Pritzker leaning on new Medicaid flexibilities to expand access during pandemic

Pritzker leaning on new Medicaid flexibilities to expand access during pandemic

Gov. JB Pritzker is taking full advantage of new flexibilities provided under the Medicaid program to expand access to care to combat the new coronavirus crisis.

Most recently, his administration submitted an 1115 waiver which would streamline the application process and allow Medicaid to cover more COVID-19 related services.

Last week, the Centers for Medicare and Medicaid Services signed off on the state’s emergency 1135 waiver request, easing regulations for out-of-state providers, suspending prior authorization requirements and authorizing reimbursement for services at unlicensed facilities.

Both are on top of the numerous executive orders and other actions that Pritzker has issued since the crisis began, including his stay-at-home order, a directive that insurers cover telehealth and a proclamation making it easier for out-of-state healthcare workers to practice in Illinois.

“We’ve put in every waiver that we can with the federal government to expand healthcare availability during this period,” Pritzker said during a media briefing on Saturday.

Pritzker has pounced on the Trump administration’s increased willingness to open up the Medicaid program. After a focus on work requirements, block grants and other initiatives that many in the healthcare industry were concerned would lead to decreased program rolls, CMS has in recent weeks taken steps to boost access, expand telehealth and provide care outside of a hospital.

In some instances, the state has gotten ahead of the federal government, telling providers to start services while it pursued approval. On March 16, it said providers should start covering testing and treatment for COVID-19 for the uninsured as well as Medicaid members. Medicaid coverage for COVID-19 treatments for the uninsured is among the provisions included in the state’s 1115 waiver, which it submitted March 26.

“They were smart to just say, ‘Proceed. Let us worry about trying to get our money,’” said Stephanie Altman, senior director of policy for the Shriver Center.

The state is also seeking, through the 1115 waiver, to use Medicaid to pay for out-of-pocket costs for COVID-19 treatment for the insured, as well as housing for the homeless during a quarantine period, services for inmates and home-delivered meals.

Additionally, the waiver would speed up access to treatment by expanding the state’s use of presumptive eligibility, waiving asset verifications and authorizing direct enrollment into managed care organizations through auto-assignment.

And it would suspend the annual renewal process for Medicaid enrollees.

“All of this is about being able to react quickly and provide more – and make sure things get paid for and are covered,” said Matt Werner, owner of M. Werner Consulting.

Danny Chun, a spokesman for the Illinois Health and Hospital Association, applauded the Pritzker administration for its comprehensive approach. He added that hospitals are in continued talks with the governor’s office on what more can be done, including broadening the list of healthcare workers impacted by Pritzker’s proclamation on out-of-state workers.

The action, which also eases regulations for recently retired workers, currently focuses on physicians, nurses, physician assistants and respiratory care therapists.

IHA also submitted and received approval for its own 1135 waiver. The provisions requested by IHA are mostly from a list of blanket waivers that CMS said it would automatically approve. They include allowing hospitals to screen patients at an off-site location to prevent the spread of COVID-19, relaxing deadlines for inputting information into medical records and waiving requirements for discharge planning.

“Hospitals and healthcare providers need maximum flexibility to deal with this crisis,” Chun said.


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