Updated December 7, 2020

Where we are:

UPDATE: On October 2, 2020 the Michigan Supreme Court ruled that Gov. Gretchen Whitmer’s executive orders no longer had “legal effect.” However, the ruling did not affect the authority of the state’s Department of Health and Human Services, which has implemented similar epidemic ordersGov. Gretchen Whitmer has made a number of executive orders and directives in response to the COVID-19 crisis.

Specifically, Gov. Whitmer has issued a number of statements regarding state actions to ensure access to timely and affordable healthcare during the COVID-19 emergency. Such actions include temporarily lifting regulatory requirements on healthcare facilities, expanding telehealth services and eliminating cost sharing for COVID-19 testing and treatment for Medicaid enrollees. As the pandemic has continued, some orders have been rescinded and others extended. For example, at the end of April, the Governor took steps to ensure equitable access to healthcare resources during the pandemic, which affirms residents’ right to medical care without discrimination, and this order has been updated and extended. Michigan has also issued a number of COVID-19 Response policies specific to the state’s Medicaid programs. And in early November, the Legislature passed bills addressing nursing home procedures and allowing certain professionals the ability to administer COVID testing services. Michigan requested a Section 1135 Medicaid waiver, which was approved by the federal government on April 6. On April 10, the state announced that nearly all private health insurance companies operating in Michigan have agreed to waive cost-sharing—including copays, deductibles and coinsurance—for COVID-19 testing and treatment. In March, Attorney General Dana Nessel signed on to a letter to the Trump Administration asking them to further clarify whether the use of Medicaid-paid services for COVID-19-related healthcare would be considered in a “public charge” test.

At the federal level, three bill packages were passed and signed into law in March, including the expansive CARES Act. The Families First Coronavirus Response Act eliminated fees associated with testing and diagnostics for COVID-19 for everyone, including those who are uninsured (and noncitizens who are uninsured). The law provided financial support to health centers across the country for emergency planning and response efforts. (Thirty-nine health centers in Michigan will share more than $2.5 million in emergency funding.) The law also provided some additional benefits to state Medicaid programs, including more federal money through a temporary 6.2% bump in the Federal Matching Assistance Percentage (FMAP) for states whose programs limit barriers to care and provide COVID-19-related services free of charge to Medicaid enrollees.

In addition, the United States Citizenship and Immigration Services has previously announced that testing and treatment related to COVID-19 will not be considered in a public charge determination for those applying for lawful permanent residence (that is, a “green card”), which remains in effect. While this remains true, on September 11, the U.S. Court of Appeals for the Second Circuit issued a decision that allows the Department of Homeland Security to resume implementing the public charge rule nationwide. The public charge rule will be applied to all applications and petitions postmarked or submitted electronically on or after February 24, 2020. Previously, in late July, implementation of the final public charge rule had been halted until the end of the national public health emergency. Then, on August 12, this ruling had been partially stayed, meaning implementation of the rule was halted only in New York, Connecticut and Vermont. Currently, the public charge rule can be implemented in all 50 states.

Our recommendations:

Submit a Medicaid Disaster Relief State Plan Amendment (SPA). UPDATE: On June 5, 2020, the Centers for Medicare and Medicaid services (CMS) approved Michigan’s pending Disaster Relief SPA (effective March 1, 2020). This SPA will impact a variety of areas of health care delivery, including: eliminate cost-sharing for COVID-19-related testing services and treatments (including laboratory services and any vaccines); provide coverage for surgical masks, hand sanitizer and patient gowns for people diagnosed with or suspected of having COVID-19; waive requirements related to non-emergency medical transportation for beneficiaries; expand the availability of telemedicine; allow pharmacy adjustments to quantity limits and prior authorization requirements for automatic renewal; and increase the payment rate for the COVID-19 Regional Hub nursing care facilities dedicated to providing non-hospital-level treatment to individuals from congregate care settings who are affected by COVID-19.

