HJAR May/Jun 2023

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2023 45 Joseph W. Thompson, MD, MPH President and Chief Executive Officer Arkansas Center for Health Improvement TELEHEALTH Some flexibilities associated with pro- viding healthcare via telehealth have ex- pired, but Congress has extended most tele- health flexibilities for Medicare beneficiaries through Dec. 31, 2024. TheArkansas General Assembly approved legislation in 2021 that made several telehealth flexibilities perma- nent, including providing Medicaid cover- age for behavioral health and substance use services delivered via telehealth. In late February, federal officials an- nounced that a policy allowing healthcare providers to prescribe controlled substanc- es, including buprenorphine, via telehealth would expire with the end of the public health emergency. This raised concerns among healthcare professionals because it would limit access to life-saving medication for people with substance use disorder. The federal government later said the Drug En- forcement Administration was working on a rule to extend this flexibility in some situ- ations; as of the deadline for this column, it was unknown what the final policy would be. MEDICAID ENROLLMENT During the public health emergency, the federal government increased its portion of funding for states’ Medicaid programs, in exchange for which states had to agree to maintain continuous coverage for Medicaid enrollees and suspend eligibility redetermi- nations. The Consolidated Appropriations Act of 2023 gave states permission to re- sume redeterminations of Medicaid eligibil- ity inApril and allowed them to take up to a year to complete the process, but Arkansas has given itself a time limit of six months. Some people on Arkansas’ Medicaid rolls, which include the more than 300,000 Medicaid enrollees will continue to have coverage for COVID-19 testing with no out- of-pocket expenses through Sept. 30, 2024, but may be subject to cost-sharing after that date. During the public health emergency, Medicare enrollees had coverage for anti- viral drugs with no out-of-pocket expenses but were subject to cost-sharing for hospi- talization or outpatient services. They can now expect cost-sharing for antiviral drugs as well. People without insurance will have to pay out of pocket to obtain antiviral drugs when the supply of government-purchased drugs runs out and will continue to pay out of pocket for other kinds of treatment. VACCINES The program under which the federal government purchased COVID-19 vac- cines and made them free for all is no lon- ger being funded. Vaccine manufacturers have said they would raise the prices of their COVID-19 vaccines after the end of the public health emergency; however, people on Medicare, Medicaid, and most private plans will continue to have coverage for the vaccines with no cost-sharing. Two excep- tions are people with grandfathered plans under the Affordable Care Act and people with short-term, limited-duration plans, which are not subject to the healthcare law’s preventive services coverage requirement. People on these plans may be responsible for all or part of the cost of their COVID-19 vaccines in the future. For people without insurance, at least one COVID-19 vaccine remains accessible: vaccine manufacturer Moderna has said its vaccine will remain free for the uninsured. Arkansans with ARHOME coverage, pre- sumably have become ineligible because of changes of circumstances such as moving out of the state or experiencing increases in income, and their removal from the rolls is appropriate. Of those who remain eligible, it is likely that some will be disenrolled be- cause of issues related to the process and will need to navigate their way back to cov- erage, hopefully without negative effects on their healthcare. To minimize erroneous disenrollments, the Arkansas Department of Human Services has taken steps such as crosslinking the Medicaid rolls with the Supplemental NutritionAssistance Program rolls, adding caseworkers, and opening a telephone hotline people can use to verify and update their contact information. Arkansans who are disenrolled fromAR- HOME because their incomes have risen above the eligibility threshold — 138% of the federal poverty level, which is $30,000 for a family of four — should be eligible for tax subsidies to obtain health plans through the Health Insurance Marketplace and should even be able to get the same plans they had under ARHOME. If their income levels are no more than 150% of the federal poverty level, they will pay no premiums. They will be able to enroll outside of the regular open enrollment period. Arkansas has much at stake. Over the past decade, we have mostly avoided the hospital closures seen in surrounding states, in large part because Medicaid expansion decreased uncompensated care. We hope the state’s preparations have set the stage for a smooth redetermination process that successfully continues coverage forArkansas families. n