The first RSV immunization recommended for all infants under 8 months old is no longer expected to be available to everyone in that age group, thanks to limited supplies nationwide.

‘Worse Than People Can Imagine’: Medicaid ‘Unwinding’ Breeds Chaos in States

KFF Health News | By Phil Galewitz, Katheryn Houghton, Brett Kelman and Samantha Liss

More than two dozen people lined up outside a state public assistance office in Montana before it opened to ensure they didn’t get cut off from Medicaid.

Callers in Missouri and Florida reported waiting on hold for more than two hours on hotlines to renew their Medicaid coverage.

The parents of a disabled man in Tennessee who had been on Medicaid for three decades fought with the state this summer to keep him enrolled as he lay dying from pneumonia in a hospital.

Seven months into what was predicted to be the biggest upheaval in the 58-year history of the government health insurance program for people with low incomes and disabilities, states have reviewed the eligibility of more than 28 million people and terminated coverage for over 10 million of them. Millions more are expected to lose Medicaid in the coming months.

The unprecedented enrollment drop comes after federal protections ended this spring that had prohibited states from removing people from Medicaid during the three pandemic years. Since March 2020, enrollment in Medicaid and the related Children’s Health Insurance Program had surged by more than 22 million to reach 94 million people.

The process of reviewing all recipients’ eligibility has been anything but smooth for many Medicaid enrollees. Some are losing coverage without understanding why. Some are struggling to prove they’re still eligible. Recipients and patient advocates say Medicaid officials sent mandatory renewal forms to outdated addresses, miscalculated income levels, and offered clumsy translations of the documents. Attempting to process the cases of tens of millions of people at the same time also has exacerbated long-standing weaknesses in the bureaucratic system. Some suspect particular states have used the confusing system to discourage enrollment.

“It’s not just bad, but worse than people can imagine,” said Camille Richoux, health policy director for the nonprofit Arkansas Advocates for Children and Families. “This unwinding has not been about determining who is eligible by all possible means, but how we can kick people off by all possible means.”

To be sure, some of the Medicaid recipients who signed on to the program when the U.S. unemployment rate soared amid covid-19 lockdowns have since gotten health insurance through new jobs as unemployment dropped back to pre-pandemic lows.

And some of the disenrolled are signing up for Affordable Care Act marketplace plans. Centene CEO Sarah London, for example, told investors on Oct. 24 that the health care giant expected as many as 2.4 million of its 15 million Medicaid managed care members to lose coverage from the unwinding, but more than 1 million customers had joined its exchange plans since the same time last year.

Still, it’s anyone’s guess how many former Medicaid beneficiaries remain uninsured. States don’t track what happens to everyone after they’re disenrolled. And the final tallies likely won’t be known until 2025, after the unwinding finishes by next summer and federal officials survey Americans’ insurance status…

Read Full Article

HHS Proposes ‘Powerful’ Penalties for Providers Found Information Blocking

HomeCare Dive | By Rebecca Pifer

Regulators on Monday proposed a long-awaited rule tying payments for hospitals and doctor’s offices in three popular Medicare programs to compliance with data-sharing regulations.

Medicare payments could soon be on the line for hospitals and doctor’s offices found blocking the free electronic flow of health information.

That’s if a new rule proposed by the HHS on Monday is finalized.

Under the rule, providers that block the access, exchange or use of electronic health information could lose out on select annual payment increases, receive lower quality scores or be kicked out of a value-based program in Medicare.

“I think these are going to be very powerful incentives to change the whole national conversation,” said Don Rucker, who led the Office of the National Coordinator during the Trump administration. The ONC oversees U.S. health IT.

“The way they resonate through the payment system — this directly affects the payment systems of providers,” Rucker said.

Long-awaited penalties

Providers have been waiting for regulators to add teeth to rules forbidding information blocking that were finalized in early 2020. Specific punishment for health IT vendors found information blocking was included in the law backing the rules — an up to $1 million fine per violation, which regulators officially enacted this summer.

The statute — the 21st Century Cures Act passed in 2016 — did not include specific penalties for providers. Instead, Congress left it up to the secretary of the HHS to establish disincentives, without granting the department any additional authority. That lack of clarity complicated oversight efforts, according to senior government officials.

Monday’s proposal “starts the process to fill in the last remaining oversight aspects” of the information blocking rules, Steve Posnack, deputy national coordinator for health information technology, told reporters during a Monday press conference.

Experts have slammed the lack of data-sharing enforcement on healthcare providers as a major oversight, since providers account for the majority of information blocking complaints, according to government data.

The new rule attaches providers’ Medicare payments to information blocking compliance. The move was appropriate given the intent of the statute, according to Rucker.

“It’s highly in line with public policy and the pretty clear intent of Congress in the Cures Act,” Rucker said.

Under the proposed rule, hospitals participating in the Medicare Promoting Interoperability Program (MPIP) — which pays providers for EHR adoption and use — won’t qualify as meaningful EHR users if they’re found guilty of information blocking.

As a result, hospitals could lose 75% of the annual market basket increase. Critical access hospitals would have their payments associated with successful participation lowered to 100% of reasonable costs, instead of 101%, according to the HHS…

Read Full Article