Internship Research, (cont.)

 

Chapter Five: American Rescue Plan

Since the beginning of the Coronavirus pandemic, the federal government has been providing economic stimulus packages to restimulate the economy. Previous aid packages provided only emergency relief to individual Americans, small businesses, state and local governments, and various other sectors (education, big corporations, public health…).  As of March 11, 2021, The Biden Administration implemented a new stimulus bill that provides benefits that were not previously included in other stimulus bills. The American Rescue Plan provides states that have not expanded Medicaid services with possible incentives if the state expands its services. This bill would also provide new coverage for pregnant and postpartum women. For a state that has not expanded Medicaid services, like South Carolina, could this be the motivation needed to expand coverage in unexpanded states? 

Here is a brief background on the current coverage under Medicaid expansion. “Individuals enrolled as part of the new adult group receive an alternative benefit plan (ABP), which is a benchmark plan modeled on commercial insurance coverage, rather than the traditional Medicaid benefit plan. Individuals with special medical needs are exempt from the ABP and states have flexibility to include additional benefits. In addition, these benefit packages must cover the 10 essential health benefits specified in the ACA. Essential health benefits are defined as ambulatory services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services, chronic disease management, and pediatric services, including oral and vision care. While states are allowed to offer ABPs to the new adult group that are less comprehensive than benefits offered to other Medicaid beneficiaries, most states have chosen to align their ABPs with traditional Medicaid benefits,” (Medicaid expansion to the new adult group, 2021).

The initial expansion under the Affordable Care Act provided many women with coverage who would otherwise have none.  In states that have expanded Medicaid services, many expectant mothers have had their coverage increased from 60 days postpartum to 12 months. This inclusion of this prevented many women from experiencing many postpartum complications. The expansion of Medicaid services has been linked to lower cases of maternal-mortality and lower incidences of pregnancy-related death.  A study presented at the Academy Health 2019 National Health Policy Conference determined that Medicaid expansion is linked to lower incidences of maternal mortality. “Confirming the hypothesis, the researchers observed that Medicaid expansion was significantly associated with lower rates of maternal mortality by 0.16 relative to states that did not expand, reflecting 1.6 fewer maternal deaths per 100,000 women. Looking at racial and ethnic subgroups, the biggest differences were seen among Hispanic mothers, with 0.22 fewer maternal deaths per 100,000 women in expansion states. However, this effect was not significant among non-Hispanic white or non-Hispanic black or African American mothers,”(Medicaid expansion linked to lower maternal mortality rates, 2019).

The American Rescue Plan offers amenities that were not offered in previous stimulus packages. This new act stands to address long-standing coverage gaps among pregnant and postpartum women.” Currently, Medicaid covers almost half of births nationally, with eligibility levels ranging from 138% to 380% of poverty across states. States must cover pregnant women with incomes up to 138% of the federal poverty level (FPL) through 60 days postpartum (the end of the month of the 60th postpartum day). The American Rescue Plan Act allows states to extend the postpartum period to a year by filing a State Plan Amendment (SPA) to their Medicaid program,” (Postpartum coverage extension, 2021). 

This new addendum would also include the Children’s Health Insurance Program (CHIP). A new incentive proposed in the American Rescue Plan may be able to encourage South Carolina officials to expand Medicaid coverage. This new incentive would provide a 5 percent increase to the state’s Federal Medical Assistance Program for two years. “The FMAP increase is immediately available to states and would begin in the first calendar quarter when a new expansion state incurs spending for people in the Medicaid adult expansion groups. If a state expands during the public health emergency (PHE), that state will receive both the COVID-19-related 6.2 percentage point FMAP and the new 5-percentage-point increase,” (Summary of American Rescue Plan, 2021).  The federal government currently provides 90 percent FMAP for states that have already expanded. If South Carolina decides to expand, that would raise the federal government’s  FMAP contribution to 100 percent. Funding has consistently been cited as one of the reasons why South Carolina officials continue to deny Medicaid expansion, but this new provision would allow for an additional increase in funding. Thus, reducing expansion costs. The current percentage of uninsured individuals is 10.8%, with a majority of individuals living below the poverty line. If South Carolina chooses to expand Medicaid coverage under this new plan, the number of uninsured individuals will decrease. Previously uninsured individuals would be able to obtain health coverage through Medicaid.

Hypothetically, if South Carolina did expand Medicaid services, many South Carolinians would be able to receive needed medical treatments, as well as financial rewards. The rates of the uninsured, maternal mortality, pregnancy-related death, and various other conditions are likely to decrease due to the influx of individuals seeking preventive services. If funding is no longer an issue, what’s stopping SC officials from helping their citizens.

On March 12th, 2021, President Biden signed into action a new COVID-19 relief package, that provides various incentives for states that have not expanded Medicaid services. States that expand their Medicaid coverage can receive 100 percent federal coverage for Medicaid. This new act also increases postpartum coverage from 60 days after birth to a full year. While these two provisions have been highly publicized, several other provisions are just as important. The Federal government is providing several incentives to entice state officials into expanding their Medicaid coverage but will state officials compromise their beliefs to better serve their citizens?

An important provision provided in this legislation is 100 percent coverage for COVID-19 vaccines and administration for Medicaid members. “The new law clarifies that COVID-19 vaccines and administration are covered without cost-sharing for Medicaid enrollees and provides 100% federal matching funds for this coverage. CMS previously had interpreted the Families First Coronavirus Response Act (FFCRA) vaccine coverage requirement to exclude certain enrollees receiving limited benefit packages. The coverage provision applies to all enrollees, except those eligible only for Medicare cost-sharing assistance (partial duals) or COBRA premium assistance, from March 11, 2021 through the last day of the 1st calendar quarter that begins at least 1 year after the COVID-19 PHE ends,” (Musumeci, 2021). This new provision would provide Medicaid enrollees and potential enrollees the opportunity to be vaccinated for COVID-19 without having to make a full or partial payment o receive it.

This bill also includes coverage of COVID-19 treatment services. The new law adds coverage of COVID-19 treatment services, without cost-sharing, for enrollees in the COVID-19 uninsured testing group and enrollees who receive alternative benefit plans (ABPs). This coverage includes specialized equipment and preventive therapies and treatment (if otherwise covered under Medicaid) of a condition that may seriously complicate the treatment of COVID-19 for those presumed to have or diagnosed with COVID-19. The COVID-19 uninsured testing group was created by the FFCRA and is available at state option, with 100% federal matching funds, during the PHE. The benefit package for this group previously was limited to COVID-19 testing and testing-related services,” Musumeci, 2021). For states that have expanded their Medicaid coverage, they will receive a 90% federal enhanced matching rate for individuals with alternative benefit plans  (ABP). If South Carolina decides to expand their Medicaid services, the state of South Carolina would receive the 90% federal matching rate, as opposed to 6.2 percentage points being added on to their current rate. States can also receive funding for Medicaid home and community-based services. “States can receive a 10 percentage point increase in federal matching funds for Medicaid home and community-based services (HCBS) from April 1, 2021 through March 30, 2022. The new funds must supplement, not supplant, the level of state HCBS spending as of April 1, 2021, and states must implement or expand one or more activities to enhance HCBS. HCBS help seniors and people with disabilities live independently in the community by assisting with daily self-care and household activities,”(Musumeci, 2021). Services covered under this initiative would include home-based services, such as assistance with activities of daily living (ADL’s).

The American Rescue Plan act also provides states with the option of providing community mobile crisis intervention services. These services would be provided by Medicaid enrollees who suffer from mental health issues and substance abuse disorders. “According to the Kaiser Family Foundation, “States have a new option to provide community-based mobile crisis intervention services with 85% federal matching funds for the first 3 years. The additional funds must supplement, not supplant, the level of state spending for these services in the fiscal year before the 1st quarter that a state elects this option. Services must be otherwise covered by Medicaid and provided by a multidisciplinary team to enrollees experiencing a mental health or substance use disorder crisis outside a hospital or other facility setting,” (Musumeci, 2021). The only issue with this provision is states have the option to impose restrictions on qualifications for these services. “These services generally do not have to be offered statewide, do not have to be comparable for all enrollees, and can restrict enrollees’ free choice of provider,”(Musumeci, 2021). While this particular provision would be a great way to address two current healthcare concerns, state officials could use this as a way to offset costs by restricting certain enrollees from using these services.

The incentives I discussed in this paper, as well as the incentives I previously discussed, should be the push South Carolina officials need to expand Medicaid services in our state. We need to expand our Medicaid services to eliminate the coverage gap in our state. “South Carolina’s governor and legislature have strongly rejected Medicaid expansion under the Affordable Care Act (ACA). As a result, there are about 121,000 people in the state who are in the “coverage gap” with no realistic access to health insurance. They are the state’s poorest residents, with incomes under the poverty level. They do not qualify for subsidies in the exchange and they also do not qualify for Medicaid,”(Norris, 2020).  The state of South Carolina could receive up to $790 million dollars in increased funding if they expand Medicaid coverage. Our state officials are being presented with an opportunity to change the lives of thousands of its citizens, yet they continue to disregard the issue. We that expanding Medicaid would be beneficial for the entire state, but how do we make our elected officials understand this?

 

American Rescue Plan Summary: On March 11, 2021, The Biden Administration implemented a new stimulus bill that provides benefits that were not previously included in other stimulus bills. The American Rescue Plan provides states that have not expanded Medicaid services with possible incentives if the state expands its services. This bill would also provide new coverage for pregnant and postpartum women.  Many hope that these new incentives will entice South Carolina officials into expanding Medicaid services. South Carolina officials have stated that the costly expense is the reason for the denial of expanded services, but this new act provides the funding that South Carolina officials say is lacking. For states that have expanded their Medicaid coverage, they will receive a 90% federal enhanced matching rate for individuals with alternative benefit plans  (ABP). If South Carolina decides to expand their Medicaid services, the state of South Carolina would receive the 90% federal matching rate, as opposed to 6.2 percentage points being added on to their current rate. The state of South Carolina could receive up to 790 million dollars in increased funding if they expand Medicaid coverage. This would help address the ongoing coverage gap for South Carolina citizens.

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