third of Wyoming births are lined by Medicaid, and condition officers estimate about 1,250 females would advantage from the improve.

    Postpartum eligibility charges are also envisioned to be taken up by legislators in Missouri and Mississippi, two states that have earlier grappled with the situation. The two states have outlawed most abortions due to the fact the U.S. Supreme Courtroom lifted federal protections in June, and Mississippi leaders have mentioned more postpartum care is essential due to the fact of the thousands of added births envisioned as a consequence of the state’s ban.

    A proposed protection expansion died in the Mississippi House last session, but Lt. Gov. Delbert Hosemann claimed the Senate will revive the measure, in accordance to Mississippi These days.

    Previous yr, federal officers approved a Medicaid waiver for Missouri that will allow the condition to lengthen postpartum eligibility. But state officials delayed employing the modify to determine how enrollment would be affected by Missouri voters’ choice in August 2020 to develop Medicaid eligibility to more persons. The hold off prompted a invoice to be filed previous session that would have prolonged postpartum protection by a 12 months. That measure died, but a point out lawmaker has pre-submitted a monthly bill that will bring again the discussion in the impending session.

    In Idaho, a children’s advocacy team stated it will push lawmakers to approve a postpartum eligibility extension, between other steps, following the point out banned approximately all abortions this calendar year.

    KHN Montana correspondent Katheryn Houghton contributed to this report.

    This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health and fitness problems and a significant running method at KFF (Kaiser Family Foundation). It has been republished with permission.

  • Medicaid winds down coverage for PT & OT telehealth

    Medicaid winds down coverage for PT & OT telehealth


    By Clarissa Donnelly-DeRoven

    Before the pandemic, Valerie Fox almost never used telehealth — nobody did at the Veterans Affairs Medical Center in Durham, where she works as a behavioral health occupational therapist.

    Now, many patients request it. 

    “Especially with the VA, a lot of people come from a lot of different parts of the state to here,” Fox said. “When we go to transition to outpatient work, it’s a lot easier.” With telehealth, people can more easily incorporate OT into their daily schedules — an hour here, an hour there. 

    “It doesn’t become this big thing,” she said. 

    But that’ll likely be changing soon. By July 1, North Carolina Medicaid will no longer cover occupational and physical therapy services done via telehealth — and getting to and from appointments will become, yet again, a big thing. The change was supposed to take place March 31, but the state extended coverage for 90 more days. 

    Kimberly Godwin, the advocacy chair at the state’s occupational therapy association, has been getting a lot of emails over the last few months from therapists such as Fox telling her how telehealth has helped them serve more clients. 

    “We’ve heard from a lot of businesses within the pediatric as well as other outpatient settings or specialized care, like mobility clinics, that have been able to just really broadly reach clients,” she said. “There’s been less cancellations, less no shows.” 

    Many providers have noted how telehealth increased access for people who can’t afford transportation to and from a clinic, or those who don’t have any transportation to begin with. 

    Even the state’s Medicaid program sounds supportive of keeping telehealth for physical and occupational therapy. 

    Data from the North Carolina Department of Health and Human Services shows that claims from people on Medicaid for telehealth services hit their height at the start of the pandemic, and have declined since. Credit: NCDHHS.

    “Over the past two years, telehealth flexibilities helped children and families access valuable PT/OT services during the unprecedented circumstances of the COVID-19 pandemic,” said state health department spokesperson Catie Armstrong. 

    But she said that right now, the federal Centers for Medicare & Medicaid Services is not allowing any permanent changes to telehealth services. During the first few months of the public health emergency, the state recorded nearly 60,000 telehealth claims from people on Medicaid. In the months since, that number has declined.

    That means, even if it wanted to, North Carolina doesn’t have the authority to permanently authorize the state Medicaid program to cover virtual OT and PT services. The coverage rollback has left many who work in the field worried about the impact it will have on people across the state, especially those in rural areas. 

    Unique role telehealth plays in OT and PT

    Since the start of the pandemic, researchers at Duke University have been investigating the role telehealth plays in expanding access to care in general. One study is examining the impact virtual care has had for people receiving OT and PT. 

    Katherine Norman, a pediatric occupational therapist, is one of the investigators on the study.

    “The population we looked at was children and adolescents, so that was anybody from zero to 20, enrolled in Medicaid from April 2020 to March 2021,” she said. The researchers analyzed the Medicaid claims data of about 137,000 children with a musculoskeletal health diagnosis who visited a provider during the time period. 

