News Briefs: Biden Admin. Likely to Extend PHE

Biden administration officials confirmed that they would extend the COVID-19 public health emergency (PHE) past July 15, when it is currently set to expire, according to press reports, though HHS Sec. Xavier Becerra has not yet issued an official proclamation to that effect. The administration has promised states that it will give them at least 60 days’ notice before the end of the emergency, in part to assist state officials as they restart Medicaid eligibility redeterminations. The PHE also allows for certain flexibilities in areas including telehealth practice. According to news reports, the PHE is likely to be extended until at least Oct. 13.

Nationally, commercial health plans pay 224% more than Medicare rates for services at hospitals, according to new research from the RAND Corp. The study is the latest in a series on hospital prices; the last installment came in 2018. Relative prices vary widely from state to state, with some states’ plans reimbursing below 175% of Medicare rates and some seeing rates of 310% or higher. The study also found that “a large portion of price variation is explained by hospital market power.”


PHE Unwinding Delay Gives States, MCOs Time to Ease Transitions

With radio silence from HHS on May 16 — when states at the very latest had expected to hear whether the COVID-19 public health emergency would end in July — HHS at press time appeared to be gearing up for another extension of the PHE. This will give states, insurers and other stakeholders more time to prepare for the inevitable resumption of Medicaid eligibility redeterminations, which could cause millions of adults and children to lose health insurance coverage.

The PHE has been extended multiple times since the start of the pandemic and remains a moving target. As a condition of receiving enhanced federal funds during the PHE, states have been required to ensure continuous Medicaid and CHIP coverage for most enrollees by pausing eligibility redeterminations. And the Biden administration has promised to provide states 60 days’ notice before any possible termination or expiration. But without such notification, sources estimate the next end date could be Oct. 13. Bloomberg on May 16 reported that the PHE would be extended past mid-July, “according to a person familiar with the matter.”

Medicaid Rolls Soar to Nearly 89 Million Beneficiaries as Redeterminations Loom

Nationwide Medicaid enrollment has grown more than 22% since the outset of the COVID-19 pandemic, topping 88.7 million lives, according to the latest update to AIS’s Directory of Health Plans. But the end of the Public Health Emergency (PHE) — which at press time was likely to be extended beyond mid-July — could leave between 5.3 million and 14.2 million people without coverage when redeterminations resume, asserted a May 10 analysis from the Kaiser Family Foundation. A separate study from the Georgetown University Heath Policy Institute found that 6.7 million children stand to lose CHIP coverage at the end of the PHE. See a state-by-state overview of three years of pandemic-fueled Medicaid enrollment changes in the chart below.

Telehealth Usage Expands by Over 7,000% During the Pandemic

Driven by the COVID-19 pandemic, telehealth utilization increased 7,060% from 2019 to 2020, while utilization dropped 38% in ambulatory surgery centers, 30% in emergency rooms, 16% in urgent care centers and 4% in retail clinics, according to a new FAIR Health white paper. The FH Medical Price Index tracks the weighted average growth in median procedure charges and median allowed amounts. Among the six procedure categories it studied, hospital evaluation and management saw the largest percent increase in both the charge amount index and allowed amount index.


With Medicaid Cliff Looming, Payers Scramble to Limit Outflow

The end of the COVID-19 public health emergency (PHE) is likely to significantly downsize Medicaid enrollment around the nation, and managed care organizations (MCOs) must figure out how to keep enrollment steady and maintain continuity of coverage among members.

Since February 2020, fueled by a COVID-induced economic downturn and resulting federal policy changes, the Medicaid ranks have ballooned by 14.6 million members, a roughly 21% increase, nearing 86 million enrollees, according to the Kaiser Family Foundation (KFF).

As a condition of receiving enhanced federal funds during the PHE, states have been required to ensure continuous Medicaid and CHIP coverage for most enrollees by pausing eligibility redeterminations. A quartet of large for-profit plans that hold 40% Medicaid market penetration nationally — Anthem, Inc., Centene Corp., Molina Healthcare, Inc., and UnitedHealth Group — are all expecting “modest enrollment declines” once the PHE ends, according to a recent KFF issue brief.


Anthem Raises Profit Forecast for 2022 After Promising 1Q

Anthem, Inc. reported strong first quarter financial results, prompting the insurer to raise its earnings guidance for the year. The company attributed the change largely to a lower-than-expected COVID-19 impact, as the Omicron variant and the long-term effect of delayed care during previous COVID peak periods was less severe than Anthem had originally projected in January.

For the first quarter, Anthem generated $8.25 in adjusted earnings per share (EPS), beating the Wall Street consensus of $7.82. The insurer increased its full-year EPS guidance to greater than $28.40, up from its previous EPS estimate of $28.25.


Insurers Applaud New Medicare Coverage for OTC COVID Tests

Medicare Part B will now cover eight over-the-counter, at-home COVID-19 tests per month with no cost sharing for beneficiaries starting April 4, according to a new Biden administration policy. Medicare Part B and Medicare Advantage beneficiaries will be able to order the tests from a government website or acquire them from participating retailers through the end of the public health emergency.

The new benefit will not require much participation from Medicare Advantage plans, although their members are eligible to receive it. Members can submit purchases for reimbursement or obtain the tests for free from retailers.


Mental Health Care Access Varies Across Demographics, Insurance Coverage

One in four adults reported symptoms of anxiety and/or depression prior to the COVID-pandemic, according to a Kaiser Family Foundation analysis of the National Health Interview Survey in 2019. While the rates of people reporting mental health symptoms across racial and ethnic groups are similar, a much larger share of Black adults with moderate to severe symptoms did not receive treatment. Meanwhile, uninsured people were significantly more likely to not receive mental health care (62%) compared to their insured counterparts (36%). Since the pandemic began, more people suffered from poor mental health, with one-third of adults reporting anxiety and/or depressive disorder in February 2022.

Millions Will Lose Medicaid Coverage After PHE Ends; Only Half of States Have Plans in Place

More than 14 million Medicaid enrollees could lose their coverage within six months when the COVID-19 public health emergency (PHE) ends, a Commonwealth Fund report projected. Meanwhile, Kaiser Family Foundation’s 50-state survey found that many states have not made key decisions on how to promote continuity of coverage. While the PHE is set to expire on April 16, HHS has said it would give at least 60 days’ notice before ending it, suggesting another extension is coming.


News Briefs: Centene Appoints New CEO Amid PBM Overhaul

Centene Corp. has named Sarah London as its new CEO after its longtime chief executive, Michael Neidorff, took a medical leave of absence ahead of his planned retirement. London, who was serving as Centene’s vice chairman, will take the helm immediately. In her previous management role, London was responsible for a “portfolio of companies independent of Centene’s health plans, designing differentiated platform capabilities, and delivering industry-leading products and services to third-party customers,” per a March 22 press release. Before coming to Centene, she worked for UnitedHealth Group’s venture capital arm, Optum Ventures, and its data solutions division, Optum Analytics. London’s appointment comes at a time when Centene is planning an overhaul of its PBM assets, with a request for proposal seeking an external vendor due this summer. The firm in recent months has paid millions of dollars to settle accusations by states that its PBM operations overcharged their Medicaid programs for prescription drugs. During Centene’s Feb. 8 conference call to discuss fourth-quarter and full-year financial results, London told analysts that “the strategy here is to outsource administrative PBM functions to an external partner, thereby allowing us to reduce our three PBM platforms down to one and to focus...[on] clinical member and provider engagement.”