Radar on Medicare Advantage

Medicaid MCOs Continue to Advocate for FMAP Increase in 2021

January 11, 2021

As the novel coronavirus erupted across the U.S. and created a widespread economic downturn, it led to increased enrollment in state Medicaid programs and created devastating budget shortfalls for states. Yet Congress’ latest pandemic relief effort — the Consolidated Appropriations Act signed by President Donald Trump on Dec. 27 — does not include direct financial help for states, which are now rolling out newly authorized COVID-19 vaccines with limited resources and guidance from the federal government.

Earlier legislation, the Families First Coronavirus Response Act, afforded states a temporary increase of 6.2% in their federal match rate, yet multiple stakeholders have beseeched Congress to enact another temporary boost during the public health emergency.

By Lauren Flynn Kelly

As the novel coronavirus erupted across the U.S. and created a widespread economic downturn, it led to increased enrollment in state Medicaid programs and created devastating budget shortfalls for states. Yet Congress’ latest pandemic relief effort — the Consolidated Appropriations Act signed by President Donald Trump on Dec. 27 — does not include direct financial help for states, which are now rolling out newly authorized COVID-19 vaccines with limited resources and guidance from the federal government.

Earlier legislation, the Families First Coronavirus Response Act, afforded states a temporary increase of 6.2% in their federal match rate, yet multiple stakeholders have beseeched Congress to enact another temporary boost during the public health emergency.

In a Dec. 14 letter to President-elect Joe Biden, Medicaid Health Plans of America President and CEO Craig Kennedy said that securing an additional Federal Medical Assistance Percentage (FMAP) increase of at least 5.8% (for a total increase of 12%) remains the trade group’s top legislative priority. To minimize disruptions in care, MHPA urged the incoming administration to immediately extend the public health emergency beyond its Jan. 20 expiration date and enact an additional FMAP increase at least through September 2021.

“There is no question that the new administration will push hard to increase funding for state Medicaid,” predicts Avalere Health Founder Dan Mendelson. “Generally, the new administration will want to expand coverage and work with the states to get that done.”

Jerry Vitti, CEO and founder of Healthcare Financial, Inc., agrees that making states whole will be a Biden priority. “This is not a blue state/red state divide. Every state has these problems, and it’s the double whammy of the decreased revenue at a time where your expenses are going way up because people need social services programs, they need Medicaid, their health care systems are strained, they have to distribute vaccines — all these associated costs need to be covered.”

Meanwhile, as the COVID-19 pandemic has highlighted so many disparities in health care, Medicaid MCOs will be expected to take concrete action to bridge care gaps, especially in communities of color, experts agree.

“With people of color comprising over half of Medicaid enrollees, 2020 has been a reckoning: COVID-19 and health disparities have made it so much more deadly for them….Medicaid MCOs will need to innovate to address equity issues,” says Abner Mason, founder and CEO of ConsejoSano.

Advocates, Providers Urge State Medicaid Programs to Extend Postpartum Coverage

January 7, 2021

As states face intense budget pressures during the COVID-19 pandemic and beneficiary advocates urge the federal government to provide additional financial support to state Medicaid programs, extending postpartum care access would resolve a longstanding issue impacting children and families and close a significant gap in coverage during the pandemic and beyond, according to advocates and providers.

Roughly 700 women die each year due to pregnancy-related complications, and about 60% of cases are preventable, according to the Centers for Disease Control and Prevention (CDC). The CDC also estimates that more than 44,000 pregnant women have become infected with the coronavirus this year, resulting in an estimated 8,500 hospitalizations. Medicaid is the largest payer of maternity care in the U.S., yet current law does not require state Medicaid programs to cover women for more than 60 days after childbirth, and states must seek waiver approval to use federal matching funds to extend coverage.

By Lauren Flynn Kelly

As states face intense budget pressures during the COVID-19 pandemic and beneficiary advocates urge the federal government to provide additional financial support to state Medicaid programs, extending postpartum care access would resolve a longstanding issue impacting children and families and close a significant gap in coverage during the pandemic and beyond, according to advocates and providers.

Roughly 700 women die each year due to pregnancy-related complications, and about 60% of cases are preventable, according to the Centers for Disease Control and Prevention (CDC). The CDC also estimates that more than 44,000 pregnant women have become infected with the coronavirus this year, resulting in an estimated 8,500 hospitalizations. Medicaid is the largest payer of maternity care in the U.S., yet current law does not require state Medicaid programs to cover women for more than 60 days after childbirth, and states must seek waiver approval to use federal matching funds to extend coverage.

