“There are California taxpayers and American taxpayers who are being defrauded because California isn’t taking its program seriously. But also, you have people who’ve been prescribed medications that they don’t even need,” Vance said. “Sometimes they’ve had drugs put into their bodies that they don’t need because fraudsters have actually encouraged false prescriptions and false administration and medications.”

Vance, standing alongside Dr. Mehmet Oz, the administrator for the Centers for Medicare and Medicaid Services, said the administration is also sending letters to all 50 states informing them that if they do not “effectively and aggressively prosecute Medicaid fraud in their states,” they will see federal funding cut off as well.

“We want California to get serious about this fraud,” said Vance, who President Trump named his “fraud czar” last month.

Oz called out what he said was widespread fraud in hospice services and similar in-home care programs nationally — and particularly in the Los Angeles region — and announced a six-month moratorium on new Medicare enrollment for hospices and home health agencies.

“A third of all these programs in the entire country are in Los Angeles. Ask yourself, how is that possible? It’s not,” Oz said. “They’re not that many people dying in Los Angeles. We’re not talking about California, just Los Angeles.”

He said he and others in the administration determined that “at least half of the hospices, in the entire area around Los Angeles, are fraudulent,” and had shut down 800 of them that last year had “charged the federal taxpayer $1.4 billion,” which “will no longer be paid.” That is a major increase from the 450 providers the administration said it had suspended as of last month.

The announcement was the latest attempt by the Trump administration to highlight and rein in fraud in federal healthcare benefits programs, particularly in blue states. The actions were met with immediate push back from California officials.

“We hate fraud. But that’s NOT what this is,” Gov. Gavin Newsom’s office posted on the social media site X. “Vance and Oz are attacking programs that keep seniors and people with disabilities OUT of nursing homes. Pretty sick.”

Newsom’s office said that the growth of In-Home Supportive Services placements in California was “simple,” and due to California “keeping more people OUT of far more expensive nursing homes!”

Such services cover assistants who help people with daily tasks such as bathing, laundry or cooking; provide needed care such as injections under the direction of a medical professional; and accompany them to and from doctor’s appointments. A 2020 report by the California state auditor found that nearly three-quarters of IHSS caregivers assist a family member.

Newsom’s office wrote IHSS care costs $30,000 a year, while nursing home care costs $137,000 a year. “SAVING TAXPAYERS: $107K per person,” it wrote.

California Atty. Gen. Rob Bonta also criticized the administration’s moves.

“Once again, California appears to be targeted solely for political reasons,” Bonta said. “The Trump administration is planning to defer over $1 billion in Medicaid funding for vital programs that helps seniors and people with disabilities remain safely in their homes.

“My team is carefully reviewing all available information. We have not hesitated to challenge unlawful actions by the Trump administration, and we will continue to act whenever Californians’ rights or access to critical services are threatened,” he said.

Democratic Sen. Alex Padilla also lashed out at the Trump administration.

“The Trump Administration is attacking California over claims that they can’t back up,” Padilla wrote on social media. “Let’s be real, this isn’t about fraud — it’s about punishing a state that didn’t vote for him. Political retribution plain and simple.”

Fraud in California’s hospice industry has been a problem for years.

Authorities in the state promised to crack down on the issue after a Times investigation in late 2020 revealed that unscrupulous providers were billing Medicare for hospice services and equipment for patients who were not actually dying — with the hospice industry in the state exploding in size.

California’s Medicaid program, known as Medi-Cal, is expected to cost about $222 billion for the budget year starting July 1, including both state and federal funding. Roughly 15 million Californians, more than a third of the state, are on Medi-Cal.

Vance, a potential 2028 presidential hopeful, has taken up his work as “fraud czar” with vigor, traveling around the country to drive home the idea that the Trump administration is working diligently to bring down healthcare costs by addressing waste, fraud and abuse that is rampant across the system.

He has said that waste and abuse is particularly prevalent in Democratic-led states such as California, New York and Minnesota.

“We have red states and blue states that go after fraud aggressively, but we also, unfortunately, have some states, mostly blue states, unfortunately, that do not take Medicaid fraud very seriously,” he said Wednesday.

Vance specifically threatened to cut off what he said is billions in federal funding for state-run fraud control units that are meant to prosecute people who abuse the system, but which he said aren’t doing the work. “This is a tool that we want the states to use, but unfortunately, a lot of states aren’t using these tools at all,” he said.

The focus on fraud comes against a backdrop of criticisms that other policy measures pushed by the administration have driven healthcare costs up or made it harder for people to access healthcare — including cuts to Obamacare subsidies and new work requirements in Medicaid, which are expected to strain hospitals around the country and led to millions of people losing healthcare coverage.

Democrats and Republicans have argued over who is to blame for rising healthcare costs, and Vance and Oz have clashed with California leaders before.

In January, Newsom filed a civil rights complaint against Oz after he posted a video accusing Armenian crime groups of carrying out widespread healthcare fraud in Los Angeles. In the video, Oz was shown driving around Van Nuys, saying about $3.5 billion worth of Medicare fraud had been perpetrated by hospice and home care businesses — and “run, quite a bit of it, by the Russian Armenian mafia.”

Newsom called Oz’s claims “baseless and racist.”

The administration previously launched investigations into potential healthcare fraud in at least five states — California, Florida, Maine, Minnesota and New York — and halted some $243 million in Medicaid payments to Minnesota over fraud concerns.

