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How Do State Medicaid Provisions Impact Patient Care Access?

A recent Kaiser Family Foundation report outlines potential changes to state Medicaid programs and how they might impact patient care access.

medicaid patient care access

Source: Thinkstock

By Sara Heath

- States are making changes to their Medicaid plan offerings that could have impacts on patient care access, according to a recent analysis from the Kaiser Family Foundation.

Specifically, Medicaid program changes would impact patient eligibility for coverage, coverage of the social determinants of health (SDOH), and access to behavioral health and substance use disorder treatment.

The analysis of state Medicaid proposals shows that numerous states are moving forward with Section 1115 waivers. States use these waivers to make changes to their Medicaid programs that are not necessarily included under federal law.

Most of these Section 1115 waivers will result in reduced patient care access and coverage access, KFF researchers noted. Six states have already implemented eligibility waivers and 11 have plans to submit those waivers in 2019. These eligibility waivers primarily relate to work requirements qualifying individuals for Medicaid coverage, which ultimately could hinder patient care access.

Analyses have found that although more stringent eligibility and work requirements could save states money with regards to enrollment costs, the administrative costs could be larger.

There are changes afoot that could help expand patient access to Medicaid coverage, however. Idaho, Nebraska, and Utah each have ballot initiatives aimed at adopting Medicaid expansion into their state policies, as allowed under the Affordable Care Act (ACA).

Additionally, some state agencies are looking to streamline Medicaid eligibility and coordinate coverage for certain populations.

“Most states are working with corrections agencies and with local jails to facilitate Medicaid enrollment prior to release and the majority of states do not terminate Medicaid coverage for enrollees who become incarcerated,” the report explained.

State Medicaid agencies are also working to integrate the social determinants of health (SDOH) into their Medicaid managed care contracts. The SDOH are the lifestyle factors that influence a patient’s ability to obtain health and wellness, and patients covered under Medicaid typically experience the SDOH in a bigger way than their higher-income peers.

“About one-third of the states reported a wide variety of initiatives implemented in FY 2018 or planned for FY 2019 that address the social determinants of health (SDOH) outside of managed care and more than one-third reported collecting or plans to collect SDOH data from various sources including screenings and assessments, data collected for other state programs, claims data, beneficiary surveys, or as part of a care management or home visiting program,” KFF reported.

States also plan to expand the number of patients to benefit from community health partnerships, which are often at the heart of efforts to address the SDOH. Nearly all states report using home- or community-based care waivers to improve patient care quality.

“Housing-related supports remain an important part of state LTSS benefits, even as Money Follows the Person (MFP) grant funds expire,” KFF said. “While 30 states reported that they expect to continue to offer housing-related supports after MFP funds are exhausted, about half of states reported plans to discontinue at least some housing-related services or administrative functions when MFP ends.”

Strong state economies are also resulting in more patient care access for behavioral health and substance misuse treatment. Nineteen states expanded covered benefits for these areas in 2018 and 24 plan to do so in 2019, the report noted.

While most of these states are looking at behavioral health and substance misuse treatment, some states are also expanding covered benefits to include telehealth, dentistry, physical or occupational therapy, and screening or home visits for pregnant women.

“Medicaid continues to play an important role in addressing the opioid epidemic and more broadly in connecting Medicaid beneficiaries to behavioral health services,” the report authors said. “Going forward, it will be important to follow trends and innovations in how states use Medicaid to increase access to behavioral health services and contain the growth of the opioid and broader SUD crisis.”

State agency support for substance use disorder treatment has also been embedded in some federal legislation. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, signed into law earlier this week, includes several provisions for Medicaid and its role in combatting the opioid epidemic.

Particularly, state Medicaid agencies may now use federal funds to deliver inpatient treatment to substance use disorder patients. Additionally, Medicaid agencies must cover all FDA-approved drugs used in medication-assisted treatment (MAT) protocol.

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