During the public health emergency, states may not disenroll women from their Medicaid programs at 60 days postpartum. But this is only a temporary policy, and groups are urging CMS and Congress to protect access to continuous postpartum care once the crisis ends.

Prior to the pandemic, three states — Illinois, Missouri and New Jersey — submitted 1115 waivers to extend postpartum coverage, according to a Dec. 8 Health Affairs article authored by ACOG Senior Health Policy Analyst Emily Eckert. And during the pandemic, Indiana submitted a waiver seeking approval to implement a coverage extension for women with SUD.

Yet CMS has not cleared any of those waiver requests, despite its recent approval of Medicaid work requirement waivers in Georgia and Nebraska, pointed out Eckert.

During a teleconference to discuss a new report from The Commonwealth Fund and the Georgetown University McCourt School of Public Policy, public health experts on Dec. 9 explained how making short-term cuts to Medicaid to deal with budget shortfalls brought on by the pandemic could have long-term impacts to children and families, especially in communities of color. Research has shown that continued insurance coverage for children can have a wide range of long-term benefits, including better health outcomes, higher education attainment, improved earnings, reduced use of government programs as an adult and lower mortality, observed the report.

MCO Messaging Plays Key Role in COVID Vaccine Rollout

December 21, 2020

States and the federal government recently began rolling out the COVID-19 vaccine to health care workers across the country. Health plans, particularly those that serve high-risk individuals, may be ideally situated to coordinate care and update members on vaccination opportunities, experts suggest.

The FDA on Dec. 11 authorized emergency use of the COVID-19 vaccine made by Pfizer Inc. and BioNTech in individuals age 16 and older. And following an advisory panel’s Dec. 15 confirmation of the efficacy and safety of Moderna’s coronavirus vaccine, an emergency use authorization for that vaccine is imminent.

By Lauren Flynn Kelly

States and the federal government recently began rolling out the COVID-19 vaccine to health care workers across the country. Health plans, particularly those that serve high-risk individuals, may be ideally situated to coordinate care and update members on vaccination opportunities, experts suggest.

The FDA on Dec. 11 authorized emergency use of the COVID-19 vaccine made by Pfizer Inc. and BioNTech in individuals age 16 and older. Then the agency on Dec. 18 authorized Moderna’s vaccine for emergency use in people 18 years or older.

Health care workers and nursing home residents have been designated by the Centers for Disease Control and Prevention as the first group (phase 1a) to receive the vaccine.

“I think the paradigm of changing tires on a moving bus applies to this venture,” remarks Margaret Murray, CEO of the Association for Community Affiliated Plans (ACAP). “We certainly support the idea of getting the vaccine to front-line health care workers and the very most vulnerable populations, such as nursing home residents, first. So CDC is off to a good start.”

But ACAP, which is composed of 77 not-for-profit safety net health plans covering Medicaid, marketplace and MA enrollees, is concerned about other vulnerable seniors — such as those who are very frail or homebound and likely dual eligible — who are not part of that first round. “We need to think about them in the next wave,” Murray tells AIS Health via email. “We also need to consider how most equitably to distribute the vaccine.”

“Hopefully, this will start to evolve quickly, but there’s yet a lot to be figured out,” concurs Cheryl Phillips, M.D., president and CEO of the SNP Alliance, pointing out that there is no mechanism for tracking who has and who hasn’t received the vaccine. The plans that are most likely to serve some of the high-risk older adults that will soon qualify for the vaccine are MA Special Needs Plans, she says, “and they can be a wonderful partner for data sharing and working with providers,” as well as communicating with members to help them get the vaccine.

Murray adds messaging from plans will be crucial, especially if members are skeptical of the vaccine or behind on their vaccines in general.

More Medicare Advantage Insurers Expand Supplemental Benefits for 2021

December 9, 2020

Although Medicare Advantage insurers were somewhat slow to adopt newly expanded supplemental benefits in 2019, recent analyses of 2021 benefit offerings indicate large jumps in the uptake of certain offerings while others remain stagnant.

According to an analysis of available plan benefit package (PBP) data from CMS, Milliman estimates that 575 unique plans in 2021 are offering at least one of the following benefits: adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, and therapeutic massage. That’s compared with just 102 plans offering a benefit in one of these categories in 2019, Milliman observes.

By Lauren Flynn Kelly

Although Medicare Advantage insurers were somewhat slow to adopt newly expanded supplemental benefits in 2019, recent analyses of 2021 benefit offerings indicate large jumps in the uptake of certain offerings while others remain stagnant.

According to an analysis of available plan benefit package (PBP) data from CMS, Milliman estimates that 575 unique plans in 2021 are offering at least one of the following benefits: adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, and therapeutic massage. That’s compared with just 102 plans offering a benefit in one of these categories in 2019, Milliman observes.