The Centers for Medicare & Medicaid Services has also acknowledged using errant figures to justify a fraud probe in New York, deepening concerns in the administration’s methods for identifying problematic activity.

Vance said the deferral of funds to California and the letters warning other states to get serious is not about political retribution, but a wake up call. He said the Trump administration wants to help states root out fraud and abuse, including with new technologies — but can’t do so if they are not “willing to help themselves” first.

“We don’t want to turn off any money. What we want to do is ensure that people are taking fraud seriously. We want to protect Medicaid, we want to protect Medicare,” Vance said. “But we can’t do that if the states that are administering those programs are allowing those programs to be fleeced by fraudsters.”

The Associated Press contributed to this article.

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The budget lawmakers approved is not the state’s final spending plan. Newsom and legislative leaders are still negotiating how to fix the shortfall before the start of the new fiscal year on July 1. But lawmakers had to pass a balanced budget by Saturday or else they would forfeit their six-figure salaries — a rule voters approved in 2010 to prevent the types of budget stalemates that had delayed negotiations in the past.

That is why Thursday’s vote was not really a public rebuke of Newsom, a Democrat who for the most part has had a good relationship with a Legislature dominated by members of his own party. Instead, the vote highlights the differences between Newsom, a second-term governor who many believe holds presidential aspirations, and a liberal state Legislature that is often more willing to take risks.

While Newsom’s budget proposal preserved most of the state’s major assistance programs, he included a number of smaller cuts that angered his Democratic allies. He proposed to stop paying for in-home caretakers for some disabled immigrants on Medicaid. He wants to eliminate a program that helps provide housing for families with incomes less than $13,000 per year. And he suggested delaying a rate increase for organizations that care for people with intellectual disabilities.

To reject these cuts, lawmakers needed to find more money. They found it by taking one of Newsom’s ideas and making it happen faster.

Newsom proposed temporarily stopping some businesses from deducting financial losses from their state taxable income, thus increasing their tax bill. It has become a common way to increase revenue during budget shortfalls. The Legislature chose to do this, too, but their plan would start the tax increase one year earlier. That generated an extra $5 billion in revenue compared with Newsom’s plan.

Lawmakers also found large budget cuts in other places. They want to cut $1 billion out of the state’s prison budget, arguing the money isn’t needed now that the prison population is about half of what it was two decades ago. And they want to cancel a $400 million loan to PG&E that would help extend the life of the Diablo Canyon nuclear power plant.

Those are just some of the disagreements that the Newsom administration and lawmakers must resolve by the end of the month. On Thursday, both sides indicated they have made good progress. Senate President Pro Tempore Mike McGuire said lawmakers could be voting on a final budget deal by the end of next week.

“I firmly believe the final budget that we’re going to have in front of us here next week will follow the same framework that’s in front of this body here today,” he said.

One major issue that has yet to be addressed by either side is what to do about a minimum wage increase for health care workers that is scheduled to start on July 1. Newsom signed a law last year that would eventually raise health care workers’ minimum wage to $25 per hour over the next decade.

The wage increase is expected to cost the state hundreds of millions of dollars in increased wages for some state workers and increased payments in the state’s Medicaid program, according to an analysis by the University of California-Berkeley Labor Center. Newsom has said he wants to delay the minimum wage increase, but he so far has been unable to get an agreement from the state Legislature.

Republicans, who don’t have enough numbers to sway policy decisions and say they were left out of the budget negotiations with Democrats, criticized the Legislature’s spending plan as unsustainable.

Republican Assemblymember Heath Flora said raising taxes on businesses to help close the deficit would be “an economy killer,” adding “our citizens are not here to provide overdraft protections.”

“We can’t continue to make up the lie that tax increases are a solution to bad management,” he said.

Democratic state Sen. Scott Wiener defended the tax proposal, noting it was just seven years ago that Congress slashed the federal corporate tax rate by 40%.

“All we are asking here during a difficult budget year is to be part of the solution,” Wiener said. “This is a very reasonable approach.”

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The U.S. Department of Health and Human Services (HHS) released new data on state Medicaid and Children’s Health Insurance Program (CHIP) enrollment changes among children and youth since full eligibility renewals for these programs restarted earlier this year. The data released today make it clear that state policy choices have real consequences for children and families during Medicaid and CHIP renewals. States that take up proven flexibilities and strategies from the Centers for Medicare & Medicaid Services (CMS) are better able to protect kids’ coverage – especially when the state has also expanded Medicaid.

According to the data:

• States that have taken up more of the federal strategies provided by CMS and prioritized auto-renewals (ex parte) to reduce red tape for families have helped more eligible children renew Medicaid and CHIP coverage. Many of CMS’ flexibilities make it easier for states to renew eligible children’s coverage by using data the state already has available.
• Barriers to coverage, such as a failure to expand Medicaid, are leading children and youth to fall through the cracks. For example, the 10 states that have not expanded Medicaid – Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming – have disenrolled more children than those that have expanded combined. In non-expansion states, youth who turned 19 while the continuous enrollment condition was in place are at risk of falling in the coverage gap and becoming uninsured; these youth on average account for 27.6% of disenrollments among children in non-expansion states since March 2023, compared to 12.1% of disenrollments in states that have expanded.
• More than 88 million people, including nearly 40 million children and youth, were enrolled in Medicaid and CHIP coverage as of September 2023. Before the pandemic, in February 2020, about 71 million people were enrolled in Medicaid and CHIP, including about 35 million children.

