CMS Guidance Promotes COVID-19 Vaccine Coverage, Medicaid Expansion

The Biden Administration and CMS have released guidelines that detail federal funding information relating to Medicaid expansion and COVID-19 testing and vaccine administration for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries.

The administration has increased state funding under the American Rescue Plan Act (ARP) and is working to continuously address health disparities for Medicaid and CHIP members.

Access to COVID-19 testing and vaccines remains a significant health barrier for some, and it is especially important to address as children start returning to school.   

“The Biden-Harris Administration continues to remind states that the fight against COVID-19 requires increased efforts to boost testing and vaccination,” HHS Secretary Xavier Becerra stated in the press release.

“As families prepare children to return to school, today’s guidance reaffirms our commitment to provide free COVID vaccination and testing for all eligible Medicaid and CHIP beneficiaries. I will continue to work with the states to get our communities vaccinated and healthy across the country.”

Ensuring free COVID-19 testing for Medicaid and CHIP members may help families feel more comfortable about sending their children back to school, even though children are currently ineligible to receive the vaccine.

CMS also assured that children participating in remote education will be eligible for any Medicaid-covered services that they normally receive through school. Children with disabilities frequently benefit from in-person services while attending school and the agency is ensuring that remote learning will not keep children from those benefits.

The new CMS guidance aims to remind individuals and states that cost is not a barrier to receiving the COVID-19 vaccine. States must cover the full costs of vaccine administration for Medicaid and CHIP members.

The ARP is also providing a temporary 100 percent federal match for Medicaid and CHIP spending on vaccines and their administration. This assures states that the federal government will continue to cover vaccination costs, the press release noted.

“Today’s guidance reinforces our commitment to providing low-income adults and children with access to COVID-19 testing and vaccination, and I urge all eligible enrollees to get vaccinated to protect themselves and their families,” CMS Administrator Chiquita Brooks-LaSure said in the press release.

In addition to the federal match for vaccine expenditures, states can receive federal matching funds for any monetary benefits that they offer to beneficiaries as an incentive to get the vaccine.

The guidelines also addressed how the ARP will aim to reduce health disparities for Medicaid beneficiaries. Any state expenditures for Medicaid services by Urban Indian Organizations and certain Native Hawaiian healthcare systems will receive a match at 100 percent of the Federal Medical Assistance Percentage (FMAP) through March 31, 2023.

Indigenous people of color, including American Indians, Alaska Natives, and Native Hawaiians, face higher rates of health disparities compared to other racial and ethnic groups in the US. CMS is determined to address this health inequity with the ARP funding.

The Biden Administration and CMS have also presented new guidelines that may encourage states to pursue Medicaid expansion.

States that expand Medicaid coverage will receive a temporary five percent increase in federal matching funds for Medicaid expenditures for up to two years. The states will also qualify for the 90 percent matching funds available through the Affordable Care Act (ACA) for newly eligible Medicaid enrollees’ healthcare services.

Expanding Medicaid could increase coverage access and lower state spending, but there are still 12 states that have not yet done so.

Oklahoma was the first state to expand its Medicaid program to cover ACA individuals in July 2021. Since then, 38 additional states, including Washington DC, have followed in its footsteps.

Following its expansion, Oklahoma became eligible for the ARP federal funding increase and helped 190,000 individuals qualify for healthcare coverage, according to the press release. Medicaid expansion allowed thousands of Oklahomans to access coverage for primary and preventive care, substance use disorder treatment, emergency medical care, and more.