Waivers to Medicaid and the Children’s Health Insurance Program (CHIP) give state programs flexibility to better respond to COVID-19.
Many private payers have waived member payment for COVID-19 testing and treatment. And telehealth is being leaned on more than ever as remote monitoring programs give providers the ability to monitor patients with chronic conditions from a distance and video conferencing allows providers to see patient’s faces before making a diagnosis.
But Medicaid and CHIP policies have been restrictive of these solutions, not covering testing options or allowing flexible payment options for members. Telehealth coverage and reimbursement was also restrictive despite it being a known solution.
The Centers for Medicare and Medicaid Services (CMS) have, therefore, recently approved over 125 waivers and amendments to state Medicaid and CHIP programs that expand coverage options and relax restrictions to give states more flexibility in responding to COVID-19.
Each state is leveraging a unique set of solutions to best fit the needs of their population. But common themes in state responses highlight key challenges providers are facing nationwide.
CO-PAYMENTS AND PREMIUMS
As coronavirus case counts continue to rise, there is a large need for continued testing and treatment. In order to fund this, many individuals are being asked to pay co-payments the moment they walk into the clinic.
Rising unemployment rates also mean that many individuals are unable to make their co-payments, some have lost their health insurance coverage altogether, and others cannot make their premium payments.
A lack of coverage or inability to pay should not inhibit a patient’s ability to seek testing or treatment, especially as fears of COVID-19 are rampant. So many states submitted waivers to CMS that waive or suspend co-payments and premiums.
Specifically, this includes states suspending or fully waiving their premiums and implementing a premium lock-out policy.
Unemployment has also impacted the number of individuals eligible for Medicaid and CHIP, expanding the need for these services to an even greater population. Meanwhile the eligibility restrictions have remained the same.
To combat this, many waivers CMS has received focus on expanding eligibility and relaxing deadlines for applications. This includes delaying the process for renewals and extending renewal response deadlines for families on Medicaid.
Some states are also delaying acting changes in circumstance that impact an individual’s eligibility for Medicaid or CHIP including a change is residency or termination in coverage. Meanwhile, several states are expanding Medicaid and CHIP services to cover individuals who are not state residents but are currently living in the state because of social isolation and quarantine restrictions.
EXPANSION OF TELEHEALTH
Telehealth is being used for patients with and without coronavirus. It limits the number of patients who need to be seen in the clinic, which helps slow the spread of COVID-19 and minimizes provider risk of contracting the virus. It also helps providers manage patients with chronic conditions who cannot be seen in the clinic.
But telehealth restrictions have hampered provider use and made many providers weary of using the technology. Coverage for telehealth is historically limited and often at a rate less than traditional care. But the industry’s large boom in telehealth to combat the coronavirus has forced many to rethink its role.
The CMS waivers and amendments recently approved for state Medicaid and CHIP programs are broadening telehealth use. This includes more reimbursement for telehealth and expanded use of telehealth services to fit the needs of state coronavirus responses.
Increasing the availability of telehealth services in combination with relaxed payments and broadened eligibility requirements is allowing states the flexibility to respond to COVID-19. There is uncertainty surrounding if these changes will remain after the pandemic and how that impacts the Medicaid and CHIP programs. But they are the temporary fix many states need in order to continue responding to COVID-19.