States Are Leveraging Medicaid to Respond to COVID-19

"Congress should support states in making these changes by further increasing Medicaid’s federal match rate."Many state Medicaid programs are proposing or implementing new policies to respond to COVID-19 and maintain access to health care during the public health crisis. States are strengthening their home- and community-based services (HCBS) programs, improving access to coverage and care, helping people access care while social distancing, and ensuring financial stability for providers so they can keep their doors open and serve their communities. More states should consider implementing these policies, especially as more people lose their jobs or incomes and need Medicaid coverage. Congress should support states in making these changes by further increasing Medicaid’s federal match rate to defray the cost of these policies, as well as to prevent states from reducing access to care.

States Are Implementing New Medicaid Policies to Respond to COVID-19

Every state has made at least one change to its Medicaid program in response to COVID-19, using various available Medicaid authorities (see the textbox below).^[1]

Expanding or Strengthening HCBS for Seniors and People With Disabilities

HCBS are especially important during the public health crisis because they help seniors and people with disabilities remain in their homes, where they are generally safer from the virus than in nursing homes.

To date, the Centers for Medicare & Medicaid Services (CMS) has approved section 1915(c) waiver Appendix K changes HCBS in 50 states, including the District of Columbia (see Table 1 for a list of changes by state). These changes are making it easier for seniors and people with disabilities to get HCBS. More than half of states are permitting providers to conduct virtual assessments and person-centered planning meetings, modifying processes for level-of-care evaluations, extending reassessment and re-evaluation dates, and modifying the person-centered planning process.

States are also using these approvals to expand services by allowing beneficiaries to receive services beyond the typical limits, adjusting prior authorizations, adding new services and supplies such as home-delivered meals and adaptive technology, and allowing HCBS to be provided in alternative settings such as hotels, schools, churches, and temporary shelters.

Finally, states are strengthening the HCBS workforce by increasing payment rates, providing retainer payments to help keep HCBS providers stay in business, and paying family caregivers.

Improving Access to Coverage and Care

States are using disaster-related state plan amendments (SPAs) and administrative actions to make it easier for people to enroll in coverage (see Table 2). For example, some states are electing the new eligibility group authorized under the Families First Act Coronavirus Response Act to cover COVID-19 testing for uninsured individuals and using less restrictive methodologies to determine eligibility.

Some states are also accepting self-attestation for all eligibility criteria covering non-residents or people living temporarily out of state due to the public health emergency, adopting a simplified/streamlined application, giving non-citizens more time (a longer reasonable opportunity period) to document their eligibility for coverage, and expanding presumptive eligibility (which lets providers and other qualified entities temporarily enroll people who appear eligible for Medicaid) to new populations, including seniors and people with disabilities.

States are also expanding coverage and making it more affordable by adjusting or increasing benefits, covering COVID-19 testing or treatment through emergency Medicaid, and eliminating copayments and other cost-sharing charges as well as premiums.

Helping People Access Care While Maintaining Social Distance

States are using a combination of disaster SPAs, administrative actions, and section 1135 waivers to maintain access to health care while people are social distancing (see Table 3). For example, states are expanding the use of telehealth by waiving or reducing telehealth copayments, paying some telehealth services at the same rate as face-to-face visits, waiving or reducing copayments for telehealth services, and giving providers more flexibility to provide telehealth services.

States are also using these authorities to prevent unnecessary trips to the doctor or pharmacy by suspending or extending prior authorizations for health care services and items, allowing Medicaid beneficiaries to get early prescription drug refills, increasing the maximum supply or quantity limit of certain drugs, making changes to preferred drug lists, and waiving or suspending prescription drug prior authorizations.

Expanding or Strengthening the Health Workforce

CMS has approved disaster SPAs that allow states to increase payment rates and supplemental payments to certain providers (see Table 4). And nearly all states are using section 1135 waivers to make it easier for providers to enroll in their Medicaid programs, allow out-of-state providers to furnish services, and allow providers to offer health care services in alternative settings, including unlicensed facilities.

States Need More Medicaid Funding to Support Their Efforts

While some of the policies above are low cost, others are expensive to implement. Congress should support states in their efforts to respond to COVID-19 by further increasing Medicaid’s federal match rate to help them cover these additional costs. Increasing the federal match rate will also help prevent people from losing access to critical services during the public health and economic crises.^[2]