How States Handled Medicaid LTSS Coverage, Benefits for COVID-19

Most states have had to expand their Medicaid long-term supports and services coverage and benefits in order to protect some of the most vulnerable populations from the coronavirus, which could have implications beyond the pandemic, a Kaiser Family Foundation issue brief revealed.

The coronavirus pandemic has underscored how heavily the senior and disabled populations depend upon Medicaid for these services and products, as these populations have been severely affected by the pandemic.

Chronic diseases and weak immune systems put the elderly and disabled at higher risk of contracting a severe form of the virus. If the coronavirus affects an elderly or disabled individual’s ability to access long-term care services or supports, the consequences could be stark.

Thus, as part of their response, states have expanded Medicaid eligibility and benefits related to long-term services and supports.

All 50 states reformed their enrollment processes for long-term services and supports in order to make the enrollment process faster and easier.

More than half of the states in the US (28 states) have expanded their long-term care facility coverage eligibility or functional eligibility criteria for long-term care.

Twenty states have lowered premiums or other forms of cost-sharing for long-term care coverage in light of the pandemic’s economic effects.

Notably, many states have chosen not to increase the number of home and community-based services waiver enrollees.

This waiver allows states to target certain groups by factors such as age or diagnosis to receive coverage for any service that the states determine. Two states have increased home and community-based services waiver enrollees in response to COVID-19.

Twenty-seven states have also added a new long-term services and supports benefit due to the coronavirus pandemic. States are mainly expanding benefits related to home and community-based services. These services often have long waitlists in many states, researchers noted.

Some of the more common services that states are starting to cover include meal delivery, medical supplies, and assistive technologies. Other new benefits are more coronavirus-specific, such as Ohio’s new Health Care Isolation Center benefit. The Ohio benefit covers discharged patients who require care in isolation, due to COVID-19 restrictions.

All but seven states have bumped their service utilization limits in order to cover services temporarily that would be essential to beneficiary health and wellbeing. For example, some states are lifting limitations on the number of times providers can visit a nursing home or the number of hours that private duty nurses can attend to a patient after hospital discharge.

All but nine have eliminated their prior authorization requirements.

Outside of the coronavirus pandemic, the lack of progress on reforming prior authorizations and reducing provider burden stirred vitriol between providers and payers. And while reducing prior authorization requirements has been integral to private and public payers’ COVID-19 strategies, provider organizations have continued to rebuke payers for slowing progress.

Additionally, 47 states have expanded telehealth care delivery for home and community-based services for groups such as therapy and rehabilitative services, behavioral, mental, and psychosocial services, and other conditions. Many private payers have seen a telehealth utilization surge for these types of services during the pandemic.

The issue brief noted that these program adjustments for the public health emergency will leave policymakers with a critical question at the end of the public health emergency: should these Medicaid coverage and benefits policies become permanent?

The experts also pointed out that these policies and federal guidance have been largely directed at nursing homes. The focus is understandable: some experts estimate that long-term care facilities such as nursing homes and assisted living facilities have contributed around 45 percent of the coronavirus death rate, as of May 2020.

However, the researchers summoned attention to the need for greater support for community-based residential settings, which are also high-risk facilities. They called for more data on the coronavirus risk in these environments.

“Beyond the pandemic, the coming age wave makes LTSS and Medicaid’s role as the primary payer likely to be policy issues faced by the next Administration, in addition to the continuing effects of the pandemic and economic crisis,” the researchers concluded.