In light of this data, CMS released new comprehensive guidance to states on strategies to protect Medicaid and CHIP coverage for children during this return to regular Medicaid and CHIP renewals. The guidance also announced an extension of these federal strategies for states through the end of 2024. 

Secretary Becerra also sent letters  to the governors of nine states with the highest child disenrollment rates by number and percentage, urging them to adopt additional federal strategies and flexibilities to help prevent children and their families from losing coverage due to red tape. Those states include Arkansas – PDF*, Florida – PDF*, Georgia – PDF*, Idaho – PDF*, Montana – PDF*, New Hampshire – PDF*, Ohio – PDF*, South Dakota – PDF*, and Texas – PDF*. These nine states account for about 60% of the decline in children’s Medicaid and CHIP enrollment from March through September 2023, as indicated in the data release – PDFtoday. This is especially important for children and families of color who are likely disproportionately impacted.

“I urge you to ensure that no eligible child in your state loses their health insurance due to ‘red tape’ or other bureaucratic barriers during the Medicaid enrollment process,” said Secretary Becerra.

Because children’s eligibility thresholds are generally higher than those for adults, many children who have been disenrolled may still meet substantive Medicaid or CHIP eligibility requirements – underscoring the need for states to take further action to prevent eligible children from falling through the cracks. In his letter, Secretary Becerra called on these governors to:

• Adopt the dozens of federal flexibilities and strategies developed to make renewals easier for children and families, including by leveraging guidance and tools published by CMS today;
• barriers, like CHIP enrollment fees and premiums, that make it harder for children to transition to CHIP coverage if they are no longer eligible for Medicaid;
• Reach additional families by reducing call center wait times and partnering with pediatric providers, managed care plans, schools, and community organizations; and
• Expand their Medicaid programs, if states have not done so already, to ensure that young adults over the age of 18 have affordable coverage options and do not fall in the coverage gap.

The actions taken today reflect HHS’ continued commitment to helping people access comprehensive, high-quality health coverage, whether through Medicaid, CHIP, the Health Insurance Marketplaces, Medicare, or an employer. To date, HHS, through CMS, has issued extensive guidance to states on federal Medicaid and CHIP renewal requirements, approved nearly 400 flexibilities for states to make renewals easier for people, made a special enrollment period available on HealthCare.gov to help individuals no longer eligible for Medicaid transition to Marketplace coverage, engaged with stakeholders across the public and private sectors, and conducted extensive outreach and advertising efforts to improve awareness about the return to regular Medicaid and CHIP renewals. HHS will continue to closely monitor states’ renewal efforts to ensure their compliance with federal Medicaid renewal requirements and will not hesitate to take action where it identifies issues of non-compliance.

“CMS is doing everything in our power to protect access to health coverage during the Medicaid and CHIP renewal process, especially for children,” said CMS Administrator Chiquita Brooks-LaSure. “That’s why we’ve put forward dozens of strategies for states to protect children and families’ ability to stay covered. Many states have worked with us to adopt the strategies we’ve put on the table – and we strongly urge all states to do their part to make sure eligible children keep the coverage they need to grow and thrive.”

In addition to this data release – PDF on children and youth, CMS is releasing a CMS Informational Bulletin – PDF that highlights steps states can take to help keep eligible children enrolled in Medicaid and CHIP and announces for the first time that (e)(14) flexibilities will be available at least through the end of 2024, giving states even more opportunity to take up these strategies; new guidance to support transitions – PDF to other forms of coverage, including from Medicaid to CHIP and additional guidance – PDF to help states adopt CMS’ strategies and flexibilities to promote continuity of coverage; and data describing other enrollment trends – PDF during renewals, including trends related to Health Insurance Marketplace® enrollment.

* This content is undergoing Section 508 remediation and people with disabilities may experience issues accessing the content. If you need assistance, contact media@hhs.gov.

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COVID booster rollout could miss vulnerable groups

With case rates already ticking up this fall, people most at risk from the coronavirus and its complications — including people of color and the elderly — may not receive the latest boosters, some epidemiologists fear. 

“Urging people to get boosters has really only worked for Democrats, college graduates, and people making over $90,000 a year,” Yale epidemiologist Gregg Gonsalves told Amy Maxmen at KFF Health News. “Those are the same people who will get this booster, because it’s not like we’re doing anything differently to confront inequities in place.”

Those in group housing, such as prisons and nursing homes, remain at high risk of contracting COVID, and there are significant disparities, both in vaccine uptake and case rates, between racial and ethnic groups. In general, low-income and unhoused people are less likely to be vaccinated, in part because many lack a regular medical provider or transportation to  a clinic.

Black Americans are at increased risk for complications from COVID and have been “harder hit by the spike than the general population,” writes Margo Snipe at Capital B News. Among the reasons are lower rates of vaccination and Paxlovid use.

COVID rates are also rising among young children, who are under-vaccinated, and among seniors, reports CNN. Yet nursing homes have not even begun to vaccinate their elderly residents, report Jordan Rau and Tony Leys at KFF Health News.

Many facilities intend to wait until October or even November, the pair write, even as the infection rate has risen to nearly 10 per 1,000 residents in September.

“Older adults in those settings are certainly the most vulnerable and should have been prioritized,” said Chad Worz, chief executive of the American Society of Consultant Pharmacists. “The distribution of the new COVID-19 vaccine is not going well.”