The Medicaid Disaster Relief SPA allows states to make temporary changes to their Medicaid State Plans. States can choose to adopt changes that fall into seven categories. For example, Michigan could make an enrollment change to expand presumptive eligibility to include seniors older than 65 and individuals with disabilities—two groups currently excluded from presumptive eligibility. Presumptive eligibility allows Medicaid applicants full access to Medicaid benefits while their application is being processed. Expanding presumptive eligibility to seniors older than 65 and individuals with disabilities would mean more Michiganders would have timely access to health coverage during the COVID-19 emergency. Michigan could also make a cost sharing change, such as suspending all copays, premiums, and other contributions for Medicaid enrollees, including those who are not directly affected by COVID-19. 

Submit a Children’s Health Insurance Program (CHIP) Disaster Relief SPA. The CHIP Disaster Relief SPA allows states to make temporary changes to the CHIP program during disasters or public health emergencies. Such changes can include preventing disenrollment from the program for the duration of the emergency and reducing cost sharing requirements. Michigan should utilize the CHIP Disaster Relief SPA to protect healthcare access for Michigan children currently covered through CHIP and eliminate monthly premiums for their families.

Take up the state option to cover COVID-19 testing and related services for uninsured people in Michigan. The Families First Coronavirus Response Act grants states the option to (1) ensure that testing and testing-related services are entirely covered for uninsured individuals and (2) receive a 100% federal match on these services during the emergency period (that is, the states will be fully reimbursed by the federal government). In Michigan, the overall uninsured rate is just above 5% and includes many people who make too much to qualify for Medicaid but cannot afford Marketplace coverage through the individual market despite being eligible for tax credits. Leveraging these available federal funds to provide currently uninsured Michiganders who fall in this coverage gap access to COVID-19 testing and testing-related services should be part of our response strategy. 

Make use of the Section 1135 Medicaid Waiver. UPDATE: On April 6, the Center for Medicare and Medicaid Services (CMS) approved Michigan’s request for a Section 1135 waiver. Section 1135 waivers are approved by the Centers for Medicare and Medicaid Services (CMS) and designed for public health emergencies like the COVID-19 pandemic. Section 1135 waivers allow states to modify or waive certain program requirements to ensure increased access to healthcare during disasters and public health emergencies. Several states are leveraging 1135 waivers to remove potential barriers to healthcare workers providing treatment, such as suspending prior authorization requirements that may delay care delivery and allowing services to be offered in alternative settings. In response to COVID-19, Michigan should consider submitting a Section 1135 Medicaid Waiver.

Why more must still be done: 

The COVID-19 pandemic continues to impact people in various areas of their life—like their income, housing and access to medical leave—and will require support from the federal and state governments. Still, the COVID-19 pandemic is at its core a public health crisis that requires healthcare—and health coverage-focused solutions. Our state’s response to COVID-19 must continue to prioritize affordable health coverage, testing and treatment options for all Michiganders and support and protection for our state’s healthcare workers.

Doctors and those providing healthcare are taking an incredible risk as COVID-19 continues to spread. While policy recommendations about coverage, testing and treatment will get more patients in the door, more patients put pressure on our healthcare system and the workers that we rely on to keep it functioning, particularly when there are not sufficient supplies available or institutional procedures to protect providers’ health. Our healthcare system is in dire need of supplies, including blood donations from those who are eligible to donate, personal protective equipment (PPE) and medical tools such as ventilators. The CARES Act includes additional funding for the Defense Production Act, which will bolster domestic supply chains for PPE, ventilators and more along with federal funding for state and local health agencies to purchase needed equipment.

Through its spending packages, with more on the horizon, Congress is leveraging its ability to direct large amounts of federal dollars to states. Our country’s healthcare system knows how beneficial federal-state partnerships can be, as evidenced by the Affordable Care Act’s Medicaid expansion and health insurance marketplaces. State and federal partnerships are more important than ever as we work to collectively address the COVID-19 crisis. For example, waivers and adjustments are built into federal programs like Medicaid to allow states to innovate and provide effective care. Continuing to take advantage of these flexibilities will allow Michigan to adapt and respond effectively to this public health crisis as it progresses.

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