    “The data that we uncovered really suggests that removing access via telehealth could impact as many as one in five kids who were using physical therapy and one in three kids who are using occupational therapy,” Norman said. To add a qualitative dimension to their study, the researchers are also speaking with people on Medicaid, health care providers, and community leaders statewide.

    Physical and occupational therapy can be critical for helping kids meet developmental milestones. PT can help children learn how to do critical physical tasks with more ease: walk and run, get on and off the floor, and play, while OT helps kids with the development of fine motor skills, such as brushing their teeth or holding a comb. 

    Imagining all those kids missing out on this kind of care deeply worries Norman. 

    Also, she says, telehealth holds a unique value within occupational therapy because of the nature of the care. If she’s seeing a patient, rather than just telling her about the stairs they have trouble climbing, or the corner they want to be able to stand behind to surprise their sibling, they can literally bring her into the room.

    “They can show me exactly how they do it,” she said, “so that I can see that and be like, ‘OK, so we need to work on your ability to crouch, or your ability to jump, or [whatever] specific movement pattern.’”

    Fox agrees. 

    In OT, “We think a lot about the environment, and how that impacts function and somebody’s ability to participate,” she said. “When it comes to having somebody leave their natural environment to come to an outpatient clinic, you have to ask a lot of questions: What does your home look like? And how do you move through your home? And what is the environment?

    “Telehealth allows you to truly see that in the moment and kind of be there with someone and I think that’s another layer, in addition to accessibility.”

    Also, Fox says, it doesn’t have to be all or nothing. In a perfect world, care going forward could be a blend of telehealth and in-person care. 

    “I just had that with a veteran,” she said. “He’s 75. He lives about an hour and a half away. So the first visit was that we do a lot of assessments, and now that we kind of know each other and I have more of an idea of his level of function, the next few sessions could be telehealth.”

    “What is the harm in keeping it as an option?” 

    Fox, who in addition to her full-time job at the VA is also the president of the North Carolina Occupational Therapy Association, said she was unaware of any outreach the state health department had done to ask occupational and physical therapists how virtual coverage was going for them and if they’d want it to continue going forward. 

    “This came to our attention when we were informed of the date of the sunset,” Fox said. Medicaid refers to the end of coverage for certain services as ‘sunsetting.’ 

    “So, we did not realize that this was coming, and definitely not that it was coming as fast as it was,” she said. “We’ve been told that they did not have the data showing that the telehealth modality was utilized enough. We are unclear on what type of data that was, or how it was collected or what their cutoff is for ‘enough,’ but that was what we’ve been told so far.”

    Spokespeople from DHHS did not directly answer the question of if they conducted outreach to providers, but said that they have qualitative data from families showing support for telehealth. Still, they said, the data the department has collected and analyzed “did not demonstrate the use of these services.”

    In a public webinar presentation on March 17, the associate director of program evaluations at North Carolina Medicaid, Sam Thompson, presented the data collected by Norman and the other Duke researchers, but came to a different conclusion than the researchers.

    “As a proportion of care, telehealth is just substantially lower in this group,” he said. “Because it’s such a small proportion of care, it’s a little bit less meaningful”

    But, Fox argues, even if utilization rates were low, if anyone used it, it’s worth keeping. 

    “It’s about access,” she said. “And so if five people throughout the year use it, what is the harm in keeping it as an option?” 

    Data collected by researchers at Duke University that NC Medicaid officials presented at the end of March. Though Thompson said utilization of these services was proportionally small, NCDHHS extended temporary Medicaid coverage of tele-OT and tele-PT services after the presentation. Credit: NCDHHS; Duke University.

    The state Medicaid office did worry at first that adding telehealth as an option would increase costs, but that’s not what they’ve seen. 

    “We have not found it to be significantly more expensive,” Thompson said. “We have some evidence to suggest that it can help prevent complicating factors that might be more expensive.”

    It’s unclear if private insurance plans will continue to cover tele-OT and PT or sunset their coverage as well. But historically, Godwin said, private insurance plans often follow what Medicaid does, meaning there’s a good chance that if telehealth for OT and PT is made permanent by the federally funded health care program, other insurance plans may follow. 

    While the state Medicaid office is limited in its ability to make permanent changes to its telehealth coverage policy, providers spoken to for this story want to encourage officials to do everything they can to make sure the coverage remains permanent. 

    If it goes away, they argue, fewer people will get the care they need. 

    “And that makes me really sad,” Godwin said.

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    by Clarissa Donnelly-DeRoven, North Carolina Health News
    April 4, 2022

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