With the COVID emergency over, the cost of the vaccine falls on individuals and their health plans, rather than the federal government, which previously paid for all the vaccines. “The transition from a single-payer program to a system where a variety of private and public insurers are covering the cost of vaccine doses was bound to make for a bumpy ride,” writes Helen Branswell at STAT.

Despite promises that the shots would be covered by insurance, many Americans encountered difficulties during the early rollout, report Fenit Nirappil and Lena H. Sun at The Washington Post.

Even people with Medicare and Medicaid, which are supposed to cover the immunizations, have on occasion been denied vaccination.

The CDC’s Bridge Access Program is supposed to help uninsured people get free vaccines, but users must hunt for a clinic that will vaccinate them.

Government shutdown averted, sparing impacts on health and social supports. Meanwhile, states have reinstated half a million people mistakenly kicked off Medicaid.

The nation narrowly averted a shutdown of the federal government Saturday night when President Joe Biden signed a continuing resolution on the budget that the U.S. House and the Senate had approved at the last minute. This stopgap measure will keep the government operation until mid-November. Without it, vulnerable groups, including disabled and elderly individuals and low-income people and families, could have faced difficulties with health care and insurance — and they still might if a more permanent agreement is not reached before this temporary agreement expires.

If that happens, Medicare’s funding for coverage would be secure, as would Medicaid’s, since it is funded into early 2024, but many employees that manage these programs would be furloughed.

That could create delays in benefit verification, Medicare card issue, and payments to health care providers, reports Sabrina Malhi at The Washington Post.

During the 1995-96 shutdown, thousands of Medicare applicants were turned away every day, albeit temporarily. And there are plenty of government health programs that rely on discretionary funding that requires Congress’s stamp of approval, reports Julie Rovner at KFF Health News. These include community health centers and HIV/AIDS initiatives.

A shutdown could also affect federal oversight and assistance as states continue to remove people from Medicaid rolls post-pandemic.

That unwinding process has been fraught, with more than 7 million Americans removed from Medicaid rolls thus far — many due to bureaucratic issues, like a renewal letter than never arrived.

The importance of federal oversight became clear with the announcement last week that computer errors in 29 states and the District of Columbia led about half a million people, including many children, to unfairly lose Medicaid. The computers were assessing households as a unit, rather than considering individual children or other family members who remained eligible.

After federal officials discovered the problem in August, they halted Medicaid terminations in several states and provided clearer instructions to fix the problem. Eligible individuals are now being reinstated, reports David A. Lieb at AP News.

As people lost their coverage, states have received a surge in appeals, reports the Post. In Arkansas, for example, appeals have risen sixfold, with more than 2,500 in July alone. And appeals are taking months to resolve.

Rural Americans are at higher risk of being disenrolled and may struggle to maintain health coverage, writes Jazmin Orozco Rodriguez at KFF Health News. That’s because they may have less internet access and live farther from eligibility offices or health care “navigator” organizations that could help them stay enrolled or find new insurance plans.

“Rural communities rely on Medicaid to form the backbone of their health care system,” said Joan Alker, executive director of the Georgetown University Center for Children and Families. “If states bungle unwinding, this is going to impact rural communities, which are already struggling to keep enough providers around and keep their hospitals.”

SoCal companies tailor Medicare plans for specific populations

Insurers are developing Medicare Advantage plans specific to Asian Americans, Latinos, and LGBTQ+ people, reports Stephanie Stephens of KFF Health News.

Medicare Advantage plans are federally funded, but administered by private companies. They are often less expensive than traditional Medicare, but limit patients to providers in their networks.

The new plans offer advantages such as health care providers who speak the patient’s language, as well as tailored coverage, such as traditional Eastern herbal supplements for Asian American enrollees or HIV prevention and management that LGBTQ+ patients might want, Stephens writes.

But Medicare Advantage plans have come under fire lately for denials of care.

“It’s strange to think about commodifying and profiting off people’s racial and ethnic identities,” said UCLA public health professor Naomi Zewde. “We should do so with care and proceed carefully, so as not to be exploitative.”

Women face higher health care costs in U.S., but get worse cancer care globally

Being a working woman in America means spending an average of 18% more money, out of pocket, on health care than male colleagues, according to a new analysis of employer health plans.

While insurance premiums are the same for both genders, working women spend $15.4 billion more of their own money on health care than working men each year, according to the report by Deloitte Consulting.

This was true even after the researchers excluded the costs of pregnancy and maternity care, reports Bertha Coombs at CNBC. The analysts found the “covert pink tax,” writes Erin Prater at Fortune Well, after examining medical spending for 16 million U.S. workers from 2017 through 2022.

Financial stressors can contribute to delayed care and health problems, said Dr. Kulleni Gebreyes of Deloitte.

Even though total health costs for women were only 10% higher than for men, more of those costs were passed on to women patients, such that women wound up paying 18% more out of pocket. This suggests the problem lies in the health plans themselves being structured in a way that exacerbates inequities.

Insurance covers a smaller proportion of the costs for services women use than the ones men need. The extra costs for women include annual gynecological exams that can trigger costly follow-up care, menopause treatment and breast imaging.

Deloitte calculated it would cost employers $11 per employee per month in premium support to close the gap.

Women worldwide also face inequities in cancer prevention and care, reports Angus Chen at STAT. 

A new report in Lancet outlines how women are more likely to go bankrupt from cancer than men. The researchers calculated that 2.3 million deaths could be avoided if women had optimal cancer prevention, detection and care. 

