States defend Medicaid unwinding choices

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Jan 04, 2024 View in browser   By Chelsea Cirruzzo and Ben Leonard Driving the Day Medicaid unwinding has led to 3.25 million kids losing the program's health coverage. | Mario Villafuerte/Getty Images AN HHS STATES STANDOFF — Many states that HHS has pointed to for high Medicaid coverage losses among children have told Pulse they stand by their unwinding processes. HHS Secretary Xavier Becerra sent letters to nine states last month asking them to take advantage of relaxed federal rules to ease coverage losses. Six of the states have since pushed back in statements to Pulse on what they consider a false narrative: That they aren’t doing enough to prevent children from becoming uninsured. As of Wednesday, 3.25 million children had lost Medicaid coverage, according to Georgetown University’s Center for Children and Families. HHS has said the nine states — Arkansas, Florida, Georgia, Idaho, Montana, New Hampshire, Ohio, South Dakota and Texas — are responsible for 60 percent of overall coverage losses among children between March and September of last year. Unless those states run afoul of federal rules, HHS said it can’t force them to accept additional help. “States that have taken up the historic number of new policy flexibilities that CMS has put on the table are better able to protect kids’ coverage,” CMS Deputy Administrator Daniel Tsai has told reporters. State officials have called the language around disenrollments “misleading” and urged patience with state Medicaid offices. Why it matters: HHS is trying to stave off concerns from advocates that high disenrollment numbers are driving people, especially families, from insurance entirely. The states, however, said they’ve been working hard to verify coverage, including through outreach via schools and pediatricians’ offices. Ohio Medicaid Director Maureen Corcoran told Pulse that Ohio Gov. Mike DeWine had spoken with Becerra after the letter and said the secretary “acknowledged Ohio was further along in the Medicaid unwinding process than most other states.” “He also noted how well the Ohio process has worked and acknowledged that the number of children found ineligible for Medicaid in Ohio is 6%, mirroring the national average,” Corcoran said in a statement. HHS confirmed the call with Ohio on Wednesday but didn’t give further details. “Regardless of reason, when eligible kids lose coverage, they and their families lose access to vital health care, security and peace of mind. HHS continues to stand ready to work with any governor who shares our goals so that no one loses their health care because of red tape,” HHS spokesperson Sara Lonardo said in a statement. Other states, including Arkansas, Florida, Georgia and Texas, defended their unwinding processes in statements to Pulse. Georgia spokesperson Garrison Douglas has told POLITICO that the Biden administration “once again missed an opportunity to urge families to fill out their paperwork.” A South Dakota spokesperson told Pulse it had reviewed the federal flexibilities and found one approach “could result in enrolling individuals in Medicaid who are not eligible.” Idaho, Montana and New Hampshire didn’t respond to requests for comment. WELCOME TO THURSDAY PULSE. Holiday gatherings may have given us all respiratory illnesses (I type this while fighting off a cold). Here are some tips on how to assess whether you should head to urgent care or the emergency room. Stay healthy and send your tips, scoops and feedback to ccirruzzo@politico.com and bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard_. Listen to today’s Pulse Check podcast At the Agencies HHS Secretary Xavier Becerra reminded leaders in the long-term care industry of their obligation to ensure their residents are up to date on their Covid shots. | Mariam Zuhaib/AP BECERRA RE-UPS VAX CONCERNS — HHS Secretary Xavier Becerra met Wednesday with long-term care facility industry leaders about low Covid-19 vaccination rates, according to an HHS release. Why it matters: The CDC has said vulnerable populations, including nursing home residents, are a priority for updated Covid vaccines. But, a CDC report released in December found that only 33 percent of nursing home residents were up to date on their shots, despite CMS requirements that nursing homes offer all residents and staff the shots. The meeting was the latest in a series of meetings Becerra has led with the industry and included leaders from LeadingAge and the American Health Care Association. LeadingAge President Katie Smith Sloan told Pulse in a statement that, at the meeting, the group asked HHS to “ease logistical issues that are barriers to uptake,” including enabling single-dose vaccine orders for nursing homes, coordinating vaccines being offered through hospitals among discharge and communicating more directly with residents and families. Both LeadingAge and the AHCA told Pulse they were thankful for the meeting and shared the urgency to increase vaccine uptake.   POLITICO AT CES® 2024: We are going ALL On at CES 2024 with a special edition of the POLITICO Digital Future Daily newsletter. The CES-focused newsletter will take you inside the most powerful tech event in the world, featuring revolutionary products that cut across verticals, and insights from industry leaders that are shaping the future of innovation. The newsletter runs from Jan. 9-12 and will focus on the public policy-related aspects of the gathering. Sign up today to receive exclusive coverage of the show.     