Scioto Government Affairs Update I

In this month’s report, we see a positive trend as states carve out more Medicaid funding for adults with disabilities and raise minimum wages for direct support workers. Additionally, as Omicron continues to crush health care workers already under strain from nearly two years of grappling with the pandemic, health care providers are making great strides as they pivot to face the mounting challenges. Providers have shifted to remote care such as telehealth and at-home care.

Stateside

As Covid-19 cases rise again in nursing homes, a few states have begun requiring visitors to present proof that they’re not infected before entering facilities, stoking frustration and dismay among family members. Officials in California, New York, and Rhode Island say new covid testing requirements are necessary to protect residents — an enormously vulnerable population — from exposure to the highly contagious omicron variant. But many family members say they can’t secure tests amid enormous demand and scarce supplies, leaving them unable to see loved ones.

• Alabama
  Senator Steve Clouse proposed investing federal funds in a state Medicaid “rainy day” fund. Clouse, who made the comments in an interview, also did not rule out the possibility of Medicaid expansion but added that it is “hard to say” whether expansion would occur.

• California
  The Assembly Health Committee passed a bill to create CalCare, a state-run, single-payer, universal healthcare plan. To fund CalCare, the bill would impose a 2.3 percent excise tax on businesses with more than $2 million in annual gross receipts, a 1.25 percent payroll tax on employers with 50 or more employees in the state, an additional one percent payroll tax on employees making over $49,900 per year, and a new marginal income tax on individuals making over $149,509 per year. The bill has been referred to the Appropriations Committee.
  Governor Gavin Newsom proposed $217.5 billion for health and human services programs in the fiscal 2023 budget. The governor’s spending plan includes reduced premiums for Medi-Cal coverage for pregnant women, children, and working adults with disabilities; increased reimbursements for Medi-Cal providers; and funding for improved maternal and child preventive care.

• Florida
  State surveyors will not check whether healthcare facilities are in compliance with the federal COVID-19 vaccine mandate, according to Governor Rick DeSantis. Separately, many Florida providers are working to comply with the mandate, which was upheld by the U.S. Supreme Court.

• Georgia
  Governor Brian Kemp’s proposed budget for fiscal 2023 includes $15 million to create an insurance Exchange run by private insurers and brokers, a tactic not yet approved by federal regulators. Georgia currently uses the federal Healthcare.gov Exchange. The budget also includes $85 million for higher Medicaid physician rates, $1 million to address rural physician shortages, and additional spending on mental health and developmental disabilities. The proposal does not include Medicaid expansion.

• Kansas
  House minority leaders plan to introduce constitutional amendments that would put Medicaid expansion on the November ballot. Medicaid expansion would provide Kansas with roughly $1 billion in federal funds annually, according to House Democratic Leader Tom Sawyer (D-Wichita).

• Kentucky
  Governor Andy Beshear’s proposed budget fully funds the state’s Medicaid program for the 2022-24 biennium. The proposal also provides funds for nursing scholarships and additional slots in waivers for support for community living and for individuals with intellectual or developmental disabilities.

• Minnesota
  The Department of Human Services released a request for proposals (RFP) for home and community-based service (HCBS) employment providers to develop and implement a business model that phases out subminimum provider wages by April 1, 2024.

• New Mexico
  CMS announced that New Mexico is seeking waiver amendments necessary to effectuate the home and community-based services outlined in a state spending plan for funds from the American Rescue Plan Act. The changes include an additional 1,000 community benefit allocation slots for individuals not eligible for Medicaid but requiring nursing facility level of care, increased limits on funding for community transition services for individuals moving from institutional to community care, and increased limits on funding for equipment or to modify physical spaces to increase an individual’s independence. Public comments will be accepted through February 13.

• New York
  Governor Kathy Hochul proposed a fiscal 2023 state budget that would allocate $3.7 billion to restore the 1.5 percent Medicaid reimbursement rate reduction from 2021 and to increase the reimbursement rate by an additional 1 percent across the board. Another $2.8 billion is allocated for payments to safety-net hospitals. The proposed budget also includes $10 billion to strengthen the healthcare workforce across the state and a $1.6 billion capital program for improvements to healthcare facilities. Details on the actual provisions will be available when specific budget bills are released.

• South Dakota
  Senator Wayne Steinhauer (R-Hartford) announced plans to introduce Medicaid expansion legislation in hopes of heading off an expansion measure set to appear on the November ballot. Steinhauer wants legislation that would allow the state to consider work requirements and scale back Medicaid expansion if the federal match is reduced.

Resources

The Coronavirus State and Local Fiscal Recovery Funds (SLFRF) Program

How States Are Spending American Rescue Plan Funds

Pandemic-Related Funding Boosts Federal Grants to States

State-by-State Breakdown: Delivery of Initial $30 Billion of CARES Act (ended 5/2021)