Many women feel unable to address signs of cancer or spend their time and money on their children instead, so the disease reaches a more advanced stage before many seek help, said study author Dr. Ophira Ginsburg of the National Cancer Institute Center for Global Health.

“On the whole, cancer is less preventable in women than in men,” Ginsburg said. “Patriarchy dominates every aspect of these issues.”

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More than 1 million people have been dropped from Medicaid in the past couple months as some states moved swiftly to halt health care coverage following the end of the coronavirus pandemic.

Most got dropped for not filling out paperwork.

Though the eligibility review is required by the federal government, President’s Joe Biden’s administration isn’t too pleased at how efficiently some other states are accomplishing the task.

“Pushing through things and rushing it will lead to eligible people — kids and families — losing coverage for some period of time,” Daniel Tsai, a top federal Medicaid official recently told reporters.

Already, about 1.5 million people have been removed from Medicaid in more than two dozen states that started the process in April or May, according to publicly available reports and data obtained by The Associated Press.

Florida has dropped several hundred thousand people, by far the most among states. The drop rate also has been particularly high in other states. For people whose cases were decided in May, around half or more got dropped in Arkansas, Idaho, Kansas, Nevada, New Hampshire, Oklahoma, South Dakota, Utah and West Virginia.

By its own count, Arkansas has dropped more than 140,000 people from Medicaid.

The eligibility redeterminations have created headaches for Jennifer Mojica, 28, who was told in April that she no longer qualified for Medicaid because Arkansas had incorrectly determined her income was above the limit.

She got that resolved, but was then told her 5-year-old son was being dropped from Medicaid because she had requested his cancellation — something that never happened, she said. Her son’s coverage has been restored, but now Mojica says she’s been told her husband no longer qualifies. The uncertainty has been frustrating, she said.

“It was like fixing one thing and then another problem came up, and they fixed it and then something else came up,” Mojica said.

Arkansas officials said they have tried to renew coverage automatically for as many people as possible and placed a special emphasis on reaching families with children. But a 2021 state law requires the post-pandemic eligibility redeterminations to be completed in six months, and the state will continue “to swiftly disenroll individuals who are no longer eligible,” the Department of Human Services said in statement.

Arkansas Gov. Sarah Huckabee Sanders has dismissed criticism of the state’s process.

“Those who do not qualify for Medicaid are taking resources from those who need them,” Sanders said on Twitter last month. “But the pandemic is over — and we are leading the way back to normalcy.”

More than 93 million people nationwide were enrolled in Medicaid as of the most recent available data in February — up nearly one-third from the pre-pandemic total in January 2020. The rolls swelled because federal law prohibited states from removing people from Medicaid during the health emergency in exchange for providing states with increased funding.

Now that eligibility reviews have resumed, states have begun plowing through a backlog of cases to determine whether people’s income or life circumstances have changed. States have a year to complete the process. But tracking down responses from everyone has proved difficult, because some people have moved, changed contact information or disregarded mailings about the renewal process.

Before dropping people from Medicaid, the Florida Department of Children and Families said it makes between five and 13 contact attempts, including texts, emails and phone calls. Yet the department said 152,600 people have been non-responsive.

Their coverage could be restored retroactively, if people submit information showing their eligibility up to 90 days after their deadline.

Unlike some states, Idaho continued to evaluate people’s Medicaid eligibility during the pandemic even though it didn’t remove anyone. When the enrollment freeze ended in April, Idaho started processing those cases — dropping nearly 67,000 of the 92,000 people whose cases have been decided so far.

“I think there’s still a lot of confusion among families on what’s happening,” said Hillarie Hagen, a health policy associate at the nonprofit Idaho Voices for Children.

She added, “We’re likely to see people showing up at a doctor’s office in the coming months not knowing they’ve lost Medicaid.”

Advocates fear that many households losing coverage may include children who are actually still eligible, because Medicaid covers children at higher income levels than their parents or guardians. A report last year by the U.S. Department of Health and Human Services forecast that children would be disproportionately impacted, with more than half of those disenrolled still actually eligible.

That’s difficult to confirm, however, because the federal Centers for Medicare & Medicaid Services doesn’t require states to report a demographic breakdown of those dropped. In fact, CMS has yet to release any state-by-state data. The AP obtained data directly from states and from other groups that have been collecting it.

Medicaid recipients in numerous states have described the eligibility redetermination process as frustrating.

Julie Talamo, of Port Richey, Florida, said she called state officials every day for weeks, spending hours on hold, when she was trying to ensure her 19-year-old special-needs son, Thomas, was going to stay on Medicaid.

She knew her own coverage would end but was shocked to hear Thomas’ coverage would be whittled down to a different program that could force her family to pay $2,000 per month. Eventually, an activist put Talamo in contact with a senior state healthcare official who confirmed her son would stay on Medicaid.

“This system was designed to fail people,” Talamo said of the haphazard process.

Some states haven’t been able to complete all the eligibility determinations that are due each month. Pennsylvania reported more than 100,000 incomplete cases in both April and May. Tens of thousands of cases also remained incomplete in April or May in Arizona, Arkansas, Indiana, Iowa, New Mexico and Ohio.

“If states are already behind in processing renewals, that’s going to snowball over time,” said Tricia Brooks, a research professor at the Georgetown University Center for Children and Families. “Once they get piles of stuff that haven’t been processed, I don’t see how they catch up easily.”

