Editor’s Note: Since the onset of the COVID-19 pandemic, federal and state policymakers have acted to preserve access to services for populations using Medicaid-covered long-term services and supports (LTSS). These populations include older adults and people with chronic conditions or disabilities who are at high risk of severe cases if they contract COVID-19 and face disruptions in access to care if they or their caregivers must quarantine or self-isolate. Among other actions, policymakers directed emergency funding to strengthen providers and maintain Medicaid coverage for individuals, and provided regulatory relief to minimize administrative, clinical, or financial barriers to accessing services.
Manatt Health described these actions in “COVID-19 State Resource Guide: Leveraging Federal and State Authorities to Ensure Access to Long-Term Services and Supports for People at High Risk», published in February 2021.1 Manatt has updated the resource guide based on an analysis of new or changed regulatory flexibilities and other state administrative measures through July 2021, as well as ongoing monitoring of overall state responses to pandemic to ensure access to LTSS for those at high risk. The main conclusions are summarized below. Click on here to access a free copy of the full update.
Manatt Health found that as states operationalized their existing temporary Medicaid regulatory flexibilities, they gained a better understanding of long-standing vulnerabilities in their LTSS systems that worsened during the pandemic and focused on the long-term improvement of the system.
Key trends in 2021 include:
- States have strategically leveraged federal funding to improve their responses to COVID-19 and invest in longer-term system reforms. All 50 states plus the District of Columbia have submitted to the Centers for Medicare & Medicaid Services (CMS) and begun implementing Home and Community Services (HCBS) “spending plans” to take advantage of the new funding federally authorized by the American Rescue Plan Act of 2021 to meet their COVID-19 related HCBS needs and to strengthen and improve their HCBS systems.2
- States, including California and Massachusetts, have taken a closer look at health disparities in their states that have been illuminated by the pandemicincluding the disproportionate impacts that COVID-19 and state vaccination efforts have had on residents and communities of color.3
- States continued to administer and monitor their existing pandemic-related regulatory flexibilities, and a few states made some temporary flexibilities permanent. Most states focused on continuing to implement and monitor their existing flexibilities and did not request new pandemic-related regulatory flexibilities or change existing ones.
Planning for 2022
The temporary regulatory flexibilities enacted during the Public Health Emergency (PHE) provide a unique opportunity for states to innovate new policies and care delivery approaches with the goal of minimizing barriers to care and strengthening their LTSS systems. Although quantitative data from Medicaid on the impact of temporary regulatory flexibilities on consumer access and use of services, health disparity reduction and caregivers and direct care providers is sparse at this time. At this stage, states are learning from their pandemic experiences, and some states have begun to make temporary reforms permanent. In 2022, all states will continue to leverage U.S. bailout funds to make strategic investments in benefits, infrastructure, and LTSS programs to ensure seamless and safe access to essential services for high-risk members. of Medicaid.
1 This report has been published as an update to the original report report published by Manatt Health in 2020.
3 Unlocking Race and Ethnicity Data to Advance Health Equity in California: Proposals for State Action (April 2021); Racism and racial inequalities in health: An introduction based on data on health disparities in Massachusetts (December 2021).