Congress must make Medicaid a top priority in any further legislative response to the COVID-19 pandemic, the Academy and other health care stakeholders told House and Senate leaders in an April 17 letter.(3 page PDF)
Specifically, lawmakers should ensure that Medicaid participants affected by the pandemic receive an appropriate proportion of the $70 billion in remaining Coronavirus Aid, Relief and Economic Security Act funds. They also should apply an additional 5.8% increase to the Federal Medical Assistance Percentage for Medicaid, for a total increase of 12%. The FMAP sets the amount of matching funds the federal government gives states for certain medical and social services.
CMS has so far released $30 billion of the $100 billion that was allocated to the CARES Act's Public Health and Social Service Emergency Fund(gop-waysandmeans.house.gov) but earmarked it for Medicare reimbursement. Meanwhile, Medicaid participants are taking on significant financial liabilities as they continue to do work that's crucial to the COVID-19 fight.
"Congress must ensure that a proportionate amount is provided to all Medicaid providers impacted by the COVID-19 pandemic for the remaining $70 billion and for any additional dollars added to the fund," said the letter from the Partnership for Medicaid.(www.partnershipformedicaid.org) The AAFP is a co-chair of the partnership.
The letter was sent to Senate Majority Leader Mitch McConnell, R-Ky.; Senate Minority Leader Chuck Schumer, D-N.Y.; House Speaker Nancy Pelosi, D-Calif.; and House Minority Leader Kevin McCarthy, R-Calif. Among the AAFP's 18 co-signatories were the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.
"Providing an FMAP increase of 12% is critical for states to ensure Medicaid beneficiaries have access to care during this public health emergency and current economic downturn," the partnership wrote, noting that the increase should continue "until the outbreak is contained and economic indicators illustrate a robust economic recovery."
The increase would both save jobs and protect patients from disruption of care, the letter said.
States will need the help. A new analysis(www.cbpp.org) from the Center on Budget and Policy Priorities found that the financial burden COVID-19 places on states will be greater than the effects of the past decade's recession.
The analysis notes that emergency relief Congress has allocated so far is "far too little to enable states and localities to respond to the immediate public health emergency, absorb increased program costs, and avoid sharp spending cuts that would deepen and prolong a recession."
While the paper calls for a program of wide-ranging grants and other assistance, it says, "The highest priority for additional state fiscal relief should be an increase in the FMAP."
Besides boosting the FMAP, the partnership's correspondence outlined five additional steps Congress should take to strengthen the public health safety net during and beyond the public health emergency:
Prevent implementation of the Medicaid Fiscal Accountability Regulation. The partnership calls this rule "shortsighted and damaging" because it would "negatively affect beneficiaries' access to care."
Raise Medicaid payment levels to at least Medicare rates. The Academy has repeatedly made similar calls to restore payment parity called for in the Patient Protection and Affordable Care Act -- the lack of which "is acutely felt in underserved or rural areas."
Apply the FMAP's continuous eligibility maintenance of effort requirement to enrollees covered in separate Children's Health Insurance Programs. Noting that the Families First Act excluded children and pregnant women covered by CHIP from protection against Medicaid disenrollment, the partnership called for Congress to expand that guardrail to all CHIP enrollees.
Delay the CHIP funding cliff by one year. Congress should extend the CHIP funding increase that is scheduled to end in 2021.
Suspend implementation of the public charge rule. The Academy has opposed this regulation since it was proposed. The partnership's letter asked Congress to place a moratorium on the rule to prevent confusion that would lead to disenrollment in Medicaid and other crucial health safety-net programs.
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