Editor’s note: This commentary is by Kay Johnson, of Hinesburg, president of Johnson Group Consulting, Inc. and a researcher, advocate, and consultant in child and family health policy.
Vermont has long had strong and effective leadership for Medicaid. Yet today, the leaders and staff at the Department of Vermont Health Access and the whole Agency of Human Services face a fire hose of health system challenges, federal policy changes, and unmet needs. They also have opportunities to better serve Vermonters during the COVID-19 pandemic.
Helping states to improve Medicaid policy for children and families has been a part of my professional life for the past 35 years, and in the COVID-19 crisis I am closely following options, innovations, and missed opportunities across the country. The Families First Coronavirus Response Act (Public Law No. 116-127) prohibits cost sharing for COVID-19 testing and permits states to extend Medicaid coverage to more people. In addition, for states that maintain current rules, the new law also temporarily increased federal matching by 6.2 percentage points, which would mean going from 54.39 to 60.59 cents on every dollar spent under Medicaid during the emergency.
As of March 30, the Centers for Medicare and Medicaid Services had approved emergency Section 1135 waivers for 35 states (including Vermont), Home and Community-Based Care waivers can be amended, and the federal government has given states other flexibility to respond using Medicaid. The following are ways Medicaid could be quickly enhanced in Vermont during the declared public health emergency.
- Quickly expand Medicaid eligibility to the uninsured, including the homeless and those recently unemployed.
- Optimize capacity for online application and enrollment, as well as setting up “presumptive eligibility” at the hospital. One step already taken in Vermont is to temporarily waive financial verifications.
- Ensure continuous enrollment, without the need to reapply. People enrolled and those with an eligibility appeal pending should not be terminated until the end of the month when the emergency period ends.
- Rapidly expand the health care workforce, by permitting licensed health providers from other states to be reimbursed for services delivered to Vermonters enrolled in Medicaid.
- Make payments for virtual services (by telephone, Internet, or other technology) at the same rate as face-to-face visits.
- Include reimbursement for virtual services delivered by a wider sector of the health care workforce, including home visitors, home health providers, community health workers, nurses who work with child care providers, mental health counselors, and others.
- Permit flexibility in delivery of prenatal, birth and postpartum, including home births by nurse midwives and support of trained doulas. Many pregnancy related services can be delivered via telemedicine.
- Expand the settings where Medicaid financing can be used, such as “hospitals without walls” and modified practices in emergency departments.
- Extend the settings and services where Medicaid can be used for people with disabilities and serious chronic conditions, including payments for family members who are caregivers (“live in caregiver” service).
- Lift certain requirements for prior authorization of services, such as those for children with complex medical and other special health care needs.
- Modify benefits to cover needed food, home delivered meals, diapers, and medical supplies people — particularly those with disabilities and chronic conditions — need to stay at home and maintain their health.
- Pay for coronavirus treatments, not just testing, without cost sharing. Vermont Medicaid has already waived hospital outpatient copayments.
Maximizing federal funding from Medicaid will help to cover the additional costs to the state, providers, and patients. Since Medicaid comprises a substantial share of our state budget, it will also help to fill fiscal shortfalls resulting from this crisis.
The Department of Vermont Health Access has set up a COVID 19 update website that can be used by providers and enrollees. And, of course, while we stay home and stay safe, Vermonters can get reliable information about the coronavirus from the Centers for Disease Control and Prevention and the Vermont Department of Health. VTDigger can follow policy changes and help Vermonters understand and use them.