Looking at a wider array of benefits that include acupuncture, dental and hearing, Avalere Health’s analysis of CMS data estimates that 4,494 PBPs in 2021 are offering supplemental benefits at the contract-plan-segment level, up from 2,888 PBPs in 2018 and 3,440 in 2019. Tom Kornfield, a senior consultant with Avalere, saysone of the most telling findings from the analysis is that meal delivery benefits have consistently grown, rising from 23% of 2018 PBPs to 57% of PBPs next year, while nutrition/wellness offerings have stayed relatively stagnant and are offered by just 19% of PBPs for 2021.

Meanwhile, “the big 3 supplemental benefits (vision, hearing, and dental) are now almost universally available (98%, 94%, and 91%, respectively),” writes Avalere. And while telehealth as a supplemental benefit has remained at a low 7% since 2018, now that MA plans are able to include additional telehealth services as a basic Medicare benefit in their bid submissions to be paid for by Medicare, 59% of plans this year have additional telehealth benefits available for Medicare-covered Part B services. In 2021 this number will jump to 94%, according to Avalere’s analysis.

The analysis also observes that one-third of MA plans (34%) will offer a variety of supplemental benefits related to the COVID-19 pandemic next year. The most popular version of these benefits includes “care/relief packages.”

To the extent that those benefits attract new enrollees, “it certainly could help, but I don’t know that it’s going to be the overarching decision” point, says Kornfield. It’s more likely that drug coverage, physician networks and projected out-of-pocket costs will remain top factors for consumers, he suggests.

MA Insurers Report Strong Performance, Predict Enrollment Growth

November 30, 2020

Select publicly traded insurers reporting third-quarter 2020 earnings this past month predicted big gains in Medicare Advantage enrollment during the current Annual Election Period (AEP), and noted that growth in government products helped offset the impact of commercial losses and COVID-19 costs in the recent quarter.

Reporting third-quarter 2020 earnings on Nov. 6, CVS Health Corp. said a 3.5% year-over-year increase in overall revenues was due in part to growth in its Health Care Benefits segment, which includes Aetna. Revenues in that segment rose 8.8% from the prior-year quarter to $18.7 billion, primarily driven by membership increases in Aetna’s government products and the favorable impact of the return of the Affordable Care Act health insurer fee for 2020.

By Lauren Flynn Kelly

Select publicly traded insurers reporting third-quarter 2020 earnings this past month predicted big gains in Medicare Advantage enrollment during the current Annual Election Period (AEP), and noted that growth in government products helped offset the impact of commercial losses and COVID-19 costs in the recent quarter.

Reporting third-quarter 2020 earnings on Nov. 6, CVS Health Corp. said a 3.5% year-over-year increase in overall revenues was due in part to growth in its Health Care Benefits segment, which includes Aetna. Revenues in that segment rose 8.8% from the prior-year quarter to $18.7 billion, primarily driven by membership increases in Aetna’s government products and the favorable impact of the return of the Affordable Care Act health insurer fee for 2020.

Although earnings for the quarter dropped slightly from adjusted earnings per share of $1.84 a year ago to $1.66 (mostly due to COVID-related expenses), CVS raised its full-year adjusted EPS guidance to a range of $7.35 to $7.45.

Aetna President Karen Lynch, who will take over for CVS Health President and CEO Larry Merlo when he retires in February, said the insurer believes it is poised for “above-market growth” in MA in 2021 and beyond.

For the quarter ending Sept. 30, Humana Inc. reported adjusted EPS of $3.08, down from $5.03 in the year-ago quarter as a result of COVID- related expenses, as the company experienced lower-than-usual utilization that was largely offset by higher COVID testing and treatment costs, said Chief Financial Officer Brian Kane. “Accordingly, in the fourth quarter, we expect to record a loss of approximately $2.40 on an adjusted EPS basis, and are tightening our full-year 2020 EPS guidance to a range of $18.50 to $18.75, still within our initial guidance expectations prior to COVID,” he stated, as per a transcript of the call from The Motley Fool.

Humana for the year expects its individual MA membership to grow by approximately 375,000 lives, representing year-over-year growth of approximately 10%.

Pointing to continued expansion of its MA business as a growth driver, Cigna Corp. President and CEO David Cordani during a Nov. 5 earnings call said the company is on track to achieve a strategic EPS goal of $20 to $21 next year. Cigna reported adjusted EPS of $4.41 for the third quarter and anticipates full-year consolidated adjusted EPS of $18.30 to $18.60.