Among those still hanging in the balance is Gary Rush, 67, who said he was notified in April that he would lose Medicaid coverage. The Pittsburgh resident said he was told that his retirement accounts make him ineligible, even though he said he doesn’t draw from them. Rush appealed with the help of an advocacy group and, at a hearing this past week, was told he has until July to get rid of about $60,000 in savings.

Still, Rush said he doesn’t know what he will do if he loses coverage for his diabetes medication, which costs about $700 a month. Rush said he gets $1,100 a month from Social Security.

In Indiana, Samantha Richards, 35, said she has been on Medicaid her whole life and currently works two part-time jobs as a custodian. Richards recalled receiving a letter earlier this year indicating that the pandemic-era Medicaid protection was ending. She said a local advocacy group helped her navigate the renewal process. But she remains uneasy.

“Medicaid can be a little unpredictable,” Richards said. “There is still that concern that just out of nowhere, I will either get a letter saying that we have to reapply because we missed some paperwork, or I missed a deadline, or I’m going to show up at the doctor’s office or the pharmacy and they’re going to say, ‘Your insurance didn’t go through.’”

___

Lieb reported from Jefferson City, Missouri, and DeMillo from Little Rock, Arkansas. Also contributing were AP reporters Anthony Izaguirre in Tallahassee, Florida; Marc Levy in Harrisburg, Pennsylvania; and Arleigh Rodgers in Bloomington, Indiana. Rodgers is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

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SACRAMENTO, Calif. (AP) — At the start of 2022, Thomas Marshall weighed 311 pounds. He had been hospitalized 10 times in five years, including six surgeries. He had an open wound on his left leg that refused to heal — made worse by living in a dirty, moldy house with five other people, two ball pythons, four Chihuahuas and a cage full of rats.

More than a year later, Marshall has lost nearly 100 pounds. His wound has healed. His blood pressure has returned to normal levels. His foot, which had nerve damage, has improved to the point he goes on regular walks to the park.

Lots of factors are at play in Marshall’s dramatic turnaround, but the one he credits the most is finally having stable housing, after the nonprofit Sacramento Covered helped him get a one-bedroom, 500 square-foot (46.4-square-meter) apartment in a downtown high rise. He has hardwood floors, white pine cabinets and a glass jar on the counter filled with Bit-O-Honeys.

“To me it’s the most important 500 square feet I’ve ever had,” he said. “Living here has just improved my well-being in every possible way.”

Marshall’s story is part of a radical rethinking of the relationship between housing and health care in the U.S. For decades, Medicaid, the joint state and federal health insurance program for people with disabilities or low incomes, would only pay for medical expenses. But last year the Biden administration gave Arizona and Oregon permission to use Medicaid money for housing — a nod to reams of research showing people in stable housing are healthier.

Now California wants to join those states, building on the success of programs like the one that got Marshall housing. Gov. Gavin Newsom has proposed spending more than $100 million per year in the state’s Medicaid program to pay for up to six months of housing for people who are or risk becoming homeless; are coming out of prison or foster care; or are at risk for hospitalization or emergency room visits.

It would be the biggest test yet of using Medicaid money for housing. California has the nation’s largest Medicaid program, with more than 13 million patients — or about a third of the state’s population. California also has nearly a third of the nation’s homeless population, according to federal data.

“It’s a huge step toward breaking down the silos that have gotten in the way of taking care of the whole person rather than limb by limb and illness by illness,” said Anthony Wright, executive director of Health Access California, a consumer advocacy group.

It would also be an expensive step. California is expected to have a $22.5 billion budget deficit this year, and it could get bigger in years to come. Meanwhile the state’s Medicaid spending is projected to increase by $2.5 billion over the next three years, according to the nonpartisan Legislative Analyst’s Office.

“What we’re really doing is expanding the welfare state, which is going to become just a huge financial problem,” said Wayne Winegarden, senior fellow at the Pacific Research Institute, a group that advocates for free-market policies.

California experimented with using Medicaid money for some housing-related expenses in 2016 when it launched a pilot project in 26 counties. While Medicaid did not pay for rent, it paid for things like security deposits and furniture.

In Marshall’s case, he pays his own rent, using some of the $1,153 per month he gets from Social Security and Supplemental Security Income. But Medicaid paid for his security deposit, bed, sofa, table, chairs and nearly 3 1/2 gallons of Pine Sol. Marshall said keeping his apartment clean is one thing that helped his leg wound to finally heal.

Over five years the program has reduced expensive hospital stays and emergency room visits for people on Medicaid, saving taxpayers an average of $383 per patient per year, according to an analysis by researchers at UCLA.

Now California wants to go further by using Medicaid money to directly pay some people’s rent. Democratic Assemblymember Joaquin Arambula, who chairs the budget subcommittee that will vet Newsom’s proposal, said lawmakers are supportive. Arambula spent a decade as an emergency room doctor.

“I became very good at being able to get cockroaches out of people’s ears,” Arambula said. “The living conditions of many of our communities, especially in our rural communities, really can affect a person’s ability to get adequate sleep, to be prepared for the next day and to stay healthy.”

Advocates for homeless people say they welcome such programs but spending more money on rent isn’t enough, noting the state still has a massive shortage of affordable housing.

Kelly Bennett, founder and CEO of Sacramento Covered, said that during California’s first experiment with using Medicaid money for housing services, it would often take up to eight months for workers to place a patient in an apartment. In some cases, people have waited for years to find a place.