Hospitals NEW JERSEY WANTS PRICE TRANSPARENCY — As Congress considers legislation to strengthen price transparency rules for hospitals, a New Jersey lawmaker is looking to do the same on the state level, POLITICO’s Daniel Han reports. Democratic State Sen. Joe Vitale has introduced a bill to require hospitals to post their prices online, which mirrors federal legislation that went into effect in 2021 to require hospitals to post their prices in a consumer-friendly format. Why it matters: According to a CMS review of 600 hospitals, 70 percent in 2022 posted their prices online, but that doesn’t mean all are in full compliance. Vitale and supporters of the bill, which includes influential labor unions, said the bill would help boost compliance. “[The bill] codifies what the feds already require hospitals to do,” Vitale said in an interview. “But the added piece for this is the added oversight by the Department of Health.” However, the New Jersey Hospital Association says the bill would duplicate federal price transparency rules and could increase costs by being overly burdensome to hospitals. THE HIGH COST OF COVID-19 — The average cost of treating a hospitalized Covid-19 patient rose by thousands of dollars in the first two years of the pandemic, a new study published in the JAMA Network Open found. Why it matters: The study sheds some light on hospitals’ full financial cost of the pandemic, which hospitals say they are still recovering from. The average increase from $10,394 in the first weeks of the pandemic to $13,072 in March 2022 — five times the rate of medical inflation during that period — is partly due to additional medical technologies that became available, researchers said. That included breathing support treatment, such as ventilation, and treatment for patients with high-risk conditions like obesity and hemophilia. The cost of care was calculated from 1.3 million inpatient stays from March 2020 through March 2022. Most hospitalized patients came to the emergency room, and just over a quarter spent time in the ICU. Thirteen percent were placed on ventilators, and 13 percent died during their stay. According to the researchers, extrapolating the study findings to all 6.2 million hospitalizations in the U.S. during the study period suggests the cost of care could have reached $70 billion. Artificial Intelligence CAN AI BE YOUR KID’S DOCTOR? An artificial intelligence chatbot incorrectly diagnosed dozens of pediatric cases, according to a study conducted at the Cohen Children’s Medical Center in Queens, New York. According to a research letter published Tuesday in JAMA Pediatrics, researchers asked a chatbot to make diagnoses based on 100 pediatric cases published in JAMA Pediatrics and the New England Journal of Medicine in the past decade. The chatbot incorrectly diagnosed 72 percent of cases and didn’t give a specific enough diagnosis in 11 percent. Despite the findings, the researchers wrote that “physicians should continue to investigate the applications of [chatbots] to medicine” and suggested that they can play a role in feeding AI tools real-time medical information to better prepare them. Why it matters: Providers are exploring ways AI can assist them, but as researchers note, such results underscore the value of clinical experience. Ethical questions also remain as to AI’s appropriateness in clinical settings. In a separate paper, pediatricians and researchers at the Washington University School of Medicine offered their framework for AI’s use in pediatric settings, including asking whether a chatbot has put out trustworthy information or whether the use of AI impacts relationships with patients. It also asks whether a clear understanding of the risks that won’t be taken with AI has been established. In Congress ADDING CBD TO YOUR DIET — The hemp industry wants Congress to pass proposed legislation requiring the FDA to regulate cannabidiol and other ingredients derived from hemp as a dietary supplement and food additive, POLITICO’s Natalie Fertig reports. The ask is part of a set of priorities from more than 30 hemp industry groups and nonprofits released Wednesday for the 2024 farm bill. Negotiations for the bill are expected to heat up in the coming weeks. The FDA doesn’t allow CBD products to be sold as dietary supplements. WHAT WE'RE READING KFF Health News reports on efforts in California to protect warehouse workers from hot indoor temperatures. The Wall Street Journal reports that Cigna is nearing a deal to offload Medicare business.   Tune in on Wednesday, Jan. 10, as POLITICO explores Taiwan's upcoming presidential election. Hear from our panel on the potential outcomes to the race and the profound implications for U.S.-China relations depending on who wins. REGISTER HERE.       Follow us on Twitter Dan Goldberg @dancgoldberg Chelsea Cirruzzo @chelseacirruzzo Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Kelly Hooper @kelhoops Robert King @rking_19 Ben Leonard @_BenLeonard_ David Lim @davidalim Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker Megan R. Wilson @misswilson   Follow us

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