Interview with Jack Rollins, National Association of Medicaid Directors

Regulation | January 13, 2021 | by Jill Schumann

Jack Rollins, Program Director for Federal Policy with the National Association of Medicaid Directors, joined the LeadingAge Coronavirus Update Call on January 13, 2021.

Jack Rollins, Program Director for Federal Policy with the National Association of Medicaid Directors, joined the LeadingAge Coronavirus Update Call on January 13, 2021. He answered questions from Ruth Katz and from callers.

(Listen to the interview here.)

Q: What are state Medicaid programs looking like, nearly a year into the pandemic? What are you hearing from Medicaid directors?

A: For this past year Medicaid directors have been laser-focused on COVID-19 and on issues of equity. They are also preparing for significantly reduced budget resources for states. It is difficult to get a specific sense of exactly what the budget challenges will be as there may be more federal interventions. This year has seen FMAP enhancement but also enrollment growth. States are trying to manage in a time of reduced resources and increased uncertainty.

Q: You mentioned that Medicaid directors are working on equity issues – please say more.

A: As you know, Medicaid focuses on underserved and lower income people, many of whom are racial and ethnic minorities. Medicad department staff and leadership at the state level don’t necessarily reflect their constituents, so directors are examining that and identifying ways to address it. They also want to be sure not to inadvertently exacerbate inequities in the distribution of vaccines. They are reaching out to partners who can assist.

Q: Please talk a bit about the various Medicaid-funded settings and COVID-19.

A: There has not been much federal attention to HCBS services. Significant federal focus has been on institutional settings, as the ACIP recommendations indicated in vaccine prioritization. But we certainly advocate for a focus on the entire universe of long term services and supports.

Q: What are you hearing about PACE organizations? How does PACE fit into Medicaid directors’ thinking?

A: There really hasn’t been much conversation about PACE and COVID, so I don’t have much to report.

Q: Would you say more about states’ financial challenges and issues of a pandemic-related recession?

A: In the early months of the pandemic, states saw a dramatic impact on state revenues and on demands and needs for services. Some mitigation measures have been helpful, such as the ability to use 1915 C Appendix K to help support providers, but CMS has put a limit on that. There have been some targeted increases to nursing home rates and some for other settings. The impact on providers has been variable. Providers who could adopt telehealth are doing okay. However, some HCBS settings can’t use telehealth. Behavioral health, for example, has seen a rapid adoption of telehealth for visits previously done in person. Some states pay at parity with in-person visits for those sessions, while others have reduced rates for telehealth visits. Medicaid directors want all types of providers to remain viable and worry about the potential loss of providers because of the pandemic.

Q: We, too, worry about the viability of our provider members, including adult day services, many of which have had to close during the pandemic. How are you seeing the role of CARES Act funding?

A: States have been able to use CARES Act dollars to provide some funds to sustain the delivery infrastructure, but the specifics are at the discretion of individual governors. We are grateful that the deadline for expending CARES Act funds has been extended to December 31, 2021. Medicaid programs have not been well-served by the Provider Relief Funds. We continue to hope and advocate for more federal relief of some kind.

Q: Rates for Medicaid programs vary so widely across the states and some rates don’t cover the cost of care. Can you help us think about solutions?

A: States are in difficult and unpredictable fiscal circumstances. You can help by advocating for greater certainty of federal funding. For example, it would be good to separate the FMAP increase from the declared public health emergency. With greater federal funding certainty states could start propping up the provider infrastructure.

Q: Please talk for a minute about COVID-19 vaccines and the role of Medicaid directors.

A: Medicaid directors are working on the vaccine rollout and are trying to figure out how to get vaccinator partners in place and how to reimburse them. With 1135 waivers the federal government is trying to smooth the way. For example, some states are looking to use veterinarians to be vaccinators – so flexibility ix key. HHS has encouraged states to pay the standard rate for COVID administration, but this can get complicated, including at the intersection with FQHCs and their much higher rates.

Q: Looking ahead to the coming year, what are some federal administrative actions we might expect?

A: In the short term, the next three months, the focus will be entirely on COVID-19 – getting the pandemic under control and vaccinating people. Longer term we anticipate that some of the Trump Administration’s actions will be rolled back. Examples might be the sunsetting of regulatory actions and pharmaceutical actions, and a working through of things more systematically. Other things might include changes in access to Medicaid and eligibility criteria, and addressing the social determinants of health in the Medicaid program.

Q: Looking ahead, given state budget constraints coupled with the need for adequate funding, what can LeadingAge members do to change the conversation?

A: Provide as much data and information about this as possible. Engage in federal advocacy and make the case to Congress about the need for additional investments in rates and infrastructure.