The administration is “working to ensure that no American has to pay for the vaccine,” said one official. The administration’s planned rule also will address other Covid-19-related issues, like expanding flexibility for Medicaid patients seeking care for the coronavirus, two people familiar with the plan said.
CMS did not respond to a request for comment about the plan or how it would pay for the cost of vaccines for the roughly 120 million Americans who receive health coverage through Medicare and Medicaid.
CMS Administrator Seema Verma teased the announcement earlier this month in remarks at the HLTH virtual conference.
“I think we’ve figured out a path forward,” Verma said on Oct. 13. “It was very clear that Congress wants to make sure that Medicare beneficiaries have this vaccine and that there isn’t any cost-sharing.”
“And so, stay tuned, you’ll see more from the agency on this very shortly,” Verma added.
Congress in March sought to mandate free coronavirus vaccine coverage as part of a broader Covid-19 relief bill. But under its current rules, the Medicare program doesn’t cover the cost of drugs authorized under emergency use designations — leaving millions of Americans at risk of facing expenses tied to the vaccine.
The Trump administration later determined that it could not fix the loophole through an executive order, setting off a scramble within the health department to find alternative solutions.
Earlier this month, the administration struck a deal with CVS and Walgreens to administer an eventual vaccine with no out-of-pocket costs to seniors and health workers in long-term care facilities. Yet that arrangement only covered a narrow slice of the nation’s more than 60 million Medicare enrollees.
Comprehensive review of state managed care contracts and 1115 waivers detail effective SDOH integration strategies
Manatt, Phelps & Phillips, LLP, a multidisciplinary, integrated professional services firm, announced today the release of its latest survey, which provides a comprehensive review of states’ social determinants of health (SDOH) initiatives through Medicaid managed care contracts and 1115 waivers. The report, titled “In Pursuit of Whole Person Health: A Review of Social Determinants of Health (SDOH) Initiatives in Medicaid Managed Care Contracts and 1115 Waivers,” was conducted by Manatt Health, the firm’s healthcare legal and consulting group. With Medicaid being the largest payer of healthcare for the low-income populations that are disproportionately impacted by social and economic challenges, this report takes a deep dive into the ways states can effectively integrate SDOH into the Medicaid delivery system and leverage 1115 waivers to foster innovation.
“This pandemic—and its disproportionate impact on low-income communities and communities of color—has brought the need to address SDOH into sharp focus,” said Melinda Dutton, partner with Manatt Health, who coauthored the report alongside director Naomi Newman, manager Mandy Ferguson and partner Cindy Mann. Newman added: “Our report serves as a resource for states, health plans, provider organizations and other stakeholders looking to improve overall health for their most vulnerable populations.”
This report details how states are using their Medicaid managed care contracts and 1115 waivers to address unmet social needs and drive innovation in this space. Through an in-depth review of the contracts of each state and territory with Medicaid managed care (41 in total), Manatt identified the provisions and subsequent intervention methods related to SDOH, and categorized them by type of service or intervention (e.g., screening and referral requirements, quality metrics); targeted populations (e.g., pregnant women, children, people experiencing homelessness); and targeted domains (e.g., housing, food/nutrition, employment).
An infographic to help illustrate the findings can be found here. The full report, including detailed state profiles with contract language, can be located through a subscription to [email protected] Health, an original content information service providing a wide range of premium analysis and data on breaking industry news and trends; in-depth evaluation of state and federal health policy changes; detailed summaries of Medicaid, Medicare and Marketplace regulatory and sub-regulatory guidance; and 50-state surveys on critical industry issues.
This report was compiled through an analysis of the contracts and 1115 waivers of each of the 41 states and territories with Medicaid managed care conducted between October 2019 and June 2020. In certain instances when states’ managed care organization (MCO) model was not released, Manatt utilized the state’s MCO “request for proposals” to understand the scope of SDOH-related requirements on plans. Of the 41 states and territories, two requested that their profiles be withheld from this publication due to ongoing MCO procurements and contract amendments.
About Manatt, Phelps & Phillips, LLP
Manatt, Phelps & Phillips, LLP, is a leading professional services firm, providing integrated legal and consulting services to a global client base. With offices strategically located in California (Los Angeles, Orange