“Even when you have the deposit money and you have some rental subsidy, it’s still very, very challenging to find units — and to find units where the landlords will lease to our clients,” Bennett said.

Marshall said he grew up in Sacramento and got a degree in dietic technology and culinary arts. But a 30-year addiction to meth landed him on the streets from the late 1990s through about 2006. He camped at an old landfill, often eating leftovers from people’s picnics at a nearby park.

He applied for apartments at multiple subsidized housing buildings, but never made it off the wait list. It took him about a year to get his current apartment, where he pays $186 per month with the help of a subsidy.

“I feel like I’m electric. … I have power and ability to do things that I could not do for a very long time,” Marshall, 64, said. “Whatever years I’ve got left now, I’m going to spend them up here in the glass tower.”

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Millions of people who enrolled in Medicaid during the COVID-19 pandemic could start to lose their coverage on April 1 if Congress passes the $1.7 trillion spending package leaders unveiled Tuesday.

The legislation will sunset a requirement of the COVID-19 public health emergency that prohibited states from booting people off Medicaid. The Biden administration has been under mounting pressure to declare the public health emergency over, with 25 Republican governors asking the president to end it in a letter on Monday, which cited growing concerns about bloated Medicaid enrollment. “This is a positive for states in terms of planning, however, this will come at the cost of some individuals losing their health care,” said Massey Whorley, a principal at health consulting firm Avalere. Millions are expected to be bumped from the program, which grants health care coverage to nearly 80 million low-income people throughout the country.

The federal government will also wind down extra funds given to states for the added enrollees over the next year under the proposal. Many will be eligible for health insurance coverage through employers, the Affordable Care Act or, in the case of kids, the Children’s Health Insurance Program. Advocates have raised concerns about how states will notify enrollees if they are being kicked off the program and what their options are. The effort will be particularly challenging for some of the country’s poorest people, who may not have stable home address or access to internet or phone services to check their status.

If passed, the spending package would allow states to start kicking people off the program as early as April, but require them to notify enrollees first. People who are on Medicaid should make sure their contact information is up to date on their accounts and that they check the mail frequently to keep an eye on their eligibility status as that April 1 date nears, said Robin Rudowitz, the director of Medicaid at Kaiser Family Foundation. “There is likely to be people who fall through the cracks,” she said.

The move will free up additional funds, however, to pay for more stable health insurance coverage for children in low-income households by requiring states to keep those children on Medicaid for at least a year once they’ve enrolled. A push require states to extend Medicaid to new mothers for a 12-month period after giving birth, however, failed to make the cut. The spending package also extends the telehealth flexibilities that were introduced during the COVID-19 pandemic and led health care systems around the country to overhaul their approach to deliver care by smartphone or computer more frequently.

Under the proposal, the restrictions that once tightly governed telehealth care under Medicare will stay loosened through the end of 2024. That will give Congress more time to study telehealth and how widespread fraud is in this program, said Andrew Hu of the Bipartisan Policy Center, a Washington think tank, which has studied the use of telehealth during the pandemic. “We can get some more time to assess where the benefits are with telehealth,” Hu said.

The Senate is expected to vote on the spending bill first, and Democrats are looking for support from at least 10 Republican senators to pass the measure before sending to the House for consideration.

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The U.S. Department of Health and Human Services (HHS) through the Centers for Medicare & Medicaid Services (CMS) announced that during the Biden-Harris Administration 253,000 parents have gained access to 12 months of postpartum coverage through Medicaid and Children’s Health Insurance Program (CHIP) extensions. President Joe Biden and Vice President Kamala Harris have made addressing the maternal mortality and morbidity crisis a key priority for their Administration.

CMS approved actions in Maine, Minnesota, New Mexico, and Washington, D.C., to extend Medicaid and CHIP coverage for 12 months after pregnancy. As a result, up to an additional 15,000 people annually in these states—including 2,000 in Maine; 7,000 in Minnesota; 5,000 in New Mexico; and 1,000 in Washington, D.C.—will have access to Medicaid or CHIP coverage for a full year after pregnancy. This extension of coverage was made possible by a new state plan opportunity established by the President’s American Rescue Plan. Maine, Minnesota, New Mexico, and Washington, D.C., join California, Florida, Kentucky, Oregon, South Carolina, Tennessee, Michigan, Louisiana, Virginia, New Jersey, and Illinois in extending Medicaid and CHIP coverage from 60 days to 12 months after pregnancy.  

“Postpartum coverage not only improves health outcomes, but also saves lives,” said HHS Secretary Xavier Becerra. “Thanks to the American Rescue Plan, new parents will now have access to the ongoing care they need during the most crucial time after giving birth. I applaud Maine, Minnesota, New Mexico, and Washington, D.C, for taking action to join the Administration’s efforts to strengthen maternal health and support safe healthy families.”

“As CMS Administrator and a mother, it’s a privilege to work with states to extend postpartum coverage across the country—most recently in Maine, Minnesota, New Mexico, and Washington, D.C,” said CMS Administrator Chiquita Brooks-LaSure. “The American Rescue Plan gives states an easier pathway to extend postpartum coverage—and gives parents and families the peace of mind of having health coverage during the vital first year after pregnancy.”

CMS continues working to extend coverage for 12 months after pregnancy in other states that have submitted extension proposals, including Connecticut, Indiana, Kansas, Maryland, Massachusetts, North Carolina, Pennsylvania, Washington, and West Virginia. If all states adopted this option, as many as 720,000 pregnant and postpartum individuals across the United States annually could be guaranteed Medicaid and CHIP coverage for 12 months after pregnancy.

Medicaid covers 42% of all births in the nation. But for too long, families have been left behind by a health care system that breaks connections to care when they are needed most. More than half of pregnancy-related deaths in the United States occur in the 12-month postpartum period; 12 percent occur after six weeks postpartum.

This new option for states to extend Medicaid and CHIP postpartum coverage is part of the ongoing efforts of HHS and the Biden-Harris Administration to address disparities in maternal health outcomes by opening the door to postpartum care for hundreds of thousands of individuals. It offers states an opportunity to provide life-saving care that can reduce pregnancy-related deaths and severe maternal morbidity, as well as improve continuity of care for chronic conditions such as diabetes, hypertension, cardiac conditions, substance use disorder, and depression—particularly for underserved communities.

As noted in a report published by the HHS Office of Assistant Secretary for Planning and Evaluation (ASPE), one in three pregnancy-related deaths occur between one week and one year after childbirth. The postpartum period is critical for recovering from childbirth, addressing complications of delivery, ensuring mental health, managing infant care, and transitioning from obstetric to primary care.

States Extending Medicaid and CHIP Postpartum Coverage to 12 Months

Visit Medicaid.gov to learn more about the Medicaid and CHIP state plan amendment extensions of postpartum coverage in Maine, Minnesota, New Mexico, and Washington, D.C.

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Tennessee and South Carolina join Louisiana, Michigan, Virginia, New Jersey, and Illinois in extending Medicaid and CHIP coverage from 60 days to 12 months postpartum. CMS is also working with another nine states and the District of Columbia to extend postpartum coverage for 12 months after pregnancy, including California, Indiana, Kentucky, Maine, Minnesota, Oregon, New Mexico, Pennsylvania, and West Virginia. As a result of these efforts, as many as 720,000 pregnant and postpartum individuals across the United States could be guaranteed Medicaid and CHIP coverage for 12 months after pregnancy. 

Medicaid covers 42% of all births in the nation. This new option for states to extend Medicaid and CHIP coverage is part the ongoing efforts of the U.S. Department of Health and Human Services (HHS), in support of the Biden-Harris Administration’s commitment to address the nation’s crisis in pregnancy-related mortality and morbidity, and disparities in maternal health outcomes, by opening the door to postpartum care for hundreds of thousands of people.

To learn about Tennessee’s state plan amendment to extend postpartum coverage under CHIP, visit https://www.medicaid.gov/chip/state-program-information/index.html

To learn more about South Carolina’s state plan amendment to extend postpartum coverage under Medicaid (including CHIP, operating as a Medicaid expansion program), visit https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments/index.html

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“We are committed to providing equitable access to quality health care and removing any barriers to quality health care,” said Health and Human Services Secretary Xavier Becerra. “We want to hear directly from stakeholders so we can strengthen our programs for the more than 80 million Americans with Medicaid or CHIP health insurance. Together, by advancing health equity, we can ensure quality health care is within reach for everyone who needs it.”

 “Medicaid and CHIP provide essential health coverage for over 80 million individuals and families,” said CMS Administrator Chiquita Brooks-LaSure. “Ensuring every eligible person can access the coverage and care to which they are entitled is a foundational principle of health equity and our work at CMS. We invite interested stakeholders and individuals with lived experience to join us in this mission, starting by responding to the request for information.”

“With this RFI, we are taking a first step towards a broader perspective of what ‘access’ to Medicaid means,” said CMS Director of the Center for Medicaid and CHIP Services Daniel Tsai. “Ensuring access to Medicaid includes addressing a range of barriers current and potential Medicaid beneficiaries may experience, from enrolling in Medicaid to maintaining coverage, to accessing care across both fee-for-service and managed care delivery systems. Access must also cross physical health care, behavioral health, and home and community based services. We look forward to capturing a wide range of perspectives from different stakeholders with this RFI.”

Feedback obtained from the RFI announced today will aid in CMS’ understanding of enrollees’ barriers to enrolling in and maintaining coverage and accessing needed health care services and support through Medicaid and CHIP. This information will help inform future polices, monitoring, and regulatory actions, helping ensure beneficiaries have equitable access to high-quality and appropriate care across all Medicaid and CHIP payment and delivery systems, including fee-for-service, managed care, and alternative payment models. The RFI submissions will also inform CMS’ work to ensure timely access to critical services, such as behavioral health care and home and community-based services. 

Evidence shows that while Medicaid and CHIP generally provide comprehensive coverage for health care services, some enrollees still experience challenges accessing providers and medical services despite statutory access protections in Medicaid. CMS’ access RFI aims to gather information to help understand many of these concerns with feedback from experts, beneficiaries, and community members with lived experience of the agency’s programs.

The RFI seeks feedback from a diverse set of stakeholders on a broad set of topics from ensuring adequate payment rates to encouraging provider availability and quality, to culturally and linguistically competent care and reducing gaps in health care coverage. Interested parties may access the RFI questions and provide comment on Medicaid.gov.  The RFI is open for a 60 day public comment period beginning February 17, 2022.

To read the RFI, visit: https://cmsmedicaidaccessrfi.gov1.qualtrics.com/jfe/form/SV_6EYj9eLS9b74Npk

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