For reimbursement services support, email us at info@girsinc.com or call us at 901-834-9119.
This year, we continue to see voters across states making decisions on how their state will proceed regarding Medicaid expansion. GIRS continues to track Medicaid expansions. On August 13, 2020, we tracked North Carolina’s Medicaid MCO Transformation Plans to Develop Targeted Payer Strategies.
After years of debate, two states: Oklahoma and Nebraska have initiated new laws to implement the Medicaid expansion programs in their state. In both states, the Medicaid expansion was enforced by the ballot initiative, and approved by the state’s voters. Nebraska Initiative 427 passed with more than half of the vote. It required the state to expand Medicaid as called for in the Affordable Care Act (ACA). Medicaid expansion in Nebraska takes effect as of October 1, 2020.
For Oklahoma, the State Question 802 did not only amend state guidelines to permit for Medicaid expansion, but as an alternative it added a new article to Oklahoma’s state constitution itself. The new article permitted adults with revenue up to 133 percent of the federal poverty level to qualify for Medicaid. Oklahoma is the first state to accept the program during the pandemic and the exact plans for their programs are still underway.
The Oklahoma Health Care Authority has three months to submit a plan and all other necessary documents to CMS for expanding the state’s Medicaid program. Oklahoma must be ready to implement the Medicaid expansion by July 2021.
When the pandemic began, the Kaiser Family Foundation (KFF) advised the federal government and states to support Medicaid expansion as a defense against coverage loss during the public health emergency (PHE). The KFF recommended for states to expand Medicaid in one of three ways:
- broaden eligibility
- endorse measures that warranted eligible individuals were enrolled in Medicaid
- pursue additional waivers from CMS that provided additional coverage and care access flexibility.
Oklahoma & Nebraska chose to increase the eligible income level.
Before the expansion, non-disabled Nebraska and Oklahoma adults without dependent children were ineligible for Medicaid regardless of how low their gross revenue was. Parents with children under the age of 18 qualified for Medicaid with a household income of up to 63 percent of the poverty level (58 percent plus a standard 5 percent income disregard; that amounts to about $16,500 for a family of four in 2020). In Nebraska, the coverage gap meant that there were approximately 16,000 low-income residents lacking any realistic access to coverage before the state expanded Medicaid. As of October 2020, coverage gap will no longer exist in Nebraska.
For the state of Oklahoma, the final decision came as the coronavirus pandemic continued to spread across the state. According to the Oklahoma State Department of Health, Oklahoma saw more than 13,000 cases in the second quarter. Almost 600 more cases were confirmed in the 24 hours as voters submitted their decisions on the State Question 802. The vote passed by less than one percent
Nebraska expects almost 100,000 people to be eligible for Medicaid coverage under the expanded eligibility guidelines (for perspective, there were about 242,000 people enrolled in Medicaid/CHIP in Nebraska as of 2019), but a recent Families USA study indicated that an additional 33,000 people could be eligible due to the unforeseeable circumstances caused by the COVID-19 pandemic. Therefore, the number of new qualified residents could be as high as 120,000.
Currently, 39 states (including DC) have accepted the Medicaid expansion. 12 states remain undecided about the expansion. North Carolina has not adopted Medicaid expansion; however, they have agreed to continue the transition from fee-for-service to privatized managed care organizations. Nebraska, Oklahoma, and Missouri have adopted the Medicaid expansion, but have not implemented yet.
Why Partner with GIRS
As more patients become Medicaid recipients and as Medicaid expansion grows, GIRS is #LookingAheadoftheCurve by educating clients about the potential impact on their payer mix and redefining payer market access strategies to secure Medicaid coverage and preferred status for their products.
We are currently working with all Medicaid Fee-for-Service programs educating them about the clinical and cost data for our client’s Products and assisting with the appropriate pricing of these Products. We also are working with Medicaid managed care plans to advocate for coverage and appropriate payment.
For more information, email us at info@girsinc.com or call us at 901-834-9119.
Disclaimer: The information in this blog is based on payer information which is dynamic. It is accurate at the time of posting but should not be construed to be reimbursement or legal advice. CPT® is the trademark of the American Medical Association (AMA).
Sources:
https://www.healthinsurance.org/nebraska-medicaid/
About GIRS
For more than 17 years, GIRS has been assisting medical technology manufacturers with their market uptake and reimbursement strategies so that patients can have access to the care that they need. To implement successful market access strategies, the GIRS Value Discovery Landscape Assessments® team and the Payer Advocacy Compass® team work together to develop and implement foundation reimbursement landscape and payer advocacy strategies to obtain positive coverage, appropriate payment, and innovative payer contracting arrangements to improve market uptake. For more information, email us at info@girsinc.com or call us at 901-834-9119.