Health Care Concept. Doctor holding a jigsaw puzzle with MEDICAID word.
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The May 11 end of the COVID-19 public health emergency — and the flexibilities it provided — means many potential changes for providers of Medicaid home- and community-based services. And those changes are worrying senior living industry advocates.

Jeanne McGlynn Delgado, vice president of government affairs for the American Seniors Housing Association, told McKnight’s Senior Living that ASHA is concerned about several changes tied to the ending of the PHE that will affect senior living, including cost-sharing on COVID-19 testing and treatments for most individuals, and states beginning Medicaid redeterminations.

Between 5 million and 14 million current Medicaid beneficiaries are expected to no longer be eligible, which may affect coverage of services provided by assisted living communities under HCBS waivers, Delgado said.

“States were also provided a 6.2% FMAP [federal medical assistance percentage] boost, which was originally tied to the PHE, but now can gradually phase down the government match rate beginning in April and running through December,” she said. 

The federal government last fall issued a compliance warning to HCBS providers to make progress on meeting the requirements of the HCBS settings final rule that goes into effect in the spring. States that thought they would be unable to meet the March 2023 deadline had until Jan. 1 to submit statewide transition plans documenting their efforts to adopt new regulations, conduct provider compliance assessments and establish processes for beneficiaries to report provider noncompliance.

HCBS waitlists total around 700,000 people nationwide, and more than 80% of providers are turning away new referrals due to limited staff capacity, Inside Health Policy reports. 

LaShuan Bethea, executive director of the National Center for Assisted Living, told McKnight’s Senior Living that assisted living providers have remained committed to delivering the highest quality of care throughout the pandemic.

“There is still more work to do to address challenges spurred by the pandemic, including a historic labor and economic crisis,” she said. “We will continue to work toward effective solutions that will help us rebuild and allow us to continue investing in and serving seniors in a meaningful way.”

Some changes will remain

The US Department of Health and Human Services and its Centers for Medicare & Medicaid hosted an informational call Monday to address what will and won’t be affected by the ending of the COVID-19 PHE.

In a letter last week to governors, HHS Secretary Xavier Becerra told governors that the   PHE would end May 11, following a similar proclamation from President Biden. HHS also provided a roadmap detailing the transition.

“The nation is in a better place,” Steven Cha, counselor to the HHS Secretary, said on Monday’s call. “Over the last two years, the administration implemented the largest adult vaccination program in US history.”

Although some Medicaid waivers and flexibilities will sunset with the end of the COVID-19 PHE, others will remain in place, including major telehealth flexibilities for those participating in Medicaid or Medicare, access to COVID-19 vaccinations and treatments, and emergency use authorization for COVID-19 tests, treatments and vaccines.

Hannah Katch, senior adviser to the CMS Office of the Administrator, said that for community-based organizations, flexibilities related to how and where Medicaid enrollees receive care will be available after the PHE if states choose to continue them. Beginning April 1, states can begin removing individuals from the Medicaid program if they no longer are eligible for coverage.

Argentum is looking at the Acute Hospital Care at Home Medicare waiver that gives hospitals flexibility from Medicare conditions of participation to receive payment for care provided for acute conditions in the home. CMS has noted that “many existing Acute Hospital Care at Home programs provide [at-home hospital level of] care in assisted living.” Legislation introduced in both the House and Senate would extend the waiver following the end of the PHE.

Actions in one setting affect all others

But another area of concern, ASHA’s Delgado said, are now-expired waivers and flexibilities that had been offered under the PHE to the skilled nursing industry to cover additional nursing staff. The loss of those workers, she said, will have a “domino effect on the broader long-term care industry,” including senior living, which is “struggling to find quality, compassionate workers to serve our residents.”

“The federal government, the agencies and Congress should recognize the challenges of staffing for all long-term care settings and seek opportunities to grow this workforce and not take steps to undermine this fragile industry at this time,” Delgado said, adding that ASHA is advocating for immigration reform to meet the growing demand for workers.

HHS pledges a smooth transition

Since the peak of the omicron variant surge at the end of January 2022, Cha said, daily COVID-19 cases are down 92%, deaths are down by more than 80% and new COVID-19 hospitalizations are down more than 80%.

“We are not done,” Cha said. “Addressing COVID-19 remains a significant public health priority for this administration.”

What won’t change, he said, is access to COVID-19 vaccines, treatments and testing. The federal government pledged to work with stakeholders to ensure a smooth transition, particularly for older adults and individuals with disabilities. Medicare and Medicaid enrollees will continue to have access to free vaccines, tests and treatments through September 2024.

Centers for Disease Control and Prevention reporting on community levels of COVID-19 — which inform recommendations related to masking and social distancing — also will not change. Community levels are based on the number of COVID-19 admissions to hospitals and the number of COVID-19 positive tests, and that definition will not change, Cha said. 

What the government will lose is lab reporting on negative tests, he said. At the end of the PHE, HHS no longer will have express authority to require lab test reporting. The CDC, however, has been working on securing voluntary agreements with states and jurisdictions to continue to share vaccine administration data.

Court orders reinstatement of benefits

Meanwhile, a federal district court judge in Connecticut issued a nationwide preliminary injunction recently in a pending case against HHS, ordering the federal government to stop enforcing an illegal interim final rule that stripped Medicaid benefits from hundreds of thousands of older adults and people with disabilities. 

A lawsuit alleges that the interim final rule, put in place in November 2020 under the Trump administration, violates the Families First Coronavirus Response Act by requiring states to reduce Medicaid rolls. The rule created several exceptions to the continuous coverage requirement.

The preliminary injunction is in effect until March 31 and requires HHS to reinstate anyone wrongly terminated from Medicaid, retroactive